Question 1

A patient is identified as having stage 2 Alzheimer's disease and elects to take donepezil (Aricept).The patient asks the primary care nurse practitioner (NP)how long the medication will be needed.The NP should tell the patient that donepezil must be taken:

A) until symptoms improve.
B) indefinitely because it is not curative.
C) for 24 weeks, which is when cognitive function improves in most patients.
D) until symptoms worsen, when a switch to memantine (Namenda) will be needed.

Accepted Answer

Cholinesterase (ChE)inhibitor drugs such as donepezil diminish symptoms; when the drug is stopped,the symptoms return.Cognitive function will show improvement at about 24 weeks,but the drug must be continued indefinitely.

Question 2

A patient has a diagnosis of depression and Alzheimer's disease with mild,intermittent symptoms.The primary care NP should prescribe a(n):&#10;A) antidepressant.&#10;B) ChE inhibitor.&#10;C) antidepressant and ginkgo biloba.&#10;D) antidepressant and a ChE inhibitor.

Accepted Answer

Antidepressants given to patients with Alzheimer's disease do not appear to be effective and cause adverse effects and unwanted drug interactions.

Question 3

A patient has been taking donepezil (Aricept)for several months after being diagnosed with Alzheimer's disease.The patient's spouse brings the patient to the clinic and reports that the patient seems to be having visual hallucinations.The primary care NP should:

A) increase the dose.
B) decrease the dose.
C) switch to memantine (Namenda).
D) switch to galantamine (Razadyne).

decrease the dose.

Accepted Answer

Hallucinations may be a sign of drug toxicity.The NP should decrease the dose.

Question 4

A patient is newly diagnosed with Alzheimer's disease stage 6 on the Global Deterioration Scale.The primary care NP should prescribe:&#10;A) donepezil (Aricept).&#10;B) rivastigmine (Exelon).&#10;C) memantine (Namenda).&#10;D) galantamine (Razadyne).

Accepted Answer

Patients with moderate to severe dementia (stages 5 to 7)may be started on memantine.

Question 5

A patient who has Alzheimer's disease has been taking donepezil for 1 year.The patient's spouse reports a worsening of symptoms.The primary care NP should consider:&#10;A) switching to ginkgo biloba.&#10;B) adding an antidepressant medication.&#10;C) changing to galantamine (Razadyne).&#10;D) adding memantine hydrochloride (Namenda).

Accepted Answer

Memantine hydrochloride can be added to therapy when symptoms worsen.Ginkgo biloba may be useful but is not recommended as adjunct therapy.Antidepressants given to patients with Alzheimer's disease who have depression appear not to be effective and often cause adverse effects or produce unwanted drug interactions.Galantamine is part of first-line therapy but should not be given with donepezil because both are ChE inhibitors.

Question 6

A patient who has Alzheimer's disease begins taking donepezil (Aricept).After 3 months of treatment,the patient does not show improvement of symptoms.The primary care NP should:&#10;A) switch to rivastigmine (Exelon).&#10;B) switch to galantamine (Razadyne).&#10;C) switch to memantine (Namenda).&#10;D) continue donepezil and reevaluate in 3 months.

Accepted Answer

Patients should be switched to other medications if initial therapy fails,but switching to another medication should be considered only after a minimum of 6 months of treatment.

Question 7

A patient who has Alzheimer's disease is taking 10 mg of donepezil daily and reports difficulty sleeping.The primary care NP should recommend:&#10;A) decreasing the dose to 5 mg.&#10;B) increasing the dose to 15 mg.&#10;C) taking the drug in the morning.&#10;D) taking the drug in the evening.

Accepted Answer

Donepezil is typically taken in the evening just before going to bed; however,in patients experiencing sleep disturbance,daytime administration is preferred.The dose should not be increased or decreased.

Question 8

A patient who is diagnosed with Alzheimer's disease experiences visual hallucinations.The primary care NP should initially prescribe:&#10;A) donepezil (Aricept).&#10;B) rivastigmine (Exelon).&#10;C) memantine (Namenda).&#10;D) galantamine (Razadyne).

Accepted Answer

Patients with dementia with Lewy bodies may show benefit with rivastigmine.Visual hallucinations are a hallmark feature of Lewy body dementia.

Question 9

Early-stage Alzheimer's disease is diagnosed in a patient,and the primary care NP recommends therapy with a ChE inhibitor.The patient asks why drug treatment is necessary because most functioning is intact.The NP should explain that medication may:

A) delay progression of symptoms.
B) produce temporary disease remission.
C) prevent depressive effects of the disease.
D) reduce the need for adjunct medications later on.

Accepted Answer

Pharmacologic treatment should begin as soon as Alzheimer's disease is suspected because early treatment can slow disease progression.Medication does not produce disease remission or prevent depression.The disease eventually progresses despite medication,and adjunct therapies are often required.

Deck 42: Medications for Dementia