AAC Pharmacological Interventions 2 — Questions and Answers
Question 1: Which cholinesterase inhibitor is approved for all stages of Alzheimer's disease, including severe?
- Galantamine
- Rivastigmine
- Donepezil (Correct answer)
- Tacrine
Correct answer: Donepezil
Donepezil (Aricept) is the only cholinesterase inhibitor FDA-approved for mild, moderate, and severe Alzheimer's disease.
Question 2: A patient taking donepezil reports vivid nightmares. The best initial recommendation is to:
- Switch to galantamine immediately
- Administer the dose in the morning instead of at night (Correct answer)
- Discontinue the medication entirely
- Add a sleep aid to the regimen
Correct answer: Administer the dose in the morning instead of at night
Switching donepezil from an evening to a morning dose often resolves vivid dreams, a known side effect, without stopping therapy.
Question 3: Memantine's mechanism of action is best described as:
- Inhibiting acetylcholinesterase to raise ACh levels
- Blocking NMDA glutamate receptors to reduce excitotoxicity (Correct answer)
- Increasing dopamine reuptake in the prefrontal cortex
- Inhibiting beta-amyloid plaque formation
Correct answer: Blocking NMDA glutamate receptors to reduce excitotoxicity
Memantine is an NMDA receptor antagonist that reduces glutamate-mediated excitotoxicity, which contributes to neuronal damage in Alzheimer's.
Question 4: Which combination therapy is FDA-approved as a single capsule for moderate-to-severe Alzheimer's disease?
- Donepezil + galantamine
- Rivastigmine + memantine
- Donepezil + memantine (Correct answer)
- Galantamine + memantine
Correct answer: Donepezil + memantine
Namzaric is the FDA-approved fixed-dose combination of donepezil and memantine for moderate-to-severe Alzheimer's disease.
Question 5: Galantamine's dual mechanism of action includes acetylcholinesterase inhibition and:
- NMDA receptor antagonism
- Nicotinic receptor allosteric modulation (Correct answer)
- Serotonin reuptake inhibition
- GABA receptor potentiation
Correct answer: Nicotinic receptor allosteric modulation
Galantamine uniquely allosterically modulates nicotinic acetylcholine receptors in addition to inhibiting acetylcholinesterase.
Question 6: A patient with Alzheimer's and severe dysphagia cannot swallow pills. Which formulation allows transdermal delivery of a cholinesterase inhibitor?
- Donepezil oral disintegrating tablet
- Rivastigmine transdermal patch (Correct answer)
- Galantamine extended-release capsule
- Memantine oral solution
Correct answer: Rivastigmine transdermal patch
Rivastigmine (Exelon Patch) is available as a transdermal patch, making it suitable for patients who cannot swallow oral medications.
Question 7: Before initiating lecanemab (Leqembi) therapy, which screening test is most critical due to a common serious adverse effect?
- Renal function panel
- MRI brain with ARIA protocol (Correct answer)
- Liver function tests
- Cardiac stress test
Correct answer: MRI brain with ARIA protocol
ARIA (amyloid-related imaging abnormalities) including edema and microhemorrhages is a major risk with anti-amyloid antibodies, so baseline MRI is mandatory.
AAC Pharmacological Interventions 2
Which cholinesterase inhibitor is approved for all stages of Alzheimer's disease, including severe?