# 護理師評估一名78歲男性，準備因中度Alzheimer病開始donepezil。哪個基線發現最需要在第一劑前與處方者討論？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391757&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

護理師評估一名78歲男性，準備因中度Alzheimer病開始donepezil。哪個基線發現最需要在第一劑前與處方者討論？

## 選項

1. 休息心率48且有二度AV block **✔ 正確答案**
2. Alzheimer病家族史
3. 可用纖維控制的輕微便秘
4. 6個月內非預期體重減輕4磅

**正確答案: 1**

## 解析

正解 (2): Cholinesterase inhibitors（donepezil, rivastigmine, galantamine）會增加acetylcholine，造成心搏過慢、AV block與昏厥。基線HR

## 深入解析

Memory Tip ChEi副作用 = SLUDGE/BBB：流涎、流淚、排尿、排便、GI、嘔吐 + 支氣管痙攣、心搏過慢、傳導阻滯。CPG 檢查基線ECG與HR；若GI不耐，可考慮rivastigmine patch。

## 臨床情境

Scenario 78歲男性，中度Alzheimer病，準備開始donepezil 5 mg PO HS。基線評估：休息心率48，有二度AV block病史。

## 重要概念

- **Cholinesterase inhibitor** — Donepezil、rivastigmine、galantamine；增加突觸acetylcholine以改善輕中度Alzheimer認知。
- **心搏過慢/AV block風險** — Cholinesterase inhibitor的迷走神經作用；基線傳導疾病時需擔心。
- **SLUDGE症候群** — 流涎、流淚、排尿、排便、GI不適、嘔吐，是膽鹼過量模式。

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