Geriatric Medicine

Answer 3 Increase the dose of donepezil. The patient has Alzheimer’s disease, characterized by a decrease in cholinergic activity in the brain. Addition of diphenhydramine, a drug with anticholinergic properties, was likely responsible for her worsening mentation and agitation (ie, drug-induced delirium and drug-disease interaction). Her urinary retention and constipation were also drug-induced, although fecal impaction is a possible cause of the distended bladder. An increase in the dose of donepezil will not help her worsened mental state and agitation. Rather, a review of the drugs she is taking and discontinuing any offending agents (in this case, diphenhydramine) is the best approach in her care. SUGGESTED READINGS 1. Dharmarajan TS, Tota R. Appropriate prescribing of medications in older adults. Fam Pract Recert 2000;22:29-38. 2. Leipzig RM. Pharmacology and appropriate prescribing. In: Cobbs EL, Duthie EH, Murphy JB, editors. Geriatrics review syllabus, 4th ed. Dubuque (IA): Kendall/Hunt Publishing Co; 1999:30-5. 3. Schwartz JB. Clinical pharmacology. In: Hazzard WR, Blass JP, Ettinger WH, et al, editors. Principles of geriatric medicine and gerontology. 4th ed. New York: McGraw-Hill, Health Professions Division; 1999:303-31. Click here to return to the questions

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