MCQ Quiz- Drugs Used in Alzheimer’s Disease

The pharmacotherapy for Alzheimer’s Disease is aimed at providing symptomatic relief and, with newer agents, attempting to modify the underlying disease pathology. A pharmacist’s role is crucial for managing these medications, counseling caregivers, and setting realistic expectations, as there is currently no cure for the disease. This quiz will test your knowledge on the primary drug classes used to treat the cognitive and behavioral symptoms of Alzheimer’s Disease.

1. The two primary classes of medications used for the symptomatic treatment of cognitive decline in Alzheimer’s Disease are:

• a. Antipsychotics and Anxiolytics
• b. Statins and Antihypertensives
• c. Cholinesterase inhibitors and NMDA receptor antagonists
• d. Opioids and NSAIDs

Answer: c. Cholinesterase inhibitors and NMDA receptor antagonists

2. What is the primary pathophysiological basis for using cholinesterase inhibitors in Alzheimer’s Disease?

• a. To increase the brain’s levels of dopamine.
• b. To compensate for the loss of cholinergic neurons and increase the availability of acetylcholine.
• c. To reduce the levels of glutamate in the brain.
• d. To clear amyloid plaques from the brain.

Answer: b. To compensate for the loss of cholinergic neurons and increase the availability of acetylcholine.

3. Which of the following is a cholinesterase inhibitor used to treat Alzheimer’s Disease?

• a. Memantine
• b. Levodopa
• c. Donepezil
• d. Citalopram

Answer: c. Donepezil

4. A common and dose-limiting side effect of cholinesterase inhibitors is:

• a. Constipation and dry mouth
• b. Nausea, vomiting, and diarrhea
• c. Hypertension and tachycardia
• d. Significant weight gain

Answer: b. Nausea, vomiting, and diarrhea

5. Memantine is an NMDA receptor antagonist. It is thought to work by:

• a. Increasing acetylcholine levels.
• b. Protecting neurons from glutamate-mediated excitotoxicity.
• c. Increasing dopamine levels.
• d. Enhancing the effect of GABA.

Answer: b. Protecting neurons from glutamate-mediated excitotoxicity.

6. For which stage of Alzheimer’s Disease is memantine typically indicated?

• a. Pre-clinical stage
• b. Mild cognitive impairment
• c. Mild Alzheimer’s Disease only
• d. Moderate to severe Alzheimer’s Disease

Answer: d. Moderate to severe Alzheimer’s Disease

7. Lecanemab and donanemab are newer monoclonal antibody therapies that work by:

• a. Targeting and helping to clear amyloid-beta plaques from the brain.
• b. Increasing acetylcholine levels.
• c. Blocking NMDA receptors.
• d. Inhibiting the tau protein.

Answer: a. Targeting and helping to clear amyloid-beta plaques from the brain.

8. A major risk and monitoring requirement for anti-amyloid monoclonal antibodies like lecanemab is:

• a. Severe liver toxicity.
• b. Agranulocytosis.
• c. Amyloid-Related Imaging Abnormalities (ARIA), which can include cerebral edema or hemorrhage.
• d. Severe hypertension.

Answer: c. Amyloid-Related Imaging Abnormalities (ARIA), which can include cerebral edema or hemorrhage.

9. What is a key counseling point for a patient or caregiver starting a cholinesterase inhibitor like donepezil?

• a. The medication will cure Alzheimer’s disease.
• b. The medication may provide a modest, temporary improvement in cognitive symptoms.
• c. The medication will work immediately.
• d. The medication has no side effects.

Answer: b. The medication may provide a modest, temporary improvement in cognitive symptoms.

10. Rivastigmine is available as a transdermal patch. What is the primary advantage of the patch formulation over the oral capsules?

• a. It is more effective at improving cognition.
• b. It has a lower incidence of gastrointestinal side effects like nausea and vomiting.
• c. It only needs to be changed once a month.
• d. It is a curative therapy.

Answer: b. It has a lower incidence of gastrointestinal side effects like nausea and vomiting.

11. Antipsychotic medications are sometimes used in patients with Alzheimer’s Disease to manage:

• a. Memory loss
• b. Agitation, aggression, or psychosis
• c. Apathy
• d. Sleep disturbances

Answer: b. Agitation, aggression, or psychosis

12. A pharmacist dispensing an antipsychotic for a patient with dementia-related psychosis must be aware of the black box warning for:

• a. Increased risk of stroke and death in elderly patients.
• b. Severe liver failure.
• c. Agranulocytosis.
• d. QT prolongation.

Answer: a. Increased risk of stroke and death in elderly patients.

13. Which cholinesterase inhibitor is also approved for the treatment of Parkinson’s disease dementia?

• a. Donepezil
• b. Rivastigmine
• c. Galantamine
• d. Memantine

Answer: b. Rivastigmine

14. The overall goal of pharmacotherapy for Alzheimer’s Disease is to:

• a. Cure the disease and restore all lost memory.
• b. Slow the progression of the disease and manage cognitive and behavioral symptoms to improve quality of life.
• c. Regenerate lost neurons in the hippocampus.
• d. Prevent the disease in all at-risk individuals.

