5 - Dementia

Question 1

Rule out ______ meds

Answer 1

anticholinergic

Question 2

What are examples of anticholinergic meds?

Answer 2

antiemetics, antihistamines, antimuscarinics, antipsychotics, TCAs

Question 3

If delusions or hallucinations occur, it usually indicates what kind of dementia?

Answer 3

lewy body dementia

Question 4

___ risk factors increase chance of dementia

Answer 4

CV

diabetes, HTN, stroke, smoking, etc.

Question 5

What drug classes have evidence to reduce risk of alzheimers?

Answer 5

• antihypertensives (diuretics, ACEi, ARB, BB)

- diuretics

Question 6

What are other things to prevent dementia?

Answer 6

• MIND diet

- exercise

Question 7

Vitamin B may be beneficial to prevent dementia only if ____ levels are elevated

Answer 7

homocysteine

Question 8

What decrease on the MMSE scale is considered beneficial?

Answer 8

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

Question 9

Monitor for effects ___ weeks after starting or changing meds

Answer 9

2

Question 10

What are the cholinesterase inhibitors?

Answer 10

donepezil, rivastigmine, galantamine

Question 11

Which ChEi can be used in all severities?

Answer 11

donepezil

Question 12

Which ChEi comes as a patch?

Answer 12

rivastigmine

Question 13

What is memantine?

Answer 13

NMDA receptor antagonist - blocks glutamate-induced neuronal excitotoxicity (final pathway in neuronal death)

Question 14

What severity is memantine used for?

Answer 14

only moderate-severe

Question 15

Is ginkgo biloba good?

Answer 15

no consistent evidence of benefit

Question 16

Key points for vascular dementia?

Answer 16

• control HTN (< 140/80 mmHg)

- add a lipid lover agent for dyslipidemias

Question 17

How can ChEi affect those with parkinsons?

Answer 17

can increase parkinson-like features such as tremor

Question 18

____ can be used for sleep or agitated behavior (associated with sun-downing)

Answer 18

trazodone

Question 19

If BZD is required, which ones do you want to use?

Why?

Answer 19

LOT

• lorazepam
• oxazepam
• temazepam

*choose from these 3 because they have no active metabolites

Question 20

Which ChEi has lowest risk for drug interactions?

Answer 20

rivastigmine

Question 21

Which ChEis need to be taken with food?

Answer 21

rivastigmine and galantamine

*donepezil is with or without food

Question 22

Which ChEi require adjustment for renal failure?

Answer 22

NONE

Question 23

Does memantine require adjustment for renal failure?

Answer 23

yes

Question 24

_____ also has less incidence of DIs

Answer 24

memantine

Question 25

which gender is more at risk for AD

Answer 25

females