Pharmacology · patient case question
If this patient also had documented xerostomia, which medication would you specifically avoid?
Patient case: The Geriatric Patient
demo: 90-year-old female
chief: “My mouth is always dry and this tooth is throbbing.”
history: Osteoporosis, mild renal impairment, hypertension. Ambulates with a walker.
meds: Alendronate, methotrexate, zoledronate infusions in the past, hydrochlorothiazide
findings: Generalized xerostomia. Tooth #30 with a periapical abscess requiring antibiotic coverage. Panoramic radiograph shows thinned mandibular cortices.
Show answer and explanation
Correct answer: A. Atropine
- A. Correct. Atropine is an antimuscarinic and would deepen the dry mouth substantially.
- B. Cevimeline is likewise a muscarinic agonist indicated for Sjögren-related dry mouth.
- C. Pilocarpine is a muscarinic agonist used to treat xerostomia, not worsen it.
- D. Saliva substitutes are purely palliative and carry no risk of worsening the condition.