Answer: b. Slow the progression of the disease and manage cognitive and behavioral symptoms to improve quality of life.

15. A pharmacist’s role in the care of a patient with Alzheimer’s disease includes:

• a. Counseling caregivers on medication administration and side effects.
• b. Screening for drug interactions that could worsen cognition.
• c. Helping to simplify medication regimens.
• d. All of the above.

Answer: d. All of the above.

16. Which of the following is NOT a first-line therapy for Alzheimer’s disease?

• a. Donepezil
• b. Rivastigmine
• c. Galantamine
• d. A benzodiazepine for memory loss.

Answer: d. A benzodiazepine for memory loss.

17. Why should medications with strong anticholinergic properties be avoided in patients with Alzheimer’s Disease?

• a. They can worsen cognitive function.
• b. They can counteract the effects of cholinesterase inhibitors.
• c. They can increase the risk of side effects like confusion and urinary retention.
• d. All of the above.

Answer: d. All of the above.

18. A key counseling point when starting memantine is to:

• a. Start at a high dose for rapid effect.
• b. Titrate the dose up slowly to improve tolerability.
• c. Take the medication on an empty stomach.
• d. Expect a cure within 6 months.

Answer: b. Titrate the dose up slowly to improve tolerability.

19. A patient with mild Alzheimer’s disease would most likely be started on which medication?

• a. A cholinesterase inhibitor like donepezil.
• b. Memantine only.
• c. A combination of donepezil and memantine.
• d. Lecanemab.

Answer: a. A cholinesterase inhibitor like donepezil.

20. The hallmark neuropathological findings in Alzheimer’s disease are amyloid plaques and neurofibrillary tangles.

• a. True
• b. False

Answer: a. True

21. A patient taking donepezil may experience which of the following as a side effect?

• a. Bradycardia
• b. Hypertension
• c. Constipation
• d. Dry mouth

Answer: a. Bradycardia

22. How are anti-amyloid monoclonal antibodies administered?

• a. As an oral tablet
• b. As an intramuscular injection
• c. As an intravenous (IV) infusion
• d. As a transdermal patch

Answer: c. As an intravenous (IV) infusion

23. The pharmacist plays a critical role in managing the side effects of Alzheimer’s medications to improve:

• a. Adherence and quality of life.
• b. The progression of the disease.
• c. The patient’s appetite.
• d. The caregiver’s stress level.

Answer: a. Adherence and quality of life.

24. The approval of anti-amyloid antibodies like lecanemab was based on their ability to:

• a. Significantly improve memory in all patients.
• b. Reduce the amount of amyloid plaque in the brain, with a modest slowing of clinical decline.
• c. Cure Alzheimer’s disease.
• d. Be administered orally.

Answer: b. Reduce the amount of amyloid plaque in the brain, with a modest slowing of clinical decline.

25. A key to managing Alzheimer’s pharmacotherapy is setting realistic expectations with the patient and their family.

• a. True
• b. False

Answer: a. True

26. Which of the following is a common non-pharmacologic intervention for managing behavioral symptoms in dementia?

• a. Redirecting the patient’s attention.
• b. Creating a calm and structured environment.
• c. Engaging the patient in simple, familiar activities.
• d. All of the above.

Answer: d. All of the above.

27. Before a patient can receive an anti-amyloid antibody, what must be confirmed?

• a. The presence of amyloid pathology in the brain, often via a PET scan or CSF analysis.
• b. The patient’s blood type.
• c. The patient’s cholesterol level.
• d. That the patient has failed a cholinesterase inhibitor.

Answer: a. The presence of amyloid pathology in the brain, often via a PET scan or CSF analysis.

28. A patient is prescribed Namzaric. The pharmacist recognizes this as a combination product containing:

• a. Donepezil and Rivastigmine
• b. Donepezil and Memantine
• c. Galantamine and Memantine
• d. Lecanemab and Donepezil

Answer: b. Donepezil and Memantine

29. The use of vitamin E has strong evidence for preventing or treating Alzheimer’s disease.

• a. True
• b. False

Answer: b. False

30. The overall management of Alzheimer’s disease is best handled by:

• a. A single physician.
• b. A multidisciplinary team including neurologists, pharmacists, social workers, and caregivers.
• c. The patient’s family alone.
• d. A community pharmacist alone.

Answer: b. A multidisciplinary team including neurologists, pharmacists, social workers, and caregivers.

31. Galantamine has a dual mechanism of action, inhibiting acetylcholinesterase and:

• a. Modulating nicotinic receptors.
• b. Blocking NMDA receptors.
• c. Inhibiting MAO-B.
• d. Stimulating dopamine release.

Answer: a. Modulating nicotinic receptors.

