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Patient Name: TR
Age: 75-year old, nursing home patient
Past medical history: Alzheimers disease
Raynauds disease
Stroke at age 70, partial disability on left side
Allergies: Penicillin
Current medications: donepezil (Aricept) 5 mg daily
nifedipine (Adalat XL) 30 mg daily
ASA 325 mg daily
lorazepam (Ativan) 1 mg qhs prn
Pravastatin (Pravachol) 20 mg qhs

1-You participate in the bi-monthly review of TRs medical progress and medication review
with the physician, nurse, nutritionist, and physiotherapist. The physiotherapist asks you how
donepezil (Aricept) works. You reply that donepezil (Aricepts) main pharmacological action
is to:
A. Inhibit the breakdown of serotonin in the brain
B. Increase acetylcholine levels in the brain
C. Decrease dopamine levels in the CNS
D. Acts as a gamma amino butyric acid agonist

2-The nutritionist reports that grapefruit juice is a regular breakfast beverage for TR. You
advise the nutritionist that grapefruit juice should be avoided because it interacts with TRs:
B. Donepezil
C. Lorazepam
D. Nifedipine
Ans.: D

3-Which recommendation would you suggest to best manage the grapefruit juice?
A. Space apart the grapefruit juice and the interacting medication by at least 2 hours
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B. Discontinue the interacting medication since risks outweigh the benefits
C. Monitor for increased levels and response of the interacting medication
D. Discontinue the grapefruit juice
Ans.: D

4-The most appropriate antidepressant therapy for the patient with Alzheimer is
a) Trazodone
b) Venlafaxine
c) Amitriptyline
d) Citalopram
Ans: D
Comments: SSRIs are the best

5-Mr. BM filled Rx for donepezil (Aricept) 5 mg in your pharmacy. A few days later, Mrs.
BM calls and says that has been feeling slightly nauseous. You suggest that:
a) Cut down the dose to Aricept 2.5 mg OD
b) Take dimenhydrinate 25 mg Q6M regularly
c) Switch to another cholinesterase inhibitor
d) Wait and see if the nausea decreased in a few days, then titrated slowly upwards.
Ans: D
Comments: Nausea usually mild and residing over time (transient)
ASA has positive beneficial effects on Alzheimers.

6. Risk factors of Alzheimers disease:
A. Female gender
B. Smoking
C. Use of alcohol
D. Obesity
E. Diabetes

7. All of the following are symptoms of Alzheimers disease, EXCEPT:
A. Slurred speech
B. Reduced cognitive functions
C. Fatigue
D. Reduced sexual function
E. Decrease in judgement and skills
Ans: C

8. A 80 old man living in elderly home with Alzheimer disease has become very aggressive; he
hits his wife a few times. Which drug would you recommend to start?
a) Risperidone
b) Diazepam
c) Trazodone
d) Chlordiazoxide
Ans: A
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9-Drugs that elevate INR in patient using warfarin and also they cross blood brain barrier?
D-St. J ohn wart

10-A 82 year old senior diagnosed with Alzheimer dementia, which of the following statement
about Alzheimers are incorrect:
A-Alzheimers associated with Gender risk factor
B-NSAIDs are effective and improve cognitive functions.
C-Goal of the treatment for Alzheimers is to decrease progression of disease
D-Gingko biloba is used in Alzheimers

11-A 55 years old patient having Alzheimer and epilepsy. He is using carbamazepine (CBZ)
400mg Po QD for his generalized tonic-clonic epilepsy. Best medication to treat his Alzheimer
(A) Donepezil
(B) Rivastigmine
(C) Galantamine
(D) Risperidone +Donepezil
(E) Memantine
Answer: E
TIPS: Memantine (N-methyl D Aspartate inhibitor) not affected by CYP 450

12-Monitoring parameters for patients with Alzheimer taking medication is/are:
I Dizziness
II Weight loss
III Dryness of mouth
(A) I only
(B) III only
(C) I and II
(D) II and III
(E) All of the above
Answer: C

13-. A 65 years old patient with psychomotor agitation was prescribed Fluoxetine for 6 weeks.
There was an improvement in his appetite and in his sleep disturbance. Doctor should now:
(A) Taper and discontinue the medication
(B) Continue the medication for 6 months
(C) Add Li
(D) Add Olanzepine
(E) C or D
Answer: (E)
Reference: Therapeutic Choices 5th edition Page 67