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Spring 15 - Pharm Unit II > Alzheimer's > Flashcards

Alzheimer's Flashcards

1
Q

Alzheimer’s Disease

A

-progressive dementia that affects memory, higher learning, reasoning, behavior, emotion

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2
Q

Brain Characteristics in AD

A
  • neurofibrillary tangles and plaques

- brain neuronal pathways destroyed (cholinergic, noradrenergic, serotonergic)

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3
Q

Name a few proposed mechanisms of AD pathogenesis.

A
  • beta amyloid plaques
  • neurofibrillary tangles
  • cholinergic deficit
  • CV risk factors are also risk factors for dementia: HTN, low HDL, high LDL, DM
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4
Q

Mild AD MMSE Score and Abilities

A
  • score 26-18
  • pt has difficulty remembering recent events or may withdraw from difficult activities
  • can carry out regular household activities
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5
Q

Moderate AD MMSE Score and Abilities

A
  • score 17-10
  • pt requires assistance with ADLs
  • frequently disoriented and may forget details of past life
  • agitation, paranoia, delusions
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6
Q

Severe AD MMSE Score and Abilities

A
  • score 10-0
  • pt loses ability to speak, walk, feed self
  • requires 24/7 care
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7
Q

What are some potential AD prevention measures?

A
  • protect the cardiovascular system (many CV risk factors are same as dementia)
  • physical activity and healthy eating
  • maintain social connections and strong intellectual activity
  • reduce head trauma
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8
Q

AD Treatment Goals

A
  • symptomatic tx of cognitive sxs
  • maintain patient function as long as possible
  • treat psychiatric and behavioral sequelae as they occur
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9
Q

Nonpharm Therapy for AD

A
  • educate pt and family/caregivers
  • make plans while patient is able
  • discuss illness course, tx decisions, legal and financial decisions
  • resources for support and research
  • distraction and redirection
  • provide a safe enviro, avoid overstimulation
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10
Q

MOA of Cholinesterase Inhibitors

A
  • cholinesterase breaks down ACh

- cholinesterase inhibitors prevent ACh breakdown –> more ACh in brain for good brain function

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11
Q

Efficacy of Cholinesterase Inhibitors

A
  • may delay or slow worsening of sxs for 6-12 months

- may have positive effects on psychiatric and behavioral sxs

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12
Q

Cholinesterase Inhibitors Indication

A

mild to moderate AD

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13
Q

Which cholinesterase inhibitor is best tolerated?

A

donepezil/Aricept

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14
Q

Adverse Effects of Donepezil, Galantamine, Rivastigmine

A
  • N/V/D
  • anorexia, weight loss
  • bradycardia (leading to syncope, dizziness, and pacemaker insertion)
  • SLUD
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15
Q

What is unique about donepezil/Aricept?

A

1/2 life of 70 hours

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16
Q

Why is the cholinesterase inhibitor Tacrine/Cognex not used as frequently as others?

A

-hepatotoxicity risk

17
Q

Memantine/Namenda Indication

A

moderate to severe AD (alone or with cholinesterase inhibitors)

18
Q

Memantine/Namenda MOA

A

decreases effects of glutamate (excitatory NT), which can cause neurodegenerative disorders

19
Q

Memantine/Namenda Adverse Effects

A
  • generally well-tolerated
  • constipation
  • dizziness, HA, somnolence
20
Q

Caprylidene/Axona

A

-medical food that can be used by neurons to generate more ATP and increase supply of ACh

21
Q

Caprylidene/Axona Adverse Effects

A

-mild GI most common: N/D, flatulence, dyspepsia

22
Q

How much benefit do AD/dementia medications provide? When should a benefit be seen?

A
  • modest benefit on average
  • not all patients benefit
  • benefits should be seen in 3-6 months
23
Q

When should dementia meds be discontinued?

A
  • patients and caregivers need to decide if meds are worth potential side effects and cost
  • consider stopping meds when impairment becomes severe (MMSE < 10)
24
Q

Possible Targets for Future AD Therapies

A
  • beta amyloid
  • tau protein
  • inflammation
  • insulin resistance
25
Q

What types of medications are used for the non-cognitive sxs of dementia?

A
  • antipsychotics
  • antidepressants
  • anticonvulsants
26
Q

What types of medications should be avoided in patients with dementia?

A
  • avoid meds that can worse cognition (anticholinergics, H2RA, benzodiazepines, zolpidem)
  • avoid antipsychotics (atypical antipsychotics assoc w/ increased risk of CVA and mortality)
27
Q

What are some signs of caregiver stress?

A
  • denial or anger
  • social withdrawal
  • anxiety or depression
  • exhaustion, sleeplessness, irritability, lack of concentration
  • health problems
28
Q

What types of community resources are available?

A
  • support groups
  • adult day programs
  • in-home assistance, visiting nurses
  • meal delivery

Spring 15 - Pharm Unit II (9 decks)

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