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Pnt Exam 2 > Alzheimer's > Flashcards

Alzheimer's Flashcards

1
Q

name two pathologic hallmarks of AD in the brain

A

neurofibrillary tangles

neuritic plaques

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2
Q

disruption of pathways by plaques and tangles leads to a shortage of what

A

acetylcholine

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3
Q

what leads to neuronal death and a higher rate of plaque formation

A

overactivation of glutamate

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4
Q

cognitive symptoms of AD

A 
memory loss
problems with language
disorientation to time and place
poor or decreased judgement
problems with learning and abstract thinking
misplacing things
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5
Q

Noncognitive symptoms of AD

A

changes in mood or behavior
changes in personality
loss of initiative

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6
Q

functional symptoms of AD

A

difficulty performing familiar tasks

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7
Q

What tests should be done to exclude other causes of dementia

A

depression screen, vitamin b 12 deficiency, thyroid function tests, CBC, and chemistry panel

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8
Q

which medication classes are associated with cognitive impairment

A 
anticholinergics
anticonvulsants
antipsychotics
benzodiazepines
hypnotics
opioids
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9
Q

onset of probable AD

A

insidious

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10
Q

onset of possible AD

A

sudden

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11
Q

history of probable AD is

A

clear

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12
Q

history or possible AD is

A

unclear

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13
Q

possible AD when presence of what

A

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

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14
Q

MMSE tests what areas

A 
orientation
short term memory 
language
attention
praxis (performance of an action)
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15
Q

Mild AD MMSE score

A

18-26

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16
Q

Moderate AD MMSE score

A

10-17

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17
Q

Severe AD MMSE score

A

0-9

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18
Q

Mild AD definition

A

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

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19
Q

Moderate AD definition

A

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

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20
Q

Severe AD defintion

A

loses ability to speak, walk, and feed self; incontinent bowel and bladder, requires 24/7 care

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21
Q

primary goal of therapy for AD

A

treat cognitive symptoms and maintain function

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22
Q

secondary goal of therapy for AD

A

treat psychiatric and behavioral symptoms that occur as a result of AD

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23
Q

cholinesterase inhibitors used in AD

A

donepezil
rivastigmine
galantamine

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24
Q

NMDA receptor antagonist

A

memantine

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25
Q

donepezil brand name

A

aricept

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26
Q

rivastigamine brand name

A

exelon

27
Q

galantamine brand name

A

razadyne

28
Q

memantine brand name

A

namenda

29
Q

Treat mild-moderate AD with what medication/s

A

cholinesterase inhibitor

30
Q

treat moderate to severe AD with what medication/s

A

memantine +/- cholinesterase inhibitor

31
Q

when to monitor AD for safety of medications

A

2-4 weeks

32
Q

When to monitor AD for effectiveness

A

3-6 months then Q6months

33
Q

When is a cholinesterase inhibitor not working

A

greater than 2-4 point decline in MMSE per year

34
Q

Initial dose of donepezil

A

5 mg QD

35
Q

maintenance dose of donepezil

A

5-23 mg QD

36
Q

Time between dose adjustment for donepezil

A

5-10 mg = 4-6 weeks

10-23 mg = 12 weeks

37
Q

therapeutic effect of cholinesterase inhibitors

A

slows cognitive decline by enhancing cholinergic activity

38
Q

common AEs of cholinesterase inhibitors

A

nausea, vomiting, diarrhea

39
Q

dose related AEs of cholinesterase inhibitors

A 
urinary incontinence
dizziness
headache
syncope
bradycardia
muscle weakness
salivation
sweating
40
Q

cholinesterase inhibitors are for what stages of AD

A

mild-moderate

donepezil also severe

41
Q

what medications should be avoided with cholinesterase inhibitors

A

anticholinergics

42
Q

memantine initial dose

A

5 mg QD or 7 mg QD (ER capsule)

43
Q

memantine maintenance dose

A

10 mg BID or 28 mg QD (ER capsule)

44
Q

time between memantine dose adjustments

A

1 week

45
Q

dose adjustments for renal impairment for memantine

A

CrCl < 30 - 10 mg or 14 mg QD

46
Q

therapeutic effects of NMDA antagonist

A

inhibits overstimulation of glutamate

47
Q

AEs of NMDA antagonists

A 
constipation
confusion
dizziness
headache
hallucinations
coughing
hypertension
48
Q

NMDA antagonists used for what stages of AD

A

moderate-severe

49
Q

Rivastigamine initial dose

A

1.5 mg BID or 4.6mg/24 hour patch

50
Q

Rivastigamine maintenance dose

A

3-6 mg BID or 9.5 mg/24 hour patch

51
Q

time between dose adjustments for rivastigamine patch

A

4 weeks

52
Q

time between dose adjustments for rivastigamine oral

A

2 weeks

53
Q

galantamine initial dose

A

4 mg BID or 8 mg QD ER

54
Q

galantamine maintenance dose

A

8-12 mg BID or 16-24 mg QD ER

55
Q

time between dose adjustments for galantamine

A

4 weeks

56
Q

dose adjustments for galantamine

A

Max 16 mg for moderate hepatic or renal funciton. DO not use in severe hepatic or renal dysfunction

57
Q

possible underlying causes of behavioral symptoms in AD

A 
pain
constipation
hunger/dehydration
depression
fear
anxiety 
loss of sleep
UTI
AEs of meds
58
Q

What antipsychotics used in AD and doses

A

olanzapine 5-10 mg
Quetiapine 100-300 mg
risperidone 0.75-2 mg

59
Q

Antipsychotics treat what behavioral AD syptoms

A 
hallucinations
delusions
suspiciousness
disruptive behaviors
aggitation
aggression
60
Q

antidepressants treat what behavioral AD symptoms

A 
poor appetite
insomnia
hopelessness
withdrawal 
suicidal thoughts
agitation
anxiety
61
Q

Which antidepressants are used in AD and doses

A

citalopram 10-20 mg
escitalopram 20-40 mg
sertraline 75-100 mg

62
Q

AEs of donepezil

A 
insomnia
nausea
diarrhea
accident
infection
63
Q

AEs of rivastigmine

A 
dizziness
weight loss
headache
agitation
falling
N/V
anorexia
abdominal pain
tremor
local reaction to patch
64
Q

AEs of galantamine

A

Nausea
vomitting
diarrhea

Pnt Exam 2 (11 decks)

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