skip to main content

Teriflunomide – Hepatotoxicity Monitoring — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardMultiple Sclerosis & CNS InflammationTeriflunomide – Hepatotoxicity MonitoringSCE Neurology

A patient with bulbar motor neurone disease has troublesome drooling and mild cognitive impairment. Oral suction and posture measures are insufficient. Which medication is the best initial fit?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Use glycopyrronium because central anticholinergic effects are limited

NICE recommends an antimuscarinic first for sialorrhoea and specifically suggests glycopyrronium for people with cognitive impairment because it penetrates the central nervous system less. Amitriptyline, hyoscine and atropine may be used in selected patients but can worsen confusion, while clonazepam is not an antimuscarinic and may impair respiration.

Reference: NICE NG42 motor neurone disease: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng42/chapter/Recommendations