Which class should be avoided in older adults because it can cause orthostatic blood pressure changes?

Which class should be avoided in older adults because it can cause orthostatic blood pressure changes?

• A. Beta-blockers
• B. SSRIs
• C. Acetylcholinesterase Inhibitors
• D. Diuretics

Answer: (C)

Orthostatic blood pressure changes in older adults are most likely when a medication increases parasympathetic (vagal) activity, because standing up requires a quick rise in heart rate and vasoconstriction to keep blood pressure stable. Acetylcholinesterase inhibitors raise acetylcholine levels, which enhances vagal stimulation of the heart. This slows the heart (bradycardia) and can blunt the normal reflex that raises heart rate and constricts vessels when you stand, making an orthostatic drop in blood pressure more likely. In older patients, who often have some autonomic or conduction system weaknesses, this risk is especially important, so these drugs are approached with caution or avoided when possible. These medications—used for conditions like Alzheimer’s disease—include donepezil, rivastigmine, and galantamine.

Orthostatic blood pressure changes in older adults are most likely when a medication increases parasympathetic (vagal) activity, because standing up requires a quick rise in heart rate and vasoconstriction to keep blood pressure stable. Acetylcholinesterase inhibitors raise acetylcholine levels, which enhances vagal stimulation of the heart. This slows the heart (bradycardia) and can blunt the normal reflex that raises heart rate and constricts vessels when you stand, making an orthostatic drop in blood pressure more likely. In older patients, who often have some autonomic or conduction system weaknesses, this risk is especially important, so these drugs are approached with caution or avoided when possible. These medications—used for conditions like Alzheimer’s disease—include donepezil, rivastigmine, and galantamine.