每日一题_2023.06.07

A 16-year-old girl visits her family physician with complaints of amenorrhea. Although she falls 20% below the minimum body weight expected for her height, she doesn’t think she is skinny enough. After breaking up with her boyfriend a year ago, she dropped out of cheer- leading and has been struggling with school, although she used to be an honors student. She admits to crying spells, feeling guilty, and thoughts of suicide. Which of the following medications is contraindicated in this patient?

一名16岁女孩因闭经就诊于家庭医生。虽然她的体重比她身高预期的最低体重低了20%，但她认为自己还不够瘦。一年前和男友分手后，她退出了啦啦队，一直在努力学习，尽管她曾经是一名优等学生。她承认有时会哭泣，感到内疚，甚至有自杀的念头。该患者禁用下列哪种药物?

(A) Bupropion 安非他酮

(B) Buspirone 丁螺环酮

(C) Haloperidol 氟哌啶醇

(D) Phenelzine 苯乙肼

(E) Sertraline 舍曲林

答案解析：

神经性厌食症是一种以过度节食、过度运动和体像障碍为特征的饮食失调。最常见于青少年和年轻成人。生理后果包括严重的体重下降、闭经、胎毛(躯干绒毛状)、结肠黑变病(滥用泻药导致结肠发黑)、骨质疏松风险增加、轻度贫血、白细胞减少和电解质紊乱。该患者的闭经和极低的体重表明她可能患有厌食症。她也有抑郁的症状:悲伤、快感缺失、内疚和自杀的想法。虽然患者可能从治疗和抗抑郁药中获益，但她的电解质紊乱使她有癫痫发作的风险，并且禁忌使用安非他酮(一种非典型抗抑郁药)。安非他酮作为去甲肾上腺素和多巴胺再摄取抑制剂发挥作用，与其他选择性5 -羟色胺再摄取抑制剂不同，它不携带性不良反应。

正确答案：A