Naplex Alzheimers

Which prescription medication approved to treat AD is also approved to treat dementia associated with Parkinson disease? A. Donepezil B. Galantamine C. Memantine D. Rivastigmine

6. D. Rivastigmine is the only cholinesterase inhibitor that is also approved for use in Parkinson Disease Dementia. This information can be found in Table 71-6.

Genetic susceptibility to late-onset AD is primarily linked to which of the following? A. Apolipoprotein E4 genotype B. Presenilin gene mutations C. Amyloid precursor protein mutations D. Apolipoprotein E2 genotype

A. Apolipoprotein E (APOE) is the main genetic risk factor associated with for late-onset AD. See "Etiology" section (Etiology and Genetics) for more information.

An 84-year-old woman was diagnosed with AD 4 years ago. Her symptoms first became apparent to her family about 1 year before the diagnosis was made. Her Mini-Mental State Examination (MMSE) score is 14, she is unable to perform most activities of daily living, and she does not recognize her caregivers on some days. Which of the following drugs/drug combinations has NOT been shown to be effective therapy for this patient's stage of AD? A. Donepezil 10 mg nightly at bedtime + rivastigmine 6 mg twice daily B. Donepezil 10 mg nightly at bedtime C. Memantine 10 mg twice daily D. Donepezil 10 mg nightly at bedtime + memantine 5 mg twice daily

A. There is no data to support effectiveness of using multiple cholinesterase inhibitors concomitantly. Moreover, there would be an increased risk of adverse drug events if donepezil, galantamine, and/or rivastigmine were used in combination. See "Treatment" section (Cholinesterase Inhibitors) for more information. .

When initiating pharmacologic treatment for a patient with a new diagnosis of AD, which of the following would be the safest and most effective option? A. Vitamin E B. Donepezil C. Ginkgo biloba D. Estrogen

B. Of the options listed, donepezil has the most safety and efficacy data to support its use. See "Treatment" section for more information about cholinesterase inhibitors, estrogen, and dietary supplements.

An 87-year-old man wasdiagnosed with AD and vascular dementia 2 years ago. At that time, he was started on donepezil 5 mg daily, and he has continued on that dose. He denies any difficulty tolerating the drug. He also takes warfarin for atrial fibrillation and lisinopril for hypertension. The patient's wife notes that his memory has declined significantly over the last several months. Which of the following statements is TRUE regarding this patient's donepezil therapy? A. He is receiving an appropriate maintenance dose of donepezil. B. He has not been titrated to the target maintenance dose of donepezil. C. Donepezil is not appropriate therapy for a patient in his stage of AD. D. Donepezil should be avoided in this patient because he has vascular dementia and atrial fibrillation.

B. The patient has been treated with donepezil 5 mg daily for 2 years. As he is not experiencing any bothersome side effects and has no known contraindications to increasing the dose, it would be appropriate to trial donepezil 10 mg daily. Dosing information can be found in Table 71-6.

A 77-year-old woman was diagnosed with AD 2 months ago. Her MMSE score at the time of diagnosis was 22. At that time, donepezil was started at a dose of 5 mg nightly at bedtime. Would it be considered appropriate to add memantine to her drug regimen at this time? A. Yes, she has moderate AD B. Yes, she is unlikely to respond to donepezil C. No, she has mild AD D. No, memantine should never be added to cholinesterase inhibitor therapy

C. As the patient is newly diagnosed with mild AD and is still taking the lowest possible dose of donepezil, adding memantine does not seem necessary at this time. It would be reasonable, however, to consider increasing the donepezil dose to 10 mg daily if the patient is tolerating the drug well. As the patient's AD progresses, it may become necessary to increase the donepezil dose and/or add memantine. Dosing information can be found in Table 71-6.

Which of the following counseling points would be appropriate to discuss with a newly diagnosed patient and their family in regard to expectations of AD therapy? A. Combination therapy with a cholinesterase inhibitor plus memantine usually halts the progression of AD. B. Risks of prescription drug side effects outweigh the benefits in mild AD. C. Time to reach significant functional decline may be delayed by drug therapy but AD will continue to progress. D. Memory noticeably improves for most patients with AD when therapy is first initiated.

