Ptx Ii Final Alzheimer's Disease

Front 1

AB is a 75 year old female recently diagnosed with Alzheimer’s. She has moderate disease. She comes to your pharmacy, accompanied by her husband, with a prescription for Named. It reads “take 5 mg po daily, increase by 5 mg per week to a dose of 10 mg twice a day. To be added to her Precept 10 mg QD.” Her husband is excited about this new drug. An on-line chat room contact related a “miraculous” reversal of memory loss for their loved one.

Which of the following is the most correct?
a. Named can be expected to cure AB’s Alzheimer’s.
b. Neither of these drugs is effective. The NICE group has banned them from the United Kingdom because they are completely ineffective.
c. Certain patients respond to these agents but it is impossible to predict which ones will do this. They are not a cure but could make life better for both AB and her husband.
d. AB’s physician has made an error- 2 cholinesterase inhibitors should not be used together. I will call and correct the prescribing error.

Back 1

a. There are NO cures for Alzheimer’s disease.
b. NICE indicated these drugs were not COST effective but did work in some patients.
c. Correct. The best we can do for the present time. See objectives 1, 2, 4.
d. Namenda is a NMDA antagonist not a cholinesterase inhibitor.

Front 2

RT is a 72 year-old female recently diagnosed with the moderate stage of Alzheimer’s disease. She is just preparing to begin treatment with donepezil (Aricept) but has heard about the patch and Namenda™ (memantine) and wonders about whether or not they are options for her.

14. Which of the following counseling points below would be appropriate for RT and her husband?

a. Aricept™ (donepezil) will stop the progression of Alzheimer’s disease
b. Exelon™ (rivastigmine) Patch is more effective in reversing the disease
c. Aricept™ should be titrated slowly upward to decrease the incidence nausea, vomiting and diarrhea
d. Combining Exelon™ Patch and Aricept™ would be most effective
e. Namenda™ (memantine) and Aricept™ should not be used together because they have the same mechanism of action and overlapping toxicities

Back 2

c. Aricept™ should be titrated slowly upward to decrease the incidence nausea, vomiting and diarrhea

A, May slow the progression but does not stop.
B, Exelon may have less side effects but not evidence of more effectiveness.
C, Correct.
D, ChEI’s should NOT be used together
E, They can be used together and do NOT have the same mechanism of action. Aricept is a cholinesterase inhibitor and Namenda is an NMDA receptor inhibitor. Toxicities are different.

Front 3

RT is a 72 year-old female recently diagnosed with the moderate stage of Alzheimer’s disease. She is just preparing to begin treatment with donepezil (Aricept) but has heard about the patch and Namenda™ (memantine) and wonders about whether or not they are options for her.

15. RT’s husband comes into the pharmacy 6 months later to pick up an anti anxiety agent, Xanax™ (alprazolam), for himself. His wife has developed restlessness, agitation, agnosia, and aphasia She has continued to take her Aricept. He wishes for you to recommend something to help RT. Which of the following is correct?

a. RT has exhausted all options and agents like Olanzapine will certainly kill her in 2 months
b. The addition of high-dose rivastigmine is an option. It has been shown that higher the dose, the greater the effect.
c. Nonpharmacological strategies such as music therapy could be implemented for the agnosia and aphasia
d. A thorough medication history should performed that includes identification of possible OTC anticholinergic drug ingestion

Back 3

d. A thorough medication history should performed that includes identification of possible OTC anticholinergic drug ingestion

A, Yes, the death rate was higher with atypicals BUT you cannot predict any one patient’s death with certainty.
B, Two ChEIs would only lead to more side effects and higher doses do not give much more in effectiveness.
C, Agnosia and aphasia are part of the disease process that would not be
Amenable to non medication therapy in contrast to the restlessness and
Agitation.
D, Correct.

Front 4

AB is a 75 year old, recently diagnosed, Alzheimer’s patient with moderate disease. She comes to your pharmacy, accompanied by her husband, with a prescription for memantine 5 mg po daily, increase by 5 mg per week to a dose of 10 mg twice a day, to be added to her donezieil 10 mg QD. Her husband is excited about this new drug. An on line chat room contact related a “miraculous” reversal of memory loss for their loved one. Your best counsel would be:
a. Memantine and donezepil and should temporarily cure his AB’s Alzheimer’s.
b. Neither of these drugs is effective. The NICE group has banned them from the United Kingdom as being completely ineffective.
c. Certain patients respond to these agents but it is impossible to predict which ones will do this. They are not a CURE but could make life better for both AB and her husband.
d. The Dr. made a mistake. Two cholinesterase inhibitors should NOT be used together. I will call and correct the prescribing error.

Back 4

a. There are NO cures for Alzheimer’s disease.
b. NICE indicated these drugs were not COST effective but did work in some patients.
c. Correct. The best we can do for the present time.
d. Namenda is a NMDA antagonist not a cholinesterase inhibitor.

Front 5

Ms R.T., 72 yr old, was recently diagnosed with the moderate stage of Alzheimer’s
disease. Her husband is on his way back to the Dr’s office and is seeking information
about possible treatment. Which of the following is correct?

Counseling for R.T. and his wife should include:
a. Memantine (Namenda) is indicted only severe stage of Alzheimer’s
disease. This medication might not be appropriate for your condition.
b. Cholinesterase inhibitors do not work at all, start with Namenda.
c. The cholinesterase inhibitors and Namenda should be titrated slowly
up to decrease the incidence of side effects.
d. Memantine has been shown to reverse the progressive neuron loss when
restoring memory.
e. Memantine and cholinesterease inihibitors should not be used together
because they have the same mechanism of action and toxicities.

Back 5

c. The cholinesterase inhibitors and Namenda should be titrated slowly
up to decrease the incidence of side effects.

Namenda is FDA approved for moderate to severe stages.
The do work on some patients. Just impossible to predict which ones.
Correct.
There are no medications used for Alzheimer’s that reverse disease progression.
They can be used together and do NOT have the mechanism of action. ChEIs are cholinesterase inhibitors and Namenda is an NMDA receptor inhibitor. Toxicities are different.

Front 6

Ms R.T’s husband comes into the pharmacy 6 months later to pick up her
galantamine (Razadyne )prescription and has a new one for low dose olanzapine
(Zyprexa). He husband states that Ms RT has begun exhibiting hallucinations and
paranoia. Which of the following is most correct?
a. R.T. must have developed schizophrenia in addition to Alzheimer’s. Clozapine (Clozaril) would be the drug of choice.
b. Unfortunately, there is nothing else that can be done for your wife; the Olanzapine will certainly kill her in 2 months.
c. Adding high dose donepezil (Aricept) is an option. It has been shown that higher the dose, the greater the effect.
d. While you know there is a great deal of uncertainty about just how well these drugs work you are somewhat reassured because the physician has written for a low dose and given detailed instructions on
monitoring.
e. Taking Vitamin E 600 units per day and Ginkgo Biloba has been shown to
be an effective treatment option.

Back 6

d. While you know there is a great deal of uncertainty about just how well these drugs work you are somewhat reassured because the physician has written for a low dose and given detailed instructions on monitoring.

Hallucinations and paranoia are complications of the Alzheimer’s disease. There is
no evidence Clozapine is better or worse in this condition.
13
Yes, the death rate was higher with atypicals BUT you cannot predict any one
patient’s death with certainty.
Two ChEIs would only lead to more side effects and higher doses do not give much
more in effectiveness.
Correct.
Studies have not shown these to be effective and most likely are not going to show
any noticeable change in memory or behavior.