# 一位護理師正在教導一位74歲、新開立mirtazapine 7.5毫克睡前口服以治療憂鬱症合併食慾不振及失眠的病人。哪一項陳述顯示衛教有效？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391733&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位護理師正在教導一位74歲、新開立mirtazapine 7.5毫克睡前口服以治療憂鬱症合併食慾不振及失眠的病人。哪一項陳述顯示衛教有效？

## 選項

1. 「我需要嚴格遵守完全不含tyramine的飲食。」
2. 「我應該預期這個藥可幫助睡眠，也可能改善食慾。」 **✔ 正確答案**
3. 「只要體重增加，我就應該立刻停藥。」
4. 「我會在早上服用這個藥，以避免晚上嗜睡。」

**正確答案: 2**

## 解析

正確答案 (2)：mirtazapine 在抗憂鬱藥物中獨特之處在於低劑量（≤15毫克）時具有強烈的鎮靜和食慾刺激作用，這是由於其對H1組織胺受體及5-HT2A/2C受體的強效阻斷。這些特性在臨床上可用於老年患者，他們常合併憂鬱、失眠及體重減輕。 (1) 錯誤 — 睡前給藥對於鎮靜效果至關重要。 (3) 酪胺限制適用於MAOI類藥物。 (4) 體重增加對此病人通常是期望的效果，並非停藥的理由。

## 深入解析

Memory Tip: Mirtazapine — MORE sedation at LOWER dose.

## 臨床情境

Scenario 74-year-old female with depression, weight loss, insomnia; mirtazapine 7.5 mg PO HS.

## 重要概念

- **Tetracyclic antidepressant** — Class of mirtazapine.
- **Histamine H1 blockade** — Mechanism of mirtazapine's sedation and appetite stimulation.
- **Geriatric depression** — Depression in adults ≥65.

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