Memantine — MRCPsych Paper B MCQ
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Correct answer: A — Memantine
Memantine is the correct answer. It is a voltage-dependent, moderate-affinity, uncompetitive antagonist at N-methyl-D-aspartate (NMDA) glutamate receptors and is licensed for moderate to severe Alzheimer's disease. In UK practice, NICE recommends memantine monotherapy for severe Alzheimer's disease, or for moderate disease when acetylcholinesterase inhibitors are contraindicated or not tolerated. It can also be added to an existing acetylcholinesterase inhibitor in moderate or severe disease. Galantamine, donepezil and rivastigmine are acetylcholinesterase inhibitors rather than NMDA-receptor antagonists. Risperidone is an antipsychotic; its limited role in Alzheimer's disease concerns short-term treatment of persistent aggression under specific risk-related circumstances, not treatment of the core cognitive syndrome.
Reference: Electronic Medicines Compendium, Memantine 20 mg film-coated tablets: Summary of Product Characteristics, sections 4.1 and 5.1, updated 8 January 2024. https://www.medicines.org.uk/emc/product/14496/smpc