# 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?

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

## Question

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?

## Option

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

**Correct answer: 1**

## 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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