A nurse assesses a 78-year-old man starting donepezil for moderate Alzheimer disease. Which baseline finding most warrants a discussion with the prescriber before the first dose?

1 Resting heart rate 48 with second-degree AV block ✓ Correct answer
2 Family history of Alzheimer disease
3 Mild constipation managed with fiber
4 A 4-pound unintentional weight loss over 6 months

Explanation

Correct (2): Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) increase acetylcholine, causing bradycardia, AV block, and syncope. Baseline HR

In-depth explanation

Memory Tip ChEi adverse effects = "SLUDGE/BBB" — Salivation, Lacrimation, Urination, Defecation, GI, Emesis + Bronchospasm, Bradycardia, Block. CPG Check baseline ECG and HR; consider rivastigmine patch for GI intolerance.

Clinical scenario

Scenario 78-year-old male, moderate Alzheimer disease, starting donepezil 5 mg PO HS. Baseline assessment: resting HR 48, history of second-degree AV block.

Key concepts

Cholinesterase inhibitor — Donepezil, rivastigmine, galantamine; increase synaptic acetylcholine for mild-moderate Alzheimer cognition.
Bradycardia/AV block risk — Vagal effect of cholinesterase inhibitors; concern in baseline conduction disease.
SLUDGE syndrome — Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis — cholinergic excess pattern.

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A nurse assesses a 78-year-old man starting donepezil for moderate Alzheimer disease. Which baseline finding most warrants a discussion with the prescriber before the first dose?

In-depth explanation

Clinical scenario

Key concepts

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