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May 2023 > 221019 PA Alzheimer's disease > Flashcards

221019 PA Alzheimer's disease Flashcards

1
Q

Dementia
Most common type

A

Alzheimer 60-80%
Tau protein buildup + Beta amyloid plaque development
=> decrease Ach + increase glutamate
age> 60
cognitive decline + motor impairment

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2
Q

Dementia
Type seen in young pt.

A

Vascular dementia
sudden after CV event (stroke, reduction of blood flow)

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3
Q

Dementia
Hallucination and motor impairment

A

Lewy body/ Parkinson’s disease
lewy bodies in nerve cells

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4
Q

Dementia
Cognitive (nhận thức) symptoms: Ấm Áp Dù gẤp gÁp
Trí nhớ - Ngôn ngữ
Định hướng
Nhận dạng - Làm theo

A

AADAA
Amnesia: memory loss
Aphasia: language ability
D
Agnosia: inability to recognize ppl/things
Apraxia: unable to perform a task/movement as instructed

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5
Q

Dementia
Non-cognitive
Tâm thần/ hành xử

A
  1. Depression
  2. Psychotic: hallucination + delusion
  3. Rối loạn hành xử: hung hăng, thiếu hợp tác, lang thang
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6
Q

Dementia
Functional symptoms

A

Khả năng tự chăm sóc bản thân (tắm, đi vệ sinh, ăn…)

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7
Q

Dementia
Risk factors: non-modifiable (3)

A

> 65
genetics - family history
Female (sống lâu hơn?)

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8
Q

Dementia
Risk factors: modifiable (kiểm soát bệnh tim, mạch, tâm thần + mối quan hệ), chế độ sinh hoạt

A

Vascular (atrial fibrillation, HTN, CHD, diabetes, obesity)
smoking, alcohol, physical inactivity
Head trauma/ social isolation/ education
Depression

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9
Q

Dementia
Lab work required

A

vitamin B12 + acid folic (optional)
CBC + electrolyte (particularly: calcium)
Thyroid function
FBG
Renal function
Optional: iron, LFT, BUN, arterial blood gas and infection
CT and MRI: in selected pt.
EEG: not required

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10
Q

Dementia
Target of efficacy with new approach

A
  1. Must be determined with caregiver
  2. decrease repetitive questions
  3. Other: irritability, impaired short-term memory
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11
Q

Dementia
Prevent Alzheimer (3)

A
  1. Physical activity
  2. Blood pressure control
  3. Cognitive training
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12
Q

Alzheimer
Non-pharm

A

CBT: mild dementia
Education of progression/QoL
Power of attorney before incompetence
Not drive after the initial stages
Inspect living environment
Group activities (music, sensory stimulation)

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13
Q

Alzheimer
Sun downing

A

worsening of behavior when the sun goes down

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14
Q

Alzheimer
1st line in Alzheimer and Parkinson
(cognitive and functional symptoms)

A

AChEi (cholinesterase inh)

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15
Q

Alzheimer
Alternative and may be combined with AChEi

A

Memantine

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16
Q

Alzheimer
2nd line antipsychotics indication

A

Non-cognitive (agitation, psychosis): severe, dangerous, cause significant distress

17
Q

Alzheimer
antipsychotics avoided for which type of Dementia?

A

Lewy body/ Parkinson dementia
But use 2nd gen.

18
Q

Alzheimer
Antidepressant (TCAs, SSRI) used when?

A

Depression is present with Alzheimer
1st line for (Alzheimer+ depression): SSRI => Monitor: Na+ b/c SSRI cause SIAH and hyponatri => worsen cognitive
8-12 wks: effect
TCAs more anticholinergic effect than SSRI

19
Q

Alzheimer
Trazodone

A

Manage agitation, sundowning, disturbed sleep

20
Q

Alzheimer
Valproate not used in?

A

not used in agitation and aggression

21
Q

Alzheimer
When and how d/c AChEi?

A

No benefit
Sx decline greater than Tx
Intolerable SE
Comorbidities continued
Taper before d/c

22
Q

Alzheimer
AChEi (Donepezil)
CYP 3A4/2D6 inh
(Disease level, dose adjustment)

A

Mild-severe AD
Adjust dose q4w (5mg to target 10mg)
With food
No renal adjustment
Best tolerance

23
Q

Alzheimer
AChEi (rivastigmine)
Low protein binding + not metabolized through CYP450
(Disease level, dose adjustment)

A

Mild-moderate AD
Approved Lewy/Parkinson
Adjust q4w
With food
Severe renal impairment: adjust to improve tolerability. Poor tolerance
Patch, liquid: available

24
Q

Alzheimer
AChEi (galantamine)
CYP 3A4/2D6 inh
(Disease level, dose adjustment)

A

Mild-moderate AD
Adjust dose q4w
With food
Renal adjustment (max 16mg/day if CrCl: 9-60mL/min)
Reg: BID, ER: die
Efficacy month: 1-2

25
Q

Alzheimer
SE AChEi (nước, khô, chậm, mất ngủ, kg)
DUMBELS

A

Diarrhea
Urination
Miosis
Bradycardia
Excessive salivation
Lacrimating: flow of tears
Sweating

26
Q

Alzheimer
Medication? if CrCl<30mL/min: renal adjustment

A

Memantine (block NMDA receptor)
N-Methyl D-Aspartatet receptior: a glutamide receptor acting on brain

27
Q

Alzheimer
Memantine indication / avoid

A

Moderate-Severe AD
Avoid: combine with angle-closure glaucocma, sick sinus syndromes, bradycardia, left bundle branch block
Caution: seizures or CVD pt.
Combine with rivastigmine => decrease NV

28
Q

Alzheimer
Gingko Biloba MOA

A

increase blood flow
decrease viscosity of blood
CI: pt taking anticoagulant/antiplatelets
Caution: pt taking NSAIDs

29
Q

Alzheimer
Gingko Biloba drug interaction

A
  • Thiazide: increase BP
  • Acetaminophen/Caffein/Ergotamine: subarachnoid hemorrhage
  • Decrease omeprazole
    +++ TCAs/Trazodone/Bupropion: decrease seizure threshold
30
Q

Alzheimer
Time frame: cognitive symptoms

A

Early improvement: 4-6 wks
Improvement: 3-6 months

31
Q

Alzheimer
Monitor if AChEi is initiated

A

Heart rate
Sign of syncope

32
Q

Alzheimer
Management of SE

A

Taking in morning if vivid dream
Taking with food if NV
Decrease dose
Change other AChEi
F/u in 2 wks after initiate or increase dose then q3m

33
Q

Two drug classes exist for slowing down the progression of cognitive and functional symptoms

A
  1. cholinesterase inhibitors (e.g. donepezil, galantamine, rivastigmine), 2. NMDA- antagonists (e.g. memantine)
34
Q

Manage behavioural symptoms such as aggression or depression

A

non-pharmacological
If ineffective, atypical antipsychotics (e.g risperidone) and antidepressants

35
Q

Tools assess cognitive function (memory, visuospatial sense,
attention and delayed recall)

A

Montreal Cognitive Assessment (MoCA)
Mini-Mental State Examination (MMSE)

36
Q

Tool measures functional disability (complete activities of daily living (ADL), such as driving, taking medications, and using the phone)

A

Functional Assessment Staging Tool (FAST)

37
Q

Time frame in which cholinesterase inh show efficacy

A

1-6 months

May 2023 (9 decks)

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