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一位82歲個案因近來跌倒及混亂加劇就診。在檢視電子病歷（病史、生命徵象、檢驗、紀錄、醫囑）後，護理師應根據Beers標準，主張與醫療提供者討論哪種藥物作為最優先的減藥目標？

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82-year-old female. HTN, type 2 diabetes, hyperlipidemia, mild osteoarthritis. Lives independently. Two falls in past 3 months without serious injury. Daughter reports daytime drowsiness and increased forgetfulness over past 2 months.82 歲女性。高血壓、第 2 型糖尿病、高血脂、輕度退化性關節炎。獨立生活。過去 3 個月 2 次跌倒未受重傷。女兒報告過去 2 個月日間嗜睡與健忘增加.

BP 138/82, HR 72, RR 16, T 36.8 C, SpO2 97% on room air, MMSE 24/30 (down from 28 last year).BP 138/82、HR 72、RR 16、T 36.8 C、室內空氣 SpO2 97%、MMSE 24/30 (較去年的 28 下降).

A1c 7.2%, eGFR 64 mL/min/1.73 m2, LDL 92 mg/dL, sodium 138, potassium 4.1, normal LFTs.A1c 7.2%、eGFR 64 mL/min/1.73 m2、LDL 92 mg/dL、鈉 138、鉀 4.1、LFT 正常.

Lisinopril 10 mg daily. Metformin 500 mg BID. Atorvastatin 20 mg at bedtime. Diphenhydramine 50 mg at bedtime PRN for sleep (taking nightly per patient). Calcium carbonate / vitamin D supplement daily.Lisinopril 10 mg 每日。Metformin 500 mg BID。Atorvastatin 20 mg 睡前。Diphenhydramine 50 mg 睡前 PRN 助眠 (病人表示每晚服用)。每日服用鈣碳酸鹽/維生素 D 補充劑.

Daughter requests medication review due to falls and cognitive decline. Patient denies symptoms but acknowledges occasional dry mouth and drowsiness during the day.女兒因跌倒與認知下降要求藥物回顧。病人否認症狀但承認偶爾口乾與日間嗜睡.

1 Lisinopril 10 mg daily for hypertension. Lisinopril 10 mg每日治療高血壓。 ✕ 2 Metformin 500 mg twice daily for type 2 diabetes. Metformin 500 mg每日2次治療第2型糖尿病。 ✕ 3 Diphenhydramine 50 mg at bedtime for sleep. Diphenhydramine 50 mg 睡前使用以幫助睡眠。 ✕ 4 Atorvastatin 20 mg at bedtime for hyperlipidemia. Atorvastatin 20 mg睡前治療高血脂。 ✕

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