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7/14 Review topic (Thyroid, OAUA, Motion sickness (none), ADHD, Anxiety, Alzhiemer

Key Concepts:

Terms in this set (27)

Which of the following drugs can cause hyperthyroidism? (Select ALL that apply.)
Answer

A
Amiodarone
B
Prednisone
C
Iodine
D
Lithium
E
Thyroid hormone taken in excess
Amiodarone
Iodine
Thyroid hormone taken in excess


*Lithium causes only hypothyroidism. Amiodarone and interferons can cause either hypothyroidism or hyperthyroidism.
Select the correct statement/s concerning levothyroxine. (Select ALL that apply.)
Answer

A
It contains T3.
B
It is the preferred agent for treating hypothyroidism.
C
It is derived from dessicated porcine gland.
D
It contains T4.
E
It will lower the TSH.
*Levothyroxine is synthetic T4, not T3. The body converts T4 to T3. Levothyroxine is the preferred agent and matches human T4.
Question

A patient has been taking Synthroid for many years. She inquires about using a generic product instead. Choose the correct statement/s concerning generic options for levothyroxine brand formulations. (Select ALL that apply.)
Answer

A
The correct source to check for therapeutic (A-rated) equivalents is the Red Book.
B
All generics of levothyroxine are A-rated to each of the available brand formulations.
C
If a patient changes manufacturers, it is prudent to monitor for symptoms of hypo or hyperthyroidism as the dosage may require adjustment.
D
Patients should be told to use brand name only.
E
Levothyroxine has a narrow therapeutic index.
If a patient changes manufacturers, it is prudent to monitor for symptoms of hypo or hyperthyroidism as the dosage may require adjustment.

Levothyroxine has a narrow therapeutic index.



***The correct source to check for therapeutic (A-rated) equivalents is the Orange Book. Levothyroxine comes in many dosages and various brands. One manufacturer's dosage may not be A-rated to the same dosage produced by a different manufacturer. If a dosage or manufacturer is changed, symptoms should be monitored. Patients should be told to try to stay with the same formulation. The pharmacist should dispense only alternatives that are A-rated to the formulation the patient has been using.
Question

CU takes warfarin for atrial fibrillation. He has been discharged from the hospital with several new medications: levothyroxine, diltiazem and amiodarone. Select the correct statement/s. (Select ALL that apply.)
Answer

A
Addition of levothyroxine can lead to a supratherapeutic INR.
B
Addition of diltiazem can decrease levels of levothyroxine and suboptimal control of hypothyroidism.
C
Addition of levothyroxine will increase the patient's risk of deep vein thrombosis.
D
Addition of amiodarone can lead to a supratherapeutic INR.
E
Addition of diltiazem can lead to a subtherapeutic INR.
Addition of levothyroxine can lead to a supratherapeutic INR.

Addition of amiodarone can lead to a supratherapeutic INR.

*Levothyroxine can increase the INR and a patient stable on warfarin will require monitoring of the INR when levothyroxine is added. Amiodarone causes a large increase in the INR and the clinician should decrease the warfarin dose when amiodarone is added to the regimen of a patient with a stable INR. Both drugs put the patient at increased risk for bleeding, not clotting.
Question

A female with overactive bladder has been prescribed darifenacin once daily. Choose the correct statements concerning darifenacin: (Select ALL that apply.)
Answer

A
Darifenacin is taken once daily, with liquid.
B
Darifenacin is available in oral and transdermal formulations.
C
The most common side effects are dry mouth and constipation.
D
Do not use this or other urge incontinence medications if the patient has glaucoma.
E
Darifenacin should be swallowed whole and not chewed, divided or crushed.
Darifenacin is taken once daily, with liquid.

Most common side effects are dry mouth and constipation.

Do not use this or other urge incontinence medications if the patient has glaucoma.

Darifenacin should be swallowed whole and not chewed, divided or crushed.