32. A pharmacist counseling a caregiver about the rivastigmine patch should instruct them to:

• a. Apply the patch to the same spot every day.
• b. Cut the patch in half if side effects occur.
• c. Rotate the application site daily to avoid skin irritation.
• d. Apply the patch to the patient’s hands or feet.

Answer: c. Rotate the application site daily to avoid skin irritation.

33. The main reason for the limited efficacy of cholinesterase inhibitors is that they:

• a. Do not stop the underlying neurodegenerative process.
• b. Are not potent enough.
• c. Do not cross the blood-brain barrier.
• d. Are poorly tolerated.

Answer: a. Do not stop the underlying neurodegenerative process.

34. The pharmacist’s role includes identifying and helping to manage drug-drug interactions for patients with Alzheimer’s, who are often on many medications.

• a. True
• b. False

Answer: a. True

35. A common side effect of memantine is:

• a. Nausea and vomiting
• b. Dizziness and confusion
• c. Bradycardia
• d. Constipation

Answer: b. Dizziness and confusion

36. A patient with severe Alzheimer’s who is having difficulty swallowing pills might be a good candidate for which formulation of rivastigmine?

• a. The oral capsule
• b. The transdermal patch
• c. A higher dose of the oral capsule
• d. No treatment is possible.

Answer: b. The transdermal patch

37. Which of the following drugs is NOT used to treat the cognitive symptoms of Alzheimer’s disease?

• a. Donepezil
• b. Memantine
• c. Haloperidol
• d. Rivastigmine

Answer: c. Haloperidol

38. The goal of using antipsychotics for agitation in dementia is:

• a. To use the highest dose possible for long-term control.
• b. To use the lowest effective dose for the shortest duration necessary after non-pharmacologic methods have failed.
• c. To cure the agitation permanently.
• d. To sedate the patient heavily.

Answer: b. To use the lowest effective dose for the shortest duration necessary after non-pharmacologic methods have failed.

39. A patient with Alzheimer’s disease may have their medication regimen simplified over time to reduce pill burden and the risk of adverse effects. This process is known as:

• a. Polypharmacy
• b. Deprescribing
• c. Adherence monitoring
• d. A drug holiday

Answer: b. Deprescribing

40. A key part of patient care for Alzheimer’s is providing support and education to:

• a. The patient only.
• b. The caregiver only.
• c. Both the patient and the caregiver.
• d. The physician only.

Answer: c. Both the patient and the caregiver.

41. Which of the following is NOT a goal of Alzheimer’s pharmacotherapy?

• a. To maintain patient function.
• b. To improve quality of life.
• c. To manage behavioral symptoms.
• d. To restore lost neurons.

Answer: d. To restore lost neurons.

42. Combining a cholinesterase inhibitor with a drug that has strong anticholinergic properties would result in:

• a. A synergistic beneficial effect.
• a. An antagonistic effect, where the drugs oppose each other’s actions.
• c. No interaction.
• d. A reduction in side effects for both drugs.

Answer: b. An antagonistic effect, where the drugs oppose each other’s actions.

43. A pharmacist plays an important role in the continuity of care for a patient with Alzheimer’s as they transition from hospital to home.

• a. True
• b. False

Answer: a. True

44. The medication management of Alzheimer’s disease is a dynamic process that requires regular reassessment.

• a. True
• b. False

Answer: a. True

45. Which of the following is a non-pharmacologic strategy that can help a patient with Alzheimer’s?

• a. Maintaining a consistent daily routine.
• b. Using memory aids like calendars and notes.
• c. Ensuring the home environment is safe and well-lit.
• d. All of the above.

Answer: d. All of the above.

46. The use of cholinesterase inhibitors is based on the “cholinergic hypothesis” of Alzheimer’s disease.

• a. True
• b. False

Answer: a. True

47. A pharmacist counseling a caregiver about starting an anti-amyloid antibody should emphasize:

• a. That the drug will cure the disease.
• b. The need for regular MRI monitoring to watch for ARIA.
• c. That the drug is administered as an oral tablet.
• d. That there are no side effects.

Answer: b. The need for regular MRI monitoring to watch for ARIA.

48. Medication adherence in a patient with Alzheimer’s disease is often managed by:

• a. The patient alone.
• b. A caregiver, with the help of tools like pillboxes.
• c. The physician.
• d. The insurance company.

Answer: b. A caregiver, with the help of tools like pillboxes.

49. The overall pharmacologic management of Alzheimer’s disease is:

• a. Simple and straightforward.
• b. Complex, with modest benefits and significant side effect considerations.
• c. Focused only on curative therapies.
• d. Based on a “one-size-fits-all” approach.

Answer: b. Complex, with modest benefits and significant side effect considerations.

50. The ultimate goal of learning about the drugs used in Alzheimer’s disease is to:

• a. Be able to safely manage medication therapy to maximize quality of life for both patients and their caregivers.
• b. Pass the neurology exam.
• c. Memorize the names of all the available drugs.
• d. Become an expert in interpreting brain imaging.

Answer: a. Be able to safely manage medication therapy to maximize quality of life for both patients and their caregivers.