Pharmacology · patient case question
The wife asks what donepezil actually does for him. What is the most accurate answer?
Patient case: Elderly man with Alzheimer disease and a symptomatic upper left molar
Patient: Male, 78 years old
Chief complaint: “His tooth has been hurting him and his face is swollen.” Reported by the wife, who accompanies him.
Background: Alzheimer disease, moderate stage. Medication: donepezil. His wife attends every appointment and manages his daily care.
Current findings: Periapical radiograph shows tooth #15 lying on its side (slanted/impacted) with an associated radiolucency. Swelling and pain localised to #15. Patient is pleasantly confused and defers all questions to his wife.
Show answer and explanation
Correct answer: A. It inhibits acetylcholinesterase, raising brain acetylcholine and improving cognitive function
- A. CORRECT. Donepezil, rivastigmine and galantamine are ACETYLCHOLINESTERASE INHIBITORS. They block the enzyme that degrades acetylcholine, raising synaptic levels and producing modest symptomatic improvement in cognition. They do not halt the underlying disease.
- B. Donepezil is not a sedative. If anything it can cause insomnia and vivid dreams.
- C. No drug in routine use clears plaques and reverses the disease; these agents are symptomatic only.
- D. That describes MEMANTINE, used in moderate-to-severe disease — a different drug class.
Note: Dental relevance: cholinesterase inhibitors increase salivation and can cause BRADYCARDIA. Avoid anticholinergic drugs in these patients — they worsen confusion.