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Donepezil - All stages
Rivastigmine - Patch available
Galantamine - Good for mild-moderate
A 78-year-old patient with moderate Alzheimer's disease is currently taking donepezil 10mg daily. The physician wants to add memantine. What should the nurse understand about this combination therapy?
Answer: This combination is appropriate and evidence-based for moderate to severe Alzheimer's, as the medications work through different mechanisms and can provide additive benefits.
| Aspect | Cholinesterase Inhibitors | Memantine |
|---|---|---|
| Mechanism | Increase acetylcholine levels | Blocks excessive glutamate |
| Disease Stage | Mild to moderate (severe for donepezil) | Moderate to severe |
| Main Side Effects | GI effects, bradycardia | Dizziness, headache |
| Combination Use | Can combine with memantine | Can combine with cholinesterase inhibitors |
Cholinesterase inhibitors for Cognition
Acetylcholine preservation
Limit glutamate with memantine
Monitor for side effects
A nurse is caring for a client with mild Alzheimer's disease who was just prescribed donepezil. Which statement by the client's family indicates understanding of the medication?
A) "This medication will cure my father's Alzheimer's disease"
B) "We should see improvement in memory within a few days"
C) "This medication may slow down the progression of symptoms"
D) "We can stop the medication if he experiences nausea"
Answer: C - Cholinesterase inhibitors slow disease progression but do not cure Alzheimer's disease.
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