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PT2 Neuro 6-9 > alzheimer's dementia and therapeutics > Flashcards

alzheimer's dementia and therapeutics Flashcards

1
Q

cognition

A

mental action or process of acquiring knowledge and understanding through thought, experience, and senses

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2
Q

3 things needed for cognitive function

A

memory
attention
executive function

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3
Q

dementia symptoms and diagnosis criteria

A

must have significantly impaired dysfunction of at least 2 of:

  • memory
  • communication and language
  • ability to focus
  • reasoning and judgment
  • visual perception
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4
Q

two schools of thought for alzheimer’s disease cause

A
  • beta-amyloid deposits

- tau protein abnormalities

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5
Q

beta-amyloid hypothesis

A

beta secretase cleaves APP (amyloid precursor protein) at a location that produces beta-amyloid which oligomerizes and forms fibers and plaques

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6
Q

tau hypothesis

A

tau protein gets hyperphosphorylated which causes it to form helices with itself and thus tangles inside of the neuronal cell

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7
Q

genetic mutation in what protein makes individuals susceptible to alzheimers at a younger age

A

presenilin

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8
Q

drug therapies for alzheimer’s

A
  • acetylcholinersterase inhibitors

- NMDA inhibitor

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9
Q

dementia diagnosis tools

A
  • MMSE
  • MOCA
  • mini-cog
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10
Q

MMSE scale

A

24-30 normal
19-23 mild impairment
10-18 moderate
1-9 severe

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11
Q

MOCA scale normal range

A

26-30

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12
Q

drugs associated with cognitive impairment

A
  • benzodiazepines
  • anticholinergics
  • opiods
  • muscle relaxants
  • antipsychotics
  • H2 antagoinsts
  • antihypertensives
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13
Q

goal of dementia treatment

A

preserve function as long as possible

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14
Q

nonpharmacological therapies for dementia

A
  • caregiver education
  • vision/hearing aids
  • adjust expectations
  • remain calm, firm, supportive
  • keep consistent, structured environments
  • provide frequent orientation cues
  • reduce choices or complex tasks
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15
Q

acetylcholinesterase inhibitors in dementia

A

donepezil
rivastigmine
galantamine

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16
Q

NMDA receptor antagonist in dementia

A

memantine

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17
Q

donepezil MoA

A

noncompetitive, reversible inhibition of acetylcholinesterase

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18
Q

donepezil dosing

A
  • start 5 mg QD, up to 23 mg QD

- most end up at 10 mg and stay there

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19
Q

donepezil adverse effects

A
  • diarrhea, headache, nausea

- rarely CNS and musculoskeletal side effects

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20
Q

donepezil drug interactions

A
  • CYP2D6 and CYP3A4 substrate

- antidepressants

21
Q

donepezil indication

A

mild to severe AD

22
Q

rivastigmine indication

A

mild-severe AD, parkinson’s dementia

23
Q

rivastigmine MoA

A

inhibits butyrylcholinesterase and acetylcholinesterase

24
Q

rivastigmine dosing

A

start 1.5 mg BID and increase slowly every 2 weeks to max dose of 6 mg BID

25
Q

what to do if patient is off rivastigmine for a few days

A

must retitrate because of the side effects

26
Q

rivastigmine adverse effects

A
  • diarrhea, nausea, dizziness, anorexia

- worsens tremor in PD due to excessive ACh

27
Q

rivastigmine drug interactions

A

nicotine increases clearance by 23%

28
Q

galantamine indication

A

mild-moderate AD

29
Q

galantamine MoA

A

selective, competitive, reversible acetylcholinesterase inhibitor

30
Q

galantamine dosing

A

IR: 4 mg BID, slowly increase q4wk up to 8-12 mg BID
ER: 8 mg QD, slowly increase q4wk up to 16-24 mg QD

31
Q

what to do if patient is off galantamine for a few days

A

must retitrate

32
Q

galantamine adverse effects

A
  • nausea, vomiting, diarrhea, anorexia

- rarely SJS, CNS paroblems, bradycardia

33
Q

galantamine drug interactions

A

CYP2D6 and 3A4

34
Q

memantine MoA

A

NMDA receptor antagonist

-protects from overstimulation to preserve learning/memory

35
Q

memantine indication

A

moderate-severe AD

36
Q

memantine dosing

A

IR: 5 mg qd, increase weekly to 10 mg BID
ER: 7 mg qd increase weekly to 28 mg QD

37
Q

memantine adverse effects

A
  • generally well tolerated

- constipation, diarrhea, vomiting, increased urination, SJS

38
Q

approved combination therapy in AD

A

donepezil and memantine

approved for moderate to severe dementia

39
Q

monitoring in AD treatment

A
  • AEs
  • adherence
  • at 3 months for cognitive effects
  • if treatment is successful
40
Q

successful treatment definition

A

MMSE/MOCA declines <2 points per year

41
Q

when to stop drugs for AD

A
  • poor adherence/tolerance
  • deteriorating after 6 months at same rate before tx
  • deterioration accelerates after starting tx
42
Q

herbals in dementia

A 
vitamine E
ginkgo
huperzine
polyphenols
omega fatty acids
43
Q

assessment of agitation

A
  • what is the behavior?
  • what triggers the behavior?
  • what is the impact of the behavior? is it harmful?
44
Q

treatment of behavioral symptoms

A
  • treat hunger, thirst, pain, or infection
  • correct sensory deficits
  • stable routine
  • simple 1-step commands
  • calm communication
  • avoid alcohol
  • home safety
45
Q

antipsychotics in dementia patients

A
  • avoid unless non-pharmacological options have failed

- has increased risk of stroke and death

46
Q

features of delirium

A
  • acute
  • fluctuating
  • reversible in days to weeks
47
Q

confusion assessment method

A

Feature 1: acute onset and fluctuating course (come and go)
Feature 2: inattention
Feature 3: disorganized thinking
Feature 4: altered level of consciousness

Must have 1 and 2, and either 3 or 4

48
Q

precipitating risk factors for delirium

A

infection

dehydration

PT2 Neuro 6-9 (5 decks)

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