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Pharmacology II Quiz 6 > Alzheimer's Dementia > Flashcards

Alzheimer's Dementia Flashcards

1
Q

Alzheimer’s Dementia Stats

A

The 6th leading cause of death in the U.S.

Accounts for 60 to 80% of dementia in the elderly

Affects approximately 5.1 million Americans

Direct and indirect costs per year amounts to over $144 billion in the United States

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2
Q

Alzheimer’s dementia is _____ or _________ in nature.

A

degenerative

progressive

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3
Q

Neuronal degeneration results in reduced levels of

A

acetylcholine

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4
Q

Cognitive symptoms of Alzheimer’s dementia

A

Impaired memory, disorientation

Language difficulties, impaired judgment

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5
Q

Non-cognitive symptoms of Alzheimer’s dementia

A

Agitation
Anxiety
Psychosis
Depression

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6
Q

Goals of pharmacotherapy in Alzheimer’s Dementia

A

No cure

Delaying tactic only

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7
Q

Azheimer’s dementia drug groupings

A

Anticholinesterases

NMDA receptor antagonists

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8
Q

Alzheimer’s dementia - mild cognitive impairment

A

Impairment that doesn’t meet the criteria for dementia

Criteria imprecise
Amnestic MCI
Non-amnestic MCI

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9
Q

Drug therapy for mild cognitive impairment in AD

A

Drug therapy
None recommended or approved
Cerebral vasodilators a thing of the past

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10
Q

Anticholinesterases

A

Rivastigmine (Exelon)
Donepezil (Aricept)
Galantamine (Razadyne)

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11
Q

MOA of anticholinesterases

A

Offset a deficiency

Try to preserve as much acetylcholine as possible.

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12
Q

Indications for Donepezil

A

Treatment of mild, moderate, or severe dementia of the Alzheimer’s type

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13
Q

Indications for Galantamine

A

Treatment of mild-to-moderate dementia of Alzheimer’s disease

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14
Q

Dosing for Galantamine

A

Maintenance: 12 mg twice a day (IR); 24 mg once a day (ER)

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15
Q

Anticholinesterase dosing

A

Nighttime

reduce impact of GI problems

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16
Q

Avoid or manage anticholinesterases in

A

pts with CVD

pts with PUD

17
Q

Anticholinesterases drug interaction with

A

cholinesterase inhibitor

causes bradycardia, cholinergic effects, lowers seizure threshold.

18
Q

Anticholinesterases ADRs

A 
Nausea
Insomnia
Headache
Blurred vision
Symptomatic bradycardia
Syncope
19
Q

Anticholinesterases Class Drug

A

Donepezil

20
Q

Donepezil

A

Donepezil
10 mg
Once a day in the evening

21
Q

NMDA Receptor Agonist Class Drug

A

Memantine (Namenda)

22
Q

NMDA Receptor Agonist MOA

A

Binds n-methyl-D-aspartate receptors, may slow calcium influx and nerve damage.

23
Q

NMDA Receptor Agonist kinetics

A

Dose reduction for severe renal impairment (below 30 mL/minute)

No hepatic impairment adjustment recommended

24
Q

ADRs of NMDA Receptor Agonist

A

Ataxia, hypokinesia

Emotional agitation, confusion, dizziness, depression, fatigue

Constipation

25
Q

Namenda

A

Namenda
10 mg
One tablet twice a day

26
Q

How do you choose a drug for Alzheimer’s patients?

A

Choice is made on the basis of clinical judgment alone

No firm criteria regarding which drug will work best in a particular patient

 Anticholinesterase alone
 Anticholinesterase plus memantine

Efficacy versus effectivenes

27
Q

Alzheimer’s Disease alternative therapy?

A 
Nonsteroidal antiinflammatory drugs
Estrogen therapy
Antioxidant vitamins
“Statins”
Nutraceuticals
28
Q

NSAIDs in Alzheimer’s Disease?

A

No, and there’s the increased risk of cardiovascular events

29
Q

Estrogen therapy in Alzheimer’s Disease?

A

No, and there may be evidence that estrogen may worsen dementia

30
Q

Antioxidant Vitamins in Alzheimer’s Disease?

A

Mixed results with alpha-tocopherol

If used, 800 to 1000 IUnits twice a day

Avoid in cardiovascular patients

31
Q

Naturaceuticals in Alzheimer’s Disease?

A

Herbals
Ginkgo biloba - Studies inconsistent and unconvincing

Dietary supplementation
B vitamins - No
Omega-3 fatty acids - No

32
Q

Statins in Alzheimer’s Disease?

A

No

Pharmacology II Quiz 6 (5 decks)

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