725 Quiz 3 Flashcards by Emily Hochwald

Dementia includes symptoms such as ___________ dysfunction, ________ loss, ___________ impairment, language and ___________ issues, and _____________ symptoms.

cognitive dysfunction
memory loss
reasoning impairment
language and communication issues, and
behavior symptoms

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What are two behavior symptoms associated with dementia?

psychosis and agitation

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According to Amyloid Cascade Hypothesis, AD is caused by the accumulation of toxic ____________ plaques, hyperphosphorylation of ______, ___________ _____________ formation, ____________ dysfunction, and ultimately _________ loss.

toxic amyloid-beta plaques
hyperphosphorylation of tau
neurofibrillary tangle formation
synaptic dysfunction
neuronal loss (w/memory loss)

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The most successful tx of cognitive and memory s/s associated with AD is associated with boosting _________ functioning and stopping the destruction of ______ .

cholinergic; AcH

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What is the target when attempting to boost cholinergic functioning and preserving AcH?

AcHE

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What three medications target AcHE? DR. G

donepezil, rivastigmine, galantamine

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Class of medication: atomoxetine

selective NE reuptake inhibitor (NRI)

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Mechanism of action: atomoxetine

selectively blocks presynaptic NETs in PFC -> increases DA/NE in PFC

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Class medication: bupropion

NDRI

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Bupropion is a _______ NRI and DAT inhibitor.

weak

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How does bupropion block reuptake DA?

as a DAT inhibitor

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Class medication: guanfacine?

alpha 2A adrenergic agonist

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Class medication: clonidine?

alpha 2A adrenergic agonist

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Stimulants mechanism of action, where?

DA NE Reuptake Inhibitor (DNRI); presynaptic cleft

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Black box warning for stimulants?

Abuse and dependence (schedule II)

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Stimulants can cause this SE in males that is an emergency.

priapism

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What are the two classes of stimulants?

methylphenidate and amphetamine

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What does amphetamine do different from methylphenidate

enhances presynaptic DA release

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Children, especially pre-school children, present with these common SEs (4) of stimulant tx

emotional outbursts
irritability
trouble falling asleep
repetitive thoughts/behaviors

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Cholinesterase inhibitors improve _________ and the ___________ but does __________ the disease; a dramatic effect is NOT typical.

symptoms and course; reverse

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Cholinesterase inhibitors have common _______ SEs and also can cause a safety concern of ______________.

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Guanfacine ER can cause a safety issue of ____________ and _____________ and can cause an emergency SE in males of ____________ .

dizziness, drowsiness, priapism

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When stopping clonidine ER what must you do and why?

taper or rebound HTN

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Common SEs of clonidine ER which can cause a safety issue?

Dizziness, drowsiness

Black box warning of atomoxetine?

children/young adults: worsening depression/SI

Although atomoxetine is not a stimulant, it can cause this SE

decreased appetite

Cognition includes me____, lan____, o__________, j__________, conducting i_________ ____________, performing a_________, and p_______-________.

memory, language, orientation, judgement, conducting IPRs, performing actions (praxis), and problem-solving.

Hallmark symptom of delirium? Typical presents with global impairments of what?

impairment in consciousness (usually decreased); cognitive functions

The primary neurotransmitter, which is reduced, in delirium is what? And speaking on this what is one of the most common causes of delirium?

AcH; too many rx'd medications with anticholinergic activity

Major differential points between delirium and dementia when dx'ing? delirium w/hallucinations/delusions vs schizophrenia? vs depression?

time to develop and fluctuation of s/s; hallucinations/delusions more constant and better organized, no change in consciousness in schizophrenia; confusion not seen in depression

Atomoxetine can cause ______ toxicity, ____ prolongation, and although not a stimulant these CV effects: ____ , increased _____, and cardiovascular ___________ .

HTN, QT, HTN, HR, collapse

Which two ADHD medication causes xerostomia?

atomoxetine and clonidine

What ADHD medication can cause sinus node dysfunction?

guanfacine

Which of the non-stimulant medications for ADHD cause fatigue/drowsiness?

ALL

Which ADHD tx can cause rebound HTN if suddenly stopped?

clonidine

Which ADHD med can cause a skin rash?

guanfacine

Which type of ADHD medication can cause peripheral vasculopathy?

stimulants

Methylphenidate blocks the transports for both what?

NE and DA

Amphetamines are similar to methylphenidates but blocks transporters in a different manner... by being a _________ __________ and pseudosubstrate for ________ and _________ which means it binds to the same site that NE and DA binds to thus __________ their uptake.

competitive inhibitor, NET and DAT, inhibits

Tics from stimulants are caused by?

excess DA

Stimulants can increase ____________ .

anxiety

Taking lower doses of atomoxetine increases the activity of ____ post synaptic neurons, and at higher doses causes ______________.

A2; sedation

Vortioxetine (Trintellix) is an SSRI and modulates ______ 5HT receptors- in AD it can help ________ and ________ by modulating glutamate, AcH, histamine, and NE in the ________ by 5HT__ blockade.

all; cognition and depression, hippocampus, 5HT3

Donepezil is a ______ acting ______ inhibitor of ______ in the _____ & _____ synapse and is _________ . It also works in and outside of the ______ and is ________ .

long; selective; AcHE; pre/post; reversible; CNS; reversible

Donezepil targets memory, behavior, & cognition, especially these 6 things in AD; it can ______ nursing home admission w/ _________ of functioning.

Memantine is a __________ antagonist which _____ abnormal activation of ________ transmission.

NMDA; decreases; glutamate

Brexiprazole is a _______ agonist at the 5HT__ __ and __ __ receptors and is a potent antagonist at the 5HT __ ___ receptor; it is FDA approved to treat what in dementia? ... which is contradictory to the black box warning of what?

partial; 5HT1A and D2; 5HT2A; agitation; increased risk of death in the elderly with dementia related psychosis

Rivastigmine inhibits _______ in the cortex and hippocampus and periphery, and _______ in the _____ but is selective more for ______ (>65%); it is ___________ acting and is _______________.

AcHE; BucHE; glia; AcHE; intermediate; pseudoirreversible

What is a potential advantage of rivastigmine in treating AD?

may help in the later stages and/or rapidly advancing AD

Gabapentin is sometimes used with AD patients for behavioral issues and is a voltage-gated _____ channel _______ - which decreases firing and increases _______ .

Ca; inhibitor; GABA

Carbamazepine (Tegretol) is sometimes used for behavioral in AD patients, 2nd line in tx'ing __________ ; it __________ _____ channels, preventing firing thereby increasing __________ .

aggression; inhibits Na; GABA

Methylphenidate blocks ____ and ____ transporters which blocks their reuptake.

DA; NE

The difference in IR and ER is the ______ ______ with IR lasting _____ hours and ER lasting _______ hours; Vyvanse lasts _______ and is a ____ drug which is preferred for someone with a hx of ______.

half life; 4-6 hours; 8-10 hours; 12 hours; pro; SUD

If a stimulant is not working long enough, what two options do you have in rx'ing?

increase dose or change to long acting

In ADHD DA and NE are decreased which results in a decreased _______ of ________ output in the _____ of the brain which increases ________.

Children with ADHD should be evaluated by using the __________ children's scale and this should be used by __________ and _________ how long after start of tx?

Vanderbilt; parents and teachers; 2 wks

Viloxazine (Qelbee) inhibits _____ and also has actions at what two receptors that may (though not FDA approved) help mood?

NET; 5HT2B and 5HT2C