# 一名78歲個案新開立cimetidine 400 mg PO BID治療消化不良後，出現新的混亂和健忘。護理師最適當的行動為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391803&lang=zh-tw  
> language: zh-TW  
> subject: Crisis Intervention  
> category: PSI

## 題目

一名78歲個案新開立cimetidine 400 mg PO BID治療消化不良後，出現新的混亂和健忘。護理師最適當的行動為何？

## 選項

1. 通知醫師 — cimetidine在高齡者有抗膽鹼和中樞作用；其他H2阻斷劑如famotidine或PPI可能較安全 **✔ 正確答案**
2. 加用diphenhydramine幫助睡眠
3. 將cimetidine劑量加倍以更好控制症狀
4. 安撫家屬這是正常老化

**正確答案: 1**

## 解析

正確 (2)：Cimetidine比其他H2阻斷劑有更多中樞穿透與抗膽鹼活性，可在高齡者造成混亂與譫妄。Cimetidine列入Beers準則。可改用famotidine或PPI。Cimetidine也廣泛抑制CYP450。(1) 不是正常老化。(3) 增量會惡化。(4) 會增加抗膽鹼負荷。

## 深入解析

記憶提示 Cimetidine =「認知受損 + CYP麻煩」。高齡者用famotidine、nizatidine較安全；ranitidine已不再上市。

## 臨床情境

情境 78歲男性，因消化不良使用cimetidine 400 mg PO BID已1週。家屬表示新出現混亂、健忘。原本認知功能完整。

## 重要概念

- **H2受體拮抗劑** — Famotidine、cimetidine、nizatidine；降低胃酸；效果不如PPI。
- **Cimetidine不良反應** — 高齡者CNS作用、男性女乳症、CYP450抑制造成多種交互作用。
- **Beers準則與H2藥物** — Cimetidine因高齡者認知風險被標示；較偏好famotidine。

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