*Incorrect
Darifenacin is taken once daily, with liquid, and with or without food. The anticholinergics are not safe to use if the patient has glaucoma. Nothing that has considerable anticholinergic properties can be used safely with glaucoma; they can raise intraocular pressure.
Older women predominantly have a problem with a sudden need to use the restroom, which can result in leakage of a larger amount of urine. What is the term for this type of incontinence?
Answer

A
Overflow
B
Mixed
C
Urge
D
Stress
E
Functional
Urge

*The term "overflow incontinence" is used primarily for BPH, and "functional incontinence" means that the person cannot reach the restroom in time, which could be due to having a problem with movement from a stroke, Parkinson's disease, paralysis or other conditions.
A female with overactive bladder has been prescribed Detrol LA. Choose the correct responses concerning this medication and side effect management: (Select ALL that apply.)
Answer

A
Encourage the patient to use sugarless hard candy or gum to aid with dry mouth.
B
Over-the-counter saliva substitutes may provide some benefit for dry mouth.
C
Reduce the use of other drugs that cause dry mouth, such as clonidine, tricyclics and antihistamines.
D
A stool softener such as docusate may help to minimize constipation.
E
Over-the-counter diphenhydramine may provide some benefit.
Answer

A
Encourage the patient to use sugarless hard candy or gum to aid with dry mouth.
B
Over-the-counter saliva substitutes may provide some benefit for dry mouth.
C
Reduce the use of other drugs that cause dry mouth, such as clonidine, tricyclics and antihistamines.
D
A stool softener such as docusate may help to minimize constipation.
Question

Agnes Simba, an 82 year-old female, will begin Detrol LA for urge incontinence. Which of the following statements concerning Detrol LA are correct? (Select ALL that apply.)
Answer

A
She is likely to experience some dry mouth and should be counseled on ways to relieve this condition.
B
Detrol LA comes as a patch formulation as well.
C
Patients should be started on immediate-release medications rather than long-acting medications.
D
It is best to combine the use of prescription drugs with pelvic floor (Kegel) exercises.
E
She is likely to experience significant cognitive dysfunction, disorientation and dizziness, which are significant in someone this age.
She is likely to experience some dry mouth and should be counseled on ways to relieve this condition.

It is best to combine the use of prescription drugs with pelvic floor (Kegel) exercises.
A hospital nurse has variable work shifts at the hospital. She went to a physician complaining of trouble staying awake and was given a prescription for Provigil. Choose the correct statements concerning Provigil: (Select ALL that apply.)
Answer

A
The generic name is modafinil.
B
It is a C-II agent.
C
Side effects include somnolence.
D
It is also approved for insomnia.
E
Dispense MedGuide due to the risk of severe rash.
The generic name is modafinil.
Dispense MedGuide due to the risk of severe rash.


Modafinil (Provigil) is a C-IV agent. It is commonly used for narcolepsy. Other indications are obstructive sleep apnea/hypopnea syndrome, and shift work disorder. It promotes wakefulness, not sleep.
Which of the following formulations of methylphenidate is not available?
Answer

A
Daily patch
B
Immediate-release chewable tablet
C
Extended-release suspension
D
Immediate-release sublingual tablet
E
Extended-release chewable tablet
Immediate-release sublingual tablet

*Unique newer formulations include: Quillivant XR is an extended-release suspension and Quillichew ER is an extended-release chewable tablet.
Question

JG is an 11 year old girl who presents on 2/2 with difficulty focusing, inattention, and inability to sit still, which has been occurring for over a year according to her mother. She has just finished treatment yesterday with an antibiotic for MRSA community acquired pneumonia.

Allergies: NKDA

Medications:
Linezolid 10 mg/kg Q8H (discontinued 2/1)
Azithromycin (discontinued 1/18)

Past Medical History:
CAP

Vitals:
Height: 4'1" Weight: 79 lbs
BP: 105/65 mmHg HR: 62 BPM
RR: 19 Temp: 98.4ºF

ECG: normal sinus rhythm

Diagnosis:
ADHD

Question:
What treatment plan can be implemented today if JG is to be started on a medication for ADHD?
Answer

A
Start methylphenidate 5 mg BID today
B
Wait 7 days, then start dexmethylphenidate 2.5 mg daily
C
Wait 7 days, then start methylphenidate 5 mg BID
D
Wait 14 days, then start Focalin XR 20 mg daily
E
Wait 14 days, then start Vyvanse 30 mg daily
Wait 14 days, then start Vyvanse 30 mg daily


*Incorrect
All stimulants for ADHD should be started after a 14-day wash-out period following use of a MAO inhibitor such as linezolid. Focalin XR 20 mg daily is not an appropriate starting dose.
Question

A pharmacist is dispensing atomoxetine to an adult patient who has a history of alcohol and drug abuse. The pharmacist should be careful to include these counseling statements: (Select ALL that apply.)
Answer

A
This drug can be abused; do not share with others and store in a safe place.
B
Use caution when driving or operating machinery while taking this medication.
C
If the patient develops nausea with a decrease in appetite, malaise (weak, lack of energy) or abdominal pain, he should be seen by a healthcare provider quickly.
D
Be careful to avoid eating fatty foods due to risk of weight gain and elevated blood sugar with this medication.
E
This medication is useful for headaches.
Use caution when driving or operating machinery while taking this medication.

