Alzheimer's Flashcards
name two pathologic hallmarks of AD in the brain
neurofibrillary tangles
neuritic plaques
disruption of pathways by plaques and tangles leads to a shortage of what
acetylcholine
what leads to neuronal death and a higher rate of plaque formation
overactivation of glutamate
cognitive symptoms of AD
memory loss problems with language disorientation to time and place poor or decreased judgement problems with learning and abstract thinking misplacing things
Noncognitive symptoms of AD
changes in mood or behavior
changes in personality
loss of initiative
functional symptoms of AD
difficulty performing familiar tasks
What tests should be done to exclude other causes of dementia
depression screen, vitamin b 12 deficiency, thyroid function tests, CBC, and chemistry panel
which medication classes are associated with cognitive impairment
anticholinergics anticonvulsants antipsychotics benzodiazepines hypnotics opioids
onset of probable AD
insidious
onset of possible AD
sudden
history of probable AD is
clear
history or possible AD is
unclear
possible AD when presence of what
concomitant cerebrovascular disease
features of dementia with Lewy bodies other than demetia itself
Another neurologic disease or nonneurological medical comorbidity
use of medication that could have substantial effect of cognition
MMSE tests what areas
orientation short term memory language attention praxis (performance of an action)
Mild AD MMSE score
18-26
Moderate AD MMSE score
10-17
Severe AD MMSE score
0-9
Mild AD definition
difficulty remembering recent events; decreased ability to manage finances, prepare food; may get lost while driving; begins to withdraw from difficult tasks and gives up hobbies
Moderate AD definition
requires assistance with ADL; disoriented with regards to time; recall of recent events is severely impaired; forgets details of past life and names of family/friends; function fluctuates from day-to-day; loses ability to drive safely; agitation, paranoia, and delusions are common
Severe AD defintion
loses ability to speak, walk, and feed self; incontinent bowel and bladder, requires 24/7 care
primary goal of therapy for AD
treat cognitive symptoms and maintain function
secondary goal of therapy for AD
treat psychiatric and behavioral symptoms that occur as a result of AD
cholinesterase inhibitors used in AD
donepezil
rivastigmine
galantamine
NMDA receptor antagonist
memantine
donepezil brand name
aricept
rivastigamine brand name
exelon
galantamine brand name
razadyne
memantine brand name
namenda
Treat mild-moderate AD with what medication/s
cholinesterase inhibitor
treat moderate to severe AD with what medication/s
memantine +/- cholinesterase inhibitor
when to monitor AD for safety of medications
2-4 weeks
When to monitor AD for effectiveness
3-6 months then Q6months
When is a cholinesterase inhibitor not working
greater than 2-4 point decline in MMSE per year
Initial dose of donepezil
5 mg QD
maintenance dose of donepezil
5-23 mg QD
Time between dose adjustment for donepezil
5-10 mg = 4-6 weeks
10-23 mg = 12 weeks
therapeutic effect of cholinesterase inhibitors
slows cognitive decline by enhancing cholinergic activity
common AEs of cholinesterase inhibitors
nausea, vomiting, diarrhea
dose related AEs of cholinesterase inhibitors
urinary incontinence dizziness headache syncope bradycardia muscle weakness salivation sweating
cholinesterase inhibitors are for what stages of AD
mild-moderate
donepezil also severe
what medications should be avoided with cholinesterase inhibitors
anticholinergics
memantine initial dose
5 mg QD or 7 mg QD (ER capsule)
memantine maintenance dose
10 mg BID or 28 mg QD (ER capsule)
time between memantine dose adjustments
1 week
dose adjustments for renal impairment for memantine
CrCl < 30 - 10 mg or 14 mg QD
therapeutic effects of NMDA antagonist
inhibits overstimulation of glutamate
AEs of NMDA antagonists
constipation confusion dizziness headache hallucinations coughing hypertension
NMDA antagonists used for what stages of AD
moderate-severe
Rivastigamine initial dose
1.5 mg BID or 4.6mg/24 hour patch
Rivastigamine maintenance dose
3-6 mg BID or 9.5 mg/24 hour patch
time between dose adjustments for rivastigamine patch
4 weeks
time between dose adjustments for rivastigamine oral
2 weeks
galantamine initial dose
4 mg BID or 8 mg QD ER
galantamine maintenance dose
8-12 mg BID or 16-24 mg QD ER
time between dose adjustments for galantamine
4 weeks
dose adjustments for galantamine
Max 16 mg for moderate hepatic or renal funciton. DO not use in severe hepatic or renal dysfunction
possible underlying causes of behavioral symptoms in AD
pain constipation hunger/dehydration depression fear anxiety loss of sleep UTI AEs of meds
What antipsychotics used in AD and doses
olanzapine 5-10 mg
Quetiapine 100-300 mg
risperidone 0.75-2 mg
Antipsychotics treat what behavioral AD syptoms
hallucinations delusions suspiciousness disruptive behaviors aggitation aggression
antidepressants treat what behavioral AD symptoms
poor appetite insomnia hopelessness withdrawal suicidal thoughts agitation anxiety
Which antidepressants are used in AD and doses
citalopram 10-20 mg
escitalopram 20-40 mg
sertraline 75-100 mg
AEs of donepezil
insomnia nausea diarrhea accident infection
AEs of rivastigmine
dizziness weight loss headache agitation falling N/V anorexia abdominal pain tremor local reaction to patch
AEs of galantamine
Nausea
vomitting
diarrhea
