An 83-year-old man presents to the community behavioral health clinic, where he is diagnosed with Alzheimer's disease by the PMHNP. He currently smokes two packs of cigarettes a day and declines help with smoking cessation. Which medication for Alzheimer's disease is contraindicated in this patient due to smoking status?
None
Galantamine (Razadyne)
Donepezil (Aricept)
Rivastigmine (Exelon)
The Correct Answer is B
Choice A reason: "None" is incorrect because certain medications can interact with metabolic pathways affected by smoking.
Choice B reason: Galantamine is metabolized by the CYP1A2 enzyme, which is induced by smoking. This induction can reduce therapeutic levels of the drug, potentially making it less effective or requiring dose adjustment, thus contraindicating its use without careful monitoring.
Choice C reason: Donepezil is metabolized primarily by CYP2D6 and CYP3A4 and is not significantly affected by smoking; it remains safe for use in smokers.
Choice D reason: Rivastigmine is metabolized by esterases, not CYP enzymes, so smoking does not alter its metabolism, making it safe in this patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Nonprobable cases would have low or zero scores, inconsistent with a score of 3.
Choice B reason: A score of 3 falls within the range indicating probable Lewy body disease, suggesting sufficient clinical features are present for diagnosis.
Choice C reason: Minimally probable cases usually have lower scores, with fewer core features than observed in this patient.
Choice D reason: Highly probable cases are associated with higher LBCRS scores and more pronounced clinical signs than a score of 3.
Correct Answer is D
Explanation
Choice A reason: Remdesivir is an antiviral and is not commonly associated with mood disturbances such as mania.
Choice B reason: Albuterol can cause mild nervousness or tremor but rarely induces full manic episodes.
Choice C reason: Famotidine is an H2 receptor antagonist and is not associated with mania.
Choice D reason: Dexamethasone is a corticosteroid that can induce psychiatric side effects including mania, agitation, and psychosis, particularly in older adults or those with underlying vulnerabilities.
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