A patient who has Alzheimer's disease has been taking donepezil ...

[Bob-Dole]

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:
 
  a. switching to ginkgo biloba.
  b. adding an antidepressant medication.
  c. changing to galantamine (Razadyne).
  d. adding memantine hydrochloride (Namenda).

Question 2

A woman who is being treated with radiotherapy for breast cancer asks her primary care nurse practitioner (NP) about using dietary supplements to improve her chance of recovery. The NP should tell her that:
 
  a. vitamin E is not harmful but has not been shown to change outcomes.
  b. no supplements have been shown to alter outcomes or response to therapy.
  c. folic acid and other B vitamins may improve ability to tolerate chemotherapy.
  d. vitamin C, taken at least 6 days per week, may lower her risk of cancer recurrence.

[Sassygurl126]

Answer to Question 1

D
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.

Answer to Question 2

D
Women with early-stage breast cancer who took supplements of vitamin C or vitamin E at least 6 days per week had a lower risk of cancer recurrence with vitamin C but no differences with vitamin E. B vitamins are not listed as effective.

[Bob-Dole]

Excellent

[ultraflyy23]

TYSM