# 一名使用茶鹼後已穩定的個案，在吸菸20年後戒菸。護理師應預期哪一種濃度調整及原因？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391783&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名使用茶鹼後已穩定的個案，在吸菸20年後戒菸。護理師應預期哪一種濃度調整及原因？

## 選項

1. 應將茶鹼加倍以補償尼古丁戒斷
2. 濃度可能上升到毒性範圍；通常需減量，因吸菸誘導CYP1A2而戒菸會使誘導作用消退 **✔ 正確答案**
3. 濃度應下降，因為尼古丁會加速茶鹼排除
4. 不會改變，因為吸菸不影響茶鹼代謝

**正確答案: 2**

## 解析

正確 (2)：香菸煙霧會誘導CYP1A2，加速茶鹼代謝。吸菸者通常需要較高劑量；戒菸後1-4週誘導作用逆轉，濃度上升並增加毒性風險，通常需要減量。(1,3,4) 方向或機轉錯誤。

## 深入解析

記憶提示 吸菸會把CYP1A2引擎催快。經CYP1A2代謝的藥物（茶鹼、咖啡因、olanzapine、clozapine）在戒菸後容易累積。

## 臨床情境

情境 58歲男性，穩定使用茶鹼300 mg BID已5年，20年來每日吸菸1包。4週前戒菸。目前例行茶鹼濃度待報告。

## 重要概念

- **CYP1A2誘導** — 香菸煙霧增加CYP1A2活性，使茶鹼、咖啡因、olanzapine、clozapine濃度下降。
- **戒菸後藥物動力學** — CYP1A2在1-4週內回到基準；其受質藥物濃度會上升。
- **茶鹼劑量調整** — 戒菸後需減量，並於1-2週檢測濃度。

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