5 - Dementia Flashcards
Rule out ______ meds
anticholinergic
What are examples of anticholinergic meds?
antiemetics, antihistamines, antimuscarinics, antipsychotics, TCAs
If delusions or hallucinations occur, it usually indicates what kind of dementia?
lewy body dementia
___ risk factors increase chance of dementia
CV
diabetes, HTN, stroke, smoking, etc.
What drug classes have evidence to reduce risk of alzheimers?
- antihypertensives (diuretics, ACEi, ARB, BB)
- diuretics
What are other things to prevent dementia?
- MIND diet
- exercise
Vitamin B may be beneficial to prevent dementia only if ____ levels are elevated
homocysteine
What decrease on the MMSE scale is considered beneficial?
An annual decrease of less than 2 points on MMSE scale while on drug therapy = beneficial
*BUT MMSE is a poor indicator for individual response so must develop personal goals with patient and caregiver
Monitor for effects ___ weeks after starting or changing meds
2
What are the cholinesterase inhibitors?
donepezil, rivastigmine, galantamine
Which ChEi can be used in all severities?
donepezil
Which ChEi comes as a patch?
rivastigmine
What is memantine?
NMDA receptor antagonist - blocks glutamate-induced neuronal excitotoxicity (final pathway in neuronal death)
What severity is memantine used for?
only moderate-severe
Is ginkgo biloba good?
no consistent evidence of benefit
Key points for vascular dementia?
- control HTN (< 140/80 mmHg)
- add a lipid lover agent for dyslipidemias
How can ChEi affect those with parkinsons?
can increase parkinson-like features such as tremor
____ can be used for sleep or agitated behavior (associated with sun-downing)
trazodone
If BZD is required, which ones do you want to use?
Why?
LOT
- lorazepam
- oxazepam
- temazepam
*choose from these 3 because they have no active metabolites
Which ChEi has lowest risk for drug interactions?
rivastigmine
Which ChEis need to be taken with food?
rivastigmine and galantamine
*donepezil is with or without food
Which ChEi require adjustment for renal failure?
NONE
Does memantine require adjustment for renal failure?
yes
_____ also has less incidence of DIs
memantine
which gender is more at risk for AD
females
