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Anticholinergic burden — DGM MCQ

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HardFallsAnticholinergic burdenDGM

An 83-year-old man with glaucoma and benign prostatic enlargement attends after night-time falls. He has dry mouth, blurred vision and constipation. His medicines are amitriptyline 25 mg nocte, finasteride, latanoprost, ramipril 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 — Amitriptyline

Amitriptyline has anticholinergic and sedating effects that can worsen constipation, urinary symptoms, cognition and falls risk. Ramipril may contribute to hypotension, but the anticholinergic symptom cluster makes amitriptyline the priority medication to review. In older adults, medicines with anticholinergic burden should be questioned whenever falls and cognitive or bowel symptoms coexist.

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