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NBME 23 Answers

nbme23/Block 4/Question#25

An 85-year-old woman is brought to the physician by ...

Donepezil

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submitted by sajaqua1(212),

The patient exhibits memory loss and cognitive impairment with gradual onset. Alzheimer's disease is likely. Acetylcholine activity is down in Alzheimer's, so ACh-esterase inhibitors are used to make ACh more available, stopping some of the effects of Alzheimer's. Donepezil is an ACh-esterase inhibitor.

https://www.drugbank.ca/drugs/DB00843

A) Co-Q- a factor in mitochondrial OxPhos, it is also an antioxidant. It is used as a dietary supplement, and is not FDA approed for the treatment of anything. C) Riluzole- a glutamate antagonist used to prevent excitotoxicity in ALS patients. D) Selegiline- Selective MAO-B inhibitor that may be used in the treatment of Parkinson's, although I believe other treatments are preferred these days. E) Zinc- important cofactor in many reactions including transcription factors (zinc fingers) and in wound healing.