Pharmacology · patient case question
Which of the following medications is LEAST likely to cause this patient's xerostomia?
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. Zoledronate
- A. Correct. Zoledronate is a bisphosphonate. Its salient oral risk is medication-related osteonecrosis of the jaw, not salivary hypofunction.
- B. Oxybutynin is an antimuscarinic used for overactive bladder and predictably causes dry mouth.
- C. Diphenhydramine is a first-generation antihistamine with strong anticholinergic activity — a classic cause of dry mouth.
- D. Tricyclic antidepressants are among the most reliably xerostomic drug classes.