AD/Dementia Flashcards
What is the difference between mild neurocognitive disorders and major neurocognitive disorders?
In mild, the impairment does not interfere with independence
MMSE
Assesses cognitive functioning
Influenced by age and educational level
Cannot assess cognitive change over time
Alzheimers Disease Assessment Scale (ADAS)
Severity of dysfunction in cognition and non-cognitive behaviors OVER TIME
Montreal Cognitive Assessment (MOCA)
assesses mild cognitive impairment
St. Louis Univeristy Mental Status Exam (SLUMS)
Used by the VA
Donepezil (Aricept)
Cholinesterase inhibitor
Dose: 5mg at bedtime for 4-6 weeks, then increase to 10mg
SE: GI bleeding, N/V/D, bradycardia, nightmares and agitation
Interacts with CYP2DC and CYP3A3/4
Galantamine (Razadyne)
Cholinesterase inhibitor
Dose: 4mg BID for 4 weeks with breakfast and dinner, increase in 8mg increments every 4 weeks. Max 12mg BID
DO NOT USE DOSES >16mg/day if renal/hepatic impairment
SE: GI bleeding, N/V/D, weight loss, syncope, insomnia
Interacts with 2D6 and 3A4
Rivastigmine (Exelon)
Cholinesterase inhibitor
Dose: (oral) 1.5mg BID for 2 weeks, titrate up by 1.5mg every 2 weeks. MAX 6MG BID
Dose: (patch) 4.6mg patch q24, increase to 9.6mg after 4 weeks, increase to 13.3mg if tolerated
Take with meals to avoid GI SE’s
SE: GI bleeding, weight loss, toxicity to not removing patch (N/V/D), bradycardia, syncope, EPS, insomnia
RESTART LOWEST DOSE IF THERAPY INTERRUPTED FOR 3 DAYS
NO P450 INTERACTIONS
Memantine (Namenda)
NMDA receptor antagonist
Dose: (IR) 5mg qd for one week, then 5mg bid for 1 week, then 5mg qam and 10mg qpm x1week, then 10mg bid
Dose: (LA) 7mg qd x1week, 14mg qd x1week, 21mg qdx1week, 28mg qd.
Dose adjustment needed for renal impariment less than 30mL/min
Use with caution in seizure pts
SE: dizziness, headache, hallucinations, insomnia, confusion, constipation
Use with caution with carbonic anhydrase inhibitors and bicarb (alkaline urine decreases excretion)
NO P450 INTERACTIONS
