Question

scenario: a 70-year-old woman with alzheimer’s disease is on donepezil. she complains of vivid dreams. question: how should the pmhnp manage this side effect? increase the dose of donepezil. switch to a different cholinesterase inhibitor. advise taking the medication in the morning. add a low-dose benzodiazepine at bedtime.

Explanation:

Donepezil, a cholinesterase inhibitor, can cause vivid dreams (a common side effect related to its cholinergic effects, often more noticeable at night). Taking it in the morning can help reduce nighttime - related side effects like vivid dreams as the drug's effects will be more distributed during waking hours, minimizing impact on sleep - related dreaming. Increasing the dose would likely worsen the side effect. Switching to another cholinesterase inhibitor may not solve the issue as they have similar mechanisms and side effect profiles. Adding a benzodiazepine is not the first - line approach for managing this side effect of donepezil and may have its own risks, especially in an elderly patient with Alzheimer's.

Answer:

C. Advise taking the medication in the morning.