A 50-year-old patient with narrow-angle glaucoma and mild cognitive impairment is being evaluated for an antispasmodic for overactive bladder. Which antimuscarinic agent should be AVOIDED due to its ability to cross the blood-brain barrier and potentially worsen cognition?
- A Trospium
- B Oxybutynin ✓
- C Darifenacin
- D Solifenacin
Correct answer: B. Oxybutynin
Explanation
Oxybutynin is a tertiary amine with high lipophilicity, readily crossing the blood-brain barrier and causing central anticholinergic effects including cognitive impairment, confusion, and memory deficits, especially in elderly patients. Trospium is a quaternary amine that does not cross the BBB. Darifenacin and solifenacin have lower CNS penetration than oxybutynin.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.