PDD – Rivastigmine Monitoring — SCE Neurology MCQ

Correct answer: B — Symptomatic bradycardia with a pulse of 42/min

The best answer is “Symptomatic bradycardia with a pulse of 42/min”. Cholinesterase inhibitors can cause clinically important bradycardia and syncope; symptomatic marked bradycardia requires prompt review of rivastigmine and other rate-limiting drugs. “Mild transient nausea during the first treatment week” is less appropriate because mild early gastrointestinal effects can often be monitored if hydration and weight remain stable “Stable pre-existing resting tremor without functional change” is less appropriate because stable tremor alone is not the strongest safety signal “Improved visual hallucinations with unchanged weight” is less appropriate because clinical benefit without weight or cardiovascular toxicity supports continued review “A small application-site erythema resolving within one day” is less appropriate because brief mild local irritation is common with a patch and is less concerning than syncope

Reference: NICE NG97: Dementia — recommendations. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations NICE NG71: Parkinson’s disease in adults — recommendations. https://www.nice.org.uk/guidance/ng71/chapter/Recommendations