Three AChEIs — MRCPsych Paper B MCQ
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Correct answer: B — Donepezil, galantamine and rivastigmine
Explanation lettering: E = shown as C · C = shown as E
Donepezil, galantamine and rivastigmine are the three acetylcholinesterase inhibitors that NICE recommends as monotherapy options for mild to moderate Alzheimer's disease. Memantine, included in options A, C, D and E, is an NMDA-receptor antagonist rather than an acetylcholinesterase inhibitor; as monotherapy, it is recommended for severe Alzheimer's disease or for moderate disease when acetylcholinesterase inhibitors are contraindicated or not tolerated. Risperidone is an antipsychotic and is not a cognitive enhancer. When choosing among the three acetylcholinesterase inhibitors, NICE advises normally starting with the lowest-acquisition-cost drug, while also considering adverse effects, adherence, comorbidity, interactions and dosing profile—not simply prescriber preference.
Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.5.2 and 1.5.6. 2018, current with subsequent updates. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations