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Anticholinergic toxicity — DGM MCQ

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HardPolypharmacyAnticholinergic toxicityDGM

An 86-year-old man becomes confused and constipated after starting medication for neuropathic pain. He has urinary retention, dry mouth and blurred vision. His medicines include pregabalin, amitriptyline, tamsulosin, simvastatin and apixaban. What is the most likely diagnosis?

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Correct answer: D — Anticholinergic adverse drug reaction

Dry mouth, urinary retention, constipation, blurred vision and confusion after starting amitriptyline indicate an anticholinergic adverse drug reaction. Dementia progression is usually slower and does not explain the autonomic symptom cluster. Older adults have increased pharmacodynamic sensitivity to anticholinergic medicines.

Reference: BNF Prescribing in elderly; STOPP/START criteria v3