If the patient develops nausea with a decrease in appetite, malaise (weak, lack of energy) or abdominal pain, he should be seen by a healthcare provider quickly.

Incorrect
Atomoxetine can cause liver damage (rarely, but possible). Symptoms of liver damage can include nausea, loss of appetite, vomiting, diarrhea, malaise, and abdominal pain in the upper right part of the stomach (near the liver). Atomoxetine does not cause weight gain. It can decrease appetite (anorexia).
Question

The pharmacist is counseling the parent of an 11-year old boy who has received an ADHD diagnosis and will begin therapy with Aptensio XR. The following counseling points should be conveyed to the parent: (Select ALL that apply.)
Answer

A
The child will have increased appetite initially; make sure that he does not overeat (eventually the appetite will decrease).
B
Report at once if the child is seeing or hearing things that are not real, believing things that are not real, or are acting suspicious.
C
This medicine has the potential to be abused; store the medicine where it cannot be taken by the wrong person or stolen.
D
Report at once if the child has chest pain, shortness of breath, or fainting.
E
The medication is likely to be increased when the patient returns to the prescriber (unless the child has good relief from the starting dose); it is normal to eventually require a stronger dose than the starting dose.
B
Report at once if the child is seeing or hearing things that are not real, believing things that are not real, or are acting suspicious.
C
This medicine has the potential to be abused; store the medicine where it cannot be taken by the wrong person or stolen.
D
Report at once if the child has chest pain, shortness of breath, or fainting.
E
The medication is likely to be increased when the patient returns to the prescriber (unless the child has good relief from the starting dose); it is normal to eventually require a stronger dose than the starting dose.


Incorrect
Stimulants including Aptensio XR (methylphenidate extended-release) should not be used in patients with heart problems or serious psychiatric conditions. Report at once if the child has chest pain, shortness of breath, or fainting. Report at once if the child is seeing or hearing things that are not real, believing things that are not real, or is suspicious. All stimulants require a MedGuide.
Question

A patient was using methylphenidate extended-release for ADHD. It helps somewhat but the psychiatrist felt that an addition of Intuniv might be useful. Which of the following statements concerning Intuniv are correct? (Select ALL that apply.)
Answer

A
Intuniv should not be taken with high-fat foods.
B
Common side effects are akathisia and agitation.
C
Intuniv can be used alone, or in addition to another ADHD medication.
D
Intuniv is a CYP 3A4 inducer.
E
Intuniv contains extended-release guanfacine.
Intuniv should not be taken with high-fat foods.

Intuniv can be used alone, or in addition to another ADHD medication.

Intuniv contains extended-release guanfacine.

Incorrect
This drug is well-tolerated overall, but possible side effects are somnolence, hypotension, bradycardia and headaches. It can also cause nausea and upper GI pain. Intuniv is a CYP 3A4 substrate (not an inducer, or inhibitor); the concentration of the Intuniv can be increased or decreased by other drugs.
Medication Guides, or MedGuides, contain important safety information. They contain FDA-approved patient education and are considered part of a drug's labeling. Choose the correct statements concerning MedGuides: (Select ALL that apply.)
Answer

A
Instruct the patient to review the MedGuide for important safety information-dispense with each new prescription and with each refill.
B
Instruct the patient to review the MedGuide for important safety information-dispense with each new prescription-refills do not require a MedGuide.
C
Atomoxetine does not require a MedGuide.
D
Stimulants used for ADHD require a MedGuide.
E
Stimulants used for narcolepsy, such as Provigil, require a MedGuide due to the risk of worsening psychiatric symptoms and risk of suicide.
Instruct the patient to review the MedGuide for important safety information-dispense with each new prescription and with each refill.

