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Cholinesterase bradycardia — DGM MCQ

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HardDementiaCholinesterase bradycardiaDGM

An 82-year-old man with Alzheimer's disease has two syncopal episodes. Pulse is 46 beats/min and ECG shows sinus bradycardia. No chest pain or seizure features are reported. Current medicines include donepezil, bisoprolol and atorvastatin. Which medication should be reviewed?

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

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Correct answer: C — Donepezil

Donepezil can cause bradycardia and syncope, especially when combined with other rate-limiting treatment. Atorvastatin, paracetamol, colecalciferol and macrogol are less likely to explain symptomatic bradycardia. Falls or syncope after cognitive enhancers should prompt pulse and medication review.

Reference: BNF; NICE NG97