C. It is important to be realistically optimistic with patients and their care partners, especially in the early stages of dementia. At present, there is no treatment option available to halt the progression of AD; however, some patients respond well to drug therapy, and large studies have shown the potential for medication use to delay functional decline and institutionalization. See "Treatment" section (Pharmacotherapy for Cognitive Symptoms) for more information

Which of the following is the most common form of dementia among older adults? A. Lewy body dementia B. Vascular dementia C. Alzheimer disease D. Organic brain syndrome

C. The majority (60%-80%) of dementia cases are AD. See "Epidemiology" section for more information.

An 87-year-old man wasdiagnosed with AD and vascular dementia 2 years ago. At that time, he was started on donepezil 5 mg daily, and he has continued on that dose. He denies any difficulty tolerating the drug. He also takes warfarin for atrial fibrillation and lisinopril for hypertension. The patient's wife notes that his memory has declined significantly over the last several months. The patient's wife confides in you that she is planning to start him on a supplement for brain health that contains Ginkgo biloba. What would be the most appropriate advice to offer to the patient's wife regarding Gingko biloba? A. Ginkgo biloba is appropriate therapy because it is more effective than donepezil. B. Ginkgo biloba should be avoided because of its potential to worsen cognitive outcomes. C. Ginkgo biloba should be avoided because of its potential drug interaction with warfarin. D. Ginkgo biloba is appropriate because it is effective for treating both AD and atrial fibrillation.

C. The risks of using Ginkgo biloba appear to outweigh the benefits in this patient. While heavily studied, convincing data to support the utility of Ginkgo biloba in AD is lacking. Moreover, in this case, Ginkgo biloba may potentiate the bleeding risk associated with warfarin. See "Treatment" section (Ginkgo biloba) for more information.

Which of the following interventions is considered first-line therapy for behavioral and psychiatric symptoms of dementia? A. Sertraline B. Quetiapine C. Carbamazepine D. Multisensory stimulation

D. Nonpharmacologic interventions are first line for neuropsychiatric symptoms of dementia. See "Treatment" section (Pharmacotherapy of Neuropsychiatric Symptoms) for more information.

Of the following, which is the most common side effect of donepezil? A. Elevated blood pressure B. Elevated blood glucose C. Agitation D. Diarrhea

D. Of the adverse drug events listed, diarrhea is most likely to be associated with donepezil. As cholinesterase inhibitors are procholinergic, patients may experience diarrhea and urinary incontinence. Adverse drug event information can be found in Table 71-7.

Which acetylcholinesterase inhibitor inhibits both butyrylcholinesterase and acetylcholinesterase? A. Donepezil B. Galantamine C. Memantine D. Rivastigmine

D. Rivastigmine inhibits both butyrylcholinesterase and acetylcholinesterase. See "Treatment" section (Cholinesterase Inhibitors) for more information.

Which of the following statements is TRUE regarding the pathophysiology of AD? A. AD is caused by amyloid plaques B. AD is caused by neurofibrillary tangles C. AD is caused by inflammatory brain processes D. The cause of AD is not completely understood

D. A multitude of genetic, environmental, and possibly additional unknown variables contribute to development of AD. See the "Etiology" and "Pathophysiology" sections for more information.

An 84-year-old woman was diagnosed with AD 4 years ago. Her symptoms first became apparent to her family about 1 year before the diagnosis was made. Her Mini-Mental State Examination (MMSE) score is 14, she is unable to perform most activities of daily living, and she does not recognize her caregivers on some days. The patient's husband asks about using Tylenol PM to help his wife fall asleep. What would you recommend? A. Tylenol PM is preferred over prescription sedative/hypnotics to treat insomnia in patients with AD. B. Tylenol PM is preferred for both pain and insomnia because it may enhance the effects of cholinesterase inhibitors in patients with AD. C. Tylenol PM should be avoided because of the pharmacokinetic drug interaction between diphenhydramine and memantine. D. Tylenol PM should be avoided because diphenhydramine may worsen cognitive function.

D. Tylenol PM contains both acetaminophen and diphenhydramine, the latter of which is strongly anticholinergic. Anticholinergic medications are known to contribute to cognitive impairment and, as such, should be avoided in this patient. See "Clinical Presentation" section (Diagnosis) for more information.

An 87-year-old man wasdiagnosed with AD and vascular dementia 2 years ago. At that time, he was started on donepezil 5 mg daily, and he has continued on that dose. He denies any difficulty tolerating the drug. He also takes warfarin for atrial fibrillation and lisinopril for hypertension. The patient's wife notes that his memory has declined significantly over the last several months. Which of the following is an appropriate recommendation for the patient's wife regarding management of his cardiovascular disease? A. Hypertension control is no longer necessary. B. The risks of continuing warfarin outweigh the potential benefits. C. Clopidogrel and aspirin should be added to patient's drug regimen to improve vascular health. D. Treating hypertension and atrial fibrillation is recommended to optimize brain vascular health.

D. Vascular health plays a significant role in vascular dementia and AD. As such, the patient's diagnosis of dementia does not negate his need for ongoing management of cardiovascular disease. See "Pathophysiology" section (Brain Vascular Disease and High Cholesterol) and "Treatment" section (Management of Vascular Brain Health) for more information.