Stimulants used for ADHD require a MedGuide.


Incorrect
The stimulants and atomoxetine require a MedGuide, with each new prescription and refill. The MedGuide warning for stimulants involves psychiatric and heart-related problems. The MedGuide warning for atomoxetine concerns suicidal thoughts in children and teenagers, worsening psychiatric problems, liver damage and heart problems. Stimulants used for narcolepsy, such as Provigil, require a MedGuide due to the risk of severe rash.
The buspirone dose must be lowered with simultaneous use of the following drugs/foods: (Select ALL that apply.)
Answer

A
Grapefruit
B
Carbamazepine
C
Verapamil
D
Phenytoin
E
Diltiazem
Grapefruit

Verapamil

Diltiazem
Case

History of Present Illness: LY presents to her PCP on August 1st with complaints of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers.

Allergies: no known drug allergies

Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety

Current Medications (obtained from active prescription bottles on 8/1):
Zestril 10 mg daily
Hydrochlorothiazide 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop
Ibuprofen 400 mg daily
Zyrtec D 1 tablet BID
Pulmicort Flexhaler 1 inhalation BID

Expired Prescriptions and No Refills:
3/15: Xanax 0.5 mg TID x 30 days. No refills
3/15: Zoloft 50 mg daily. Disp #30. No refills.
4/25: Valium 2 mg BID x 5 days. No refills.
6/1: Lyrica 50 mg TID. Disp #90. No refills

Vitals:
Height: 5'6" Weight: 125 pounds
BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10

Labs:
Na (mEq/L) = 139 (135 - 145)
K (mEq/L) = 3.1 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 25 (24 - 30)
BUN (mg/dL) = 12 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 147 (100 - 125)
TSH (mIU/L) = 0.15 (0.3 - 3)
Ca (mg/dL) = 8.8 (8.5 - 10.5)
Albumin (g/dL) = 3.2 (3.5 - 5)

Question

Which of the following may be contributing to LY's anxiety? (Select ALL that apply.)
Answer

A
Use of a steroid
B
Use of a decongestant
C
Incorrect use or overuse of albuterol
D
Untreated hyperthyroidism
E
Use of aripiprazole
Use of a steroid

Use of a decongestant

Incorrect use or overuse of albuterol

Untreated hyperthyroidism
Case

History of Present Illness: LY presents to her PCP on August 1st with complaints of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers.

Allergies: no known drug allergies

Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety

Current Medications (obtained from active prescription bottles on 8/1):
Zestril 10 mg daily
Hydrochlorothiazide 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop
Ibuprofen 400 mg daily
Zyrtec D 1 tablet BID
Pulmicort Flexhaler 1 inhalation BID

Expired Prescriptions and No Refills:
3/15: Xanax 0.5 mg TID x 30 days. No refills
3/15: Zoloft 50 mg daily. Disp #30. No refills.
4/25: Valium 2 mg BID x 5 days. No refills.
6/1: Lyrica 50 mg TID. Disp #90. No refills

Vitals:
Height: 5'6" Weight: 125 pounds
BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10

Labs:
Na (mEq/L) = 139 (135 - 145)
K (mEq/L) = 3.1 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 25 (24 - 30)
BUN (mg/dL) = 12 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 147 (100 - 125)
TSH (mIU/L) = 0.15 (0.3 - 3)
Ca (mg/dL) = 8.8 (8.5 - 10.5)
Albumin (g/dL) = 3.2 (3.5 - 5)

Question

Of all of the medications that have been prescribed for LY, which is considered first-line to treat a chronic anxiety disorder?
Answer

A
Prednisone
B
Xanax
C
Valium
D
Zoloft
E
Lyrica
Zoloft

SSRIs and SNRIs are first-line for treating anxiety. Benzodiazepines may be approrpriate when anxiety is acute or temporary.
Which of the following agents used for dementia should be taken with food regardless of whether GI side effects are present?
Answer

A
Aricept
B
Aricept ODT
C
Exelon
D
Namenda
E
Ginkgo biloba
Exelon
Question

A patient will begin therapy with the Exelon patch. Which of the following are correct counseling statements? (Select ALL that apply.)
Answer

A
Apply the patch once weekly; choose a day of the week that it is easy to remember.
B
Apply on the back, upper arm or chest, and always change the site from day-to-day so that the skin does not become irritated.
C
Prior to applying the patch, lubricate the skin well to reduce the risk of irritation with a product such as Cetaphil or Lubriderm.
D
Remove the patch prior to an MRI procedure or skin will burn.
E
Remove the protective liner from one side of the patch, and place the sticky side on skin, then remove the second side of the liner.
B
Apply on the back, upper arm or chest, and always change the site from day-to-day so that the skin does not become irritated.


