Alzheimer disease: cholinesterase inhibitors: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Alzheimer disease: cholinesterase inhibitors

Sample item

A 74-year-old with mild Alzheimer disease is started on donepezil. Which adverse effect should be monitored for?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Bradycardia, nausea and vivid dreams

Donepezil, rivastigmine and galantamine inhibit acetylcholinesterase and can cause nausea, diarrhoea, bradycardia, syncope, weight loss and vivid dreams. They are cautioned in sick sinus syndrome and heart block. Benefit is modest and symptomatic.

Option by option

  • A. Hepatic failure

    Hepatic failure is rare and was associated with tacrine.

  • B. Hyperprolactinaemia

    Hyperprolactinaemia is associated with dopamine antagonists.

  • C. Agranulocytosis

    Agranulocytosis is a clozapine concern.

  • D. Bradycardia, nausea and vivid dreams (correct)

    Correct. Cholinergic effects include bradycardia and gastrointestinal upset.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Bradycardia, nausea and vivid dreams. Donepezil, rivastigmine and galantamine inhibit acetylcholinesterase and can cause nausea, diarrhoea, bradycardia, syncope, weight loss and vivid dreams.

Why is "Hepatic failure" not the answer?

Hepatic failure is rare and was associated with tacrine.

Why is "Hyperprolactinaemia" not the answer?

Hyperprolactinaemia is associated with dopamine antagonists.

Why is "Agranulocytosis" not the answer?

Agranulocytosis is a clozapine concern.

What concept does this question test?

It tests Alzheimer disease: cholinesterase inhibitors in Psychiatry. They are cautioned in sick sinus syndrome and heart block. Benefit is modest and symptomatic.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Alzheimer disease: cholinesterase inhibitors?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.