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Z-drug related falls — DGM MCQ

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HardFallsZ-drug related fallsDGM

An 84-year-old woman is reviewed after two falls and a distal radius fracture. She has insomnia, COPD and mild cognitive impairment. Her medicines are zopiclone 7.5 mg nocte, tiotropium, colecalciferol and paracetamol; AMTS is 8/10 and her gait is unsteady. Which medication should be reviewed?

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Correct answer: C — Zopiclone

Z-drugs increase sedation, impaired balance and falls risk in older adults, and STOPP/START principles support reviewing hypnotics when falls or cognitive impairment are present. Tiotropium can cause anticholinergic effects but is less likely than zopiclone to explain nocturnal sedation and falls. The clinical pearl is that sleep medicines often persist after a short intended course and should be actively deprescribed.

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