E
Remove the protective liner from one side of the patch, and place the sticky side on skin, then remove the second side of the liner.
Question

A caregiver is picking up a new prescription of Namenda for her patient. The pharmacist will counsel the caregiver on this medication. Which of the following statements are correct? (Select ALL that apply.)
Answer

A
This medication comes in different forms, such as a capsule and an oral solution, which may be easier to administer.
B
This medication can be taken with or without food.
C
If there is any difficulty swallowing the extended-release capsule, it can be opened and the contents sprinkled on applesauce.
D
The common side effects are headache, racing heart and shortness of breath.
E
This medication can reverse the symptoms of memory loss if taken regularly.
This medication comes in different forms, such as a capsule and an oral solution, which may be easier to administer.
B
This medication can be taken with or without food.
C
If there is any difficulty swallowing the extended-release capsule, it can be opened and the contents sprinkled on applesauce.


Incorrect
Unfortunately, the medications used for dementia offer little (very mild) benefit. Possible side effects of Namenda include dizziness, constipation (and in some patients, diarrhea), and headache.
Question

Select the indications for the use of donepezil: (Select ALL that apply.)
Answer

A
For mild to severe Alzheimer's Disease
B
For wearing off associated with rivastigmine therapy
C
For moderate to severe disease in combination with memantine
D
For wearing off associated with galantamine therapy
E
For moderate to severe disease in combination with rivastigmine
For mild to severe Alzheimer's Disease
For moderate to severe disease in combination with memantine
Question

Johanna Young is a 72 year old female who comes into the clinic for a follow-up on her depression medications on 1/18 with her husband. He states that she is having trouble finding the right words to say and becomes easily frustrated when she can't remember simple things, which is happening quite often. Her MMSE score today is 21.

Allergies: Penicillin

Vitals:
Height: 5'7" Weight: 144 lbs
BP: 137/89 mmHg HR: 72 BPM
Temp: 98.4ºF Pain: 1/10

Past Medical History:
Depression
General Anxiety Disorder
Overactive Bladder

1/18 Medications:
Fluoxetine 40 mg daily
Buspirone 15 mg BID
Ditropan XL 5 mg daily
Ativan 0.5 mg BID prn anxiety
Diphenhydramine 25 mg QHS prn sleep

1/18 Labs:
CH, T (mg/dL)=195 (125 - 200)
TG (mg/dL) = 130 (< 150)
HDL (mg/dL) = 45 (> 40)
LDL (mg/dL) = 110 (< 100)
Glucose (mg/dL)=123 (65 - 99)
Na (mEq/L) = 141 (135 - 145)
K (mEq/L) = 4.2 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 28 (24 - 30)
BUN (mg/dL) = 17 (7 - 20)
SCr (mg/dL) = 1.1 (0.6 - 1.3)
Mg (mEq/L) = 1.9 (1.3 - 2.1)
PO4 (mg/dL) = 4.4 (2.3 - 4.7)
Ca (mg/dL) = 9.5 (8.5 - 10.5)
TSH (mIU/L) = 1.9 (0.3 - 3.0)

Diagnosis:
Alzheimer's Disease (mild)

Question:
Ms. Young comes back to the clinic on 2/19 for a follow-up. She was prescribed rivastigmine 3 mg PO BID, however, she cannot tolerate the nausea associated with taking the medication, even with a large meal. Her physician would like to switch her to an Exelon patch. What dosage should the pharmacist recommend when converting the patient to the patch formulation?

