QuestionSBA
QuestionChoice
This may be generally useful as mood disorders are common among patients with Alzheimer’s disease but is not essential
34363
d
PHQ-9
QuestionChoice
This is not necessary with this medication
34364
e
Weight
QuestionChoice
An ECG should be performed to rule out bradycardia or high-grade heart block prior to starting this drug
34362
c
No routine monitoring is required
QuestionChoice
This is not necessary with this medication
34361
b
Full blood count
QuestionChoice
Donepezil increases cholinergic activity not just in the central nervous system but also peripherally, and may exert a parasympathetic effect on the heart. As such it is contraindicated in patients with high-grade heart block or symptomatic bradycardia and this should be ruled out with an ECG beforehand
34360
a
ECG
QuestionComment
Is it not technically the case that you check the pulse first to look for bradycardia, and if there is anything to suggest heart block you would then do an ECG?
6487
User
subscriber
Kawasaki Pudendal
QuestionComment
Where does it state this in the BNF?
6844
QuestionComment
Cautions, further information
Elderly

8557
User
subscriber
Juice Myopathy
QuestionComment
Yes, immediately after it states ‘WITH A KNOWN HISTORY’. The way I approach these questions is that if the monitoring section is missing I know there is no routine monitoring. If the question has thrown something in the stem to suggest some form of cardiac disturbance the answer provided here would then be valid.
17570
User
subscriber
Zika Biopsy
User
subscriber
Giggy G
QuestionComment
Doesn't state this on the BNF
8491
QuestionComment
Cautions, further information
Elderly
8558
User
subscriber
Juice Myopathy
User
subscriber
Neoplasia Complement
QuestionComment
Donepazil on the BNF has no section for "Monitoring Requirement", cautions in the elderly state known history of bradycardia would make this a potentially inappropriate prescription. Can we have the question re-worded to include a PMH of bradycardia, please?
18389
User
subscriber
Roshimitsu
QuestionComment
There is no routine monitoring on the bnf for this drug
39776
User
subscriber
Just Another Med Student
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2815
Donepazil side effects
Topic
74
Elderly Care
6883
Case Presentation: A 75 year old man attends the memory clinic with his partner. He has been having difficulty with remembering important personal details such as his debit card PIN as well as social appointments he has made with friends and family. **PMH** Bradycardia, diverticular disease, haemorrhoids. **DH** senna 7.5mg PO BD, Anusol cream topical ON.


**Investigations**

Addenbrooke’s Cognitive Examination: 81/100

A diagnosis of early Alzheimer’s disease is made and he is advised to start donepezil hydrochloride 5mg PO OD and to attend a follow-up appointment in 3 months.

Question: Select the most appropriate monitoring option required before starting donepezil hydrochloride.
a