Answer

A
Exelon patch 4.6 mg/12 hrs
B
Exelon patch 4.6 mg/24 hrs
C
Exelon patch 9.5 mg/12 hrs
D
Exelon patch 9.5 mg/24 hrs
E
Exelon patch 13.3 mg/24 hrs
Exelon patch 9.5 mg/24 hrs

Incorrect
If oral daily dose is < 6 mg, switch to 4.6 mg/24 hrs patch. If oral daily dose is 6 - 12 mg, switch to 9.5 mg/24 hrs patch. The dose can be increased to 13.3 mg/24 hrs if 9.5 mg is tolerated x 4 weeks.
Question

Johanna Young is a 72 year old female who comes into the clinic for a follow-up on her depression medications on 1/18 with her husband. He states that she is having trouble finding the right words to say and becomes easily frustrated when she can't remember simple things, which is happening quite often. Her MMSE score today is 21.

Allergies: Penicillin

Vitals:
Height: 5'7" Weight: 144 lbs
BP: 137/89 mmHg HR: 72 BPM
Temp: 98.4ºF Pain: 1/10

Past Medical History:
Depression
General Anxiety Disorder
Overactive Bladder

1/18 Medications:
Fluoxetine 40 mg daily
Buspirone 15 mg BID
Ditropan XL 5 mg daily
Ativan 0.5 mg BID prn anxiety
Diphenhydramine 25 mg QHS prn sleep

1/18 Labs:
CH, T (mg/dL)=195 (125 - 200)
TG (mg/dL) = 130 (< 150)
HDL (mg/dL) = 45 (> 40)
LDL (mg/dL) = 110 (< 100)
Glucose (mg/dL)=123 (65 - 99)
Na (mEq/L) = 141 (135 - 145)
K (mEq/L) = 4.2 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 28 (24 - 30)
BUN (mg/dL) = 17 (7 - 20)
SCr (mg/dL) = 1.1 (0.6 - 1.3)
Mg (mEq/L) = 1.9 (1.3 - 2.1)
PO4 (mg/dL) = 4.4 (2.3 - 4.7)
Ca (mg/dL) = 9.5 (8.5 - 10.5)
TSH (mIU/L) = 1.9 (0.3 - 3.0)

Diagnosis:
Alzheimer's Disease (mild)

Question:
What medication is the best choice to start Ms. Young on at this time based on her MMSE score and diagnosis?

Answer

A
Namenda
B
Namzaric
C
Razadyne
D
Aricept 23 mg
E
Abilify
Razadyne

Incorrect
Ms. Young has mild cognitive impairment. Namenda (memantine) and Namzaric (donepezil + memantine) are reserved for moderate to severe Alzheimer's Disease. Aricept 23 mg is reserved for advanced disease and should not be used as initial treatment. Abilify can worsen symptoms of memory loss. Antipsychotics should only be used when there are signs of psychosis, with the benefits outweighing the risks, because they increase the risk of death in elderly patients.
Question

Which of the following treatment regimens can be used in a patient with moderate Alzheimer's Disease? (Select ALL that apply.)
Answer

A
Aricept monotherapy
B
Namenda monotherapy
C
Namenda + Aricept
D
Razadyne + Exelon
E
Aricept + Exelon
Aricept monotherapy
B
Namenda monotherapy
C
Namenda + Aricept

Incorrect
Namenda may be used alone or in combination with an acetylcholinesterase inhibitor for treatment of moderate to severe Alzheimer's disease. Using two acetylcholinesterase inhibitors together would be considered duplicate therapy, and not advantageous.
Question

Sam Gates is a 79 year-old male who has been using rivastigmine for one year. His wife reports that it initially was helpful. Now, she is not sure. She states Mr. Gates is forgetful to the point that he cannot remember their grandchildrens' names. She has asked the physician for a stronger medicine. She presents to the pharmacy with a prescription for memantine. Choose the correct statement regarding memantine:
Answer

A
The brand name is Exelon.
B
The brand name is Comtan.
C
Memantine is dosed initially at 20 mg PO QHS.
D
Memantine is approved for moderate to severe disease.
E
Memantine causes significant GI side effects and should be taken with food.
Memantine is approved for moderate to severe disease.

Incorrect
Memantine is an NMDA receptor antagonist (which is where the brand name came from), approved for use alone or in combination with donepezil for moderate to severe dementia of the Alzheimer's type. The starting dose of memantine is 5 mg once daily.
A patient gave the pharmacist a prescription for Razadyne ER 8 mg once daily #30. Which of the following is an appropriate generic substitution for Razadyne?
Answer

A
Tacrine
B
Cognex
C
Rivastigmine
D
Galantamine
E
Memantine
Galantamine
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