Alzheimer's Disease Flashcards
Which of the following meds can cause confusion in the elderly?
a. Galantamine
b. Rivastigmine
c. Benztropine
d. Pyridoxine
e. Metformin
c
Drugs that can worsen dementia:
-Antiemetics (e.g., promethazine)
-Antihistamines (e.g., diphenhydramine, doxylamine)
-Antipsychotics (e.g., chlorpromazine, aripiprazole)
-Barbiturates (e.g., phenobarbital, butalbital)
-BZDs (e.g., alprazolam, clonazepam)
-Central anticholinergics (e.g., benztropine)
-Peripheral anticholinergics (including incontinence and IBS drugs)
-Skeletal muscle relaxants (e.g., baclofen)
-Other CNS depressants (e.g., opioids, sedative hypnotics)
A pt will begin therapy with the rivastigmine patch. How often should the pt be instructed to change the patch?
a. Weekly
b. Every 72 hours
c. Twice daily
d. Every 48 hours
e. Daily
e
The patches are applied daily, at the same time each day, to the upper or lower back, upper arm, or chest. Patch sites should be rotated to avoid skin irritation. A site shouldn’t be reused for 14 days.
Select the MOA of memantine:
a. Decarboxylase inhibitor
b. Norepinephrine reuptake inhibitor
c. Centrally-acting adrenergic agonist
d. Centrally-acting anticholinergic
e. NMDA-receptor antagonist
e
A caregiver is picking up a new Rx for Namenda XR capsules. Which of the following are possible side effects of this med?
a. Tachycardia and SOB
b. Dizziness and HA
c. Diarrhea and rash
d. Bradycardia and cough
e. Nausea and metallic taste in the mouth
b
Common side effects of memantine are dizziness, confusion, headache, and constipation.
Select the MOA of donepezil:
a. Decarboxylase inhibitor
b. Norepinephrine reuptake inhibitor
c. Acetylcholinesterase inhibitor
d. Centrally-acting anticholinergic
e. NMDA-receptor antagonist
c
JY is a 72 y/o female who comes into the clinic on 1/18 for a follow-up on her depression meds. Her husband is with her and states that she’s having trouble finding the right words to say in convo and becomes easily frustrated when she can’t remember simple things, which happening quite often. Her MMSE score today is 21.
What is the best med to start JY on at this time based on her MMSE score and diagnosis?
a. Namenda
b. Donepezil/Memantine
c. Aricept
d. Ropinirole
e. Abilify
c
-JY has mild cognitive impairment. Memantine (Namenda) and donepezil/memantine (Namzaric) are reserved for moderate to severe Alzheimer’s Disease.
-Abilify can worsen symptoms of memory loss.
JY is a 72 y/o female who comes into the clinic on 1/18 for a follow-up on her depression meds. Her husband is with her and states that she’s having trouble finding the right words to say in convo and becomes easily frustrated when she can’t remember simple things, which happening quite often. Her MMSE score today is 21.
Allergies: Penicillin
PMH: Depression, general anxiety disorder, overactive bladder
1/18 Meds:
Fluoxetine 40 mg daily
Buspirone 15 mg BID
Ditropan XL 5 mg daily
Ativan 0.5 mg BID PRN anxiety
Diphenhydramine 25 mg QHS PRN sleep
Of the meds that JY is currently taking, which can worsen dementia?
a. Fluoxetine
b. Ditropan XL
c. Buspirone
d. Ativan
e. Diphenhydramine
b, d, e
Drugs that can worsen dementia:
-Antiemetics (e.g., promethazine)
-Antihistamines (e.g., diphenhydramine, doxylamine)
-Antipsychotics (e.g., chlorpromazine, aripiprazole)
-Barbiturates (e.g., phenobarbital, butalbital)
-BZDs (e.g., alprazolam, clonazepam)
-Central anticholinergics (e.g., benztropine)
-Peripheral anticholinergics (including incontinence and IBS drugs)
-Skeletal muscle relaxants (e.g., baclofen)
-Other CNS depressants (e.g., opioids, sedative hypnotics)
JY is a 72 y/o female who comes into the clinic on 1/18 for a follow-up on her depression meds. Her husband is with her and states that she’s having trouble finding the right words to say in convo and becomes easily frustrated when she can’t remember simple things, which happening quite often. Her MMSE score today is 21.
Allergies: Penicillin
PMH: Depression, general anxiety disorder, overactive bladder
1/18 Meds:
Fluoxetine 40 mg daily
Buspirone 15 mg BID
Ditropan XL 5 mg daily
Ativan 0.5 mg BID PRN anxiety
Diphenhydramine 25 mg QHS PRN sleep
JY is started on donepezil 5 mg QHS. Which of the following is a possible AE of this med?
a. Bradycardia
b. Hyperkalemia
c. Weight gain
d. Peripheral neuropathy
e. Urine discoloration
a
JY is a 72 y/o female who comes into the clinic on 1/18 for a follow-up on her depression meds. Her husband is with her and states that she’s having trouble finding the right words to say in convo and becomes easily frustrated when she can’t remember simple things, which happening quite often. Her MMSE score today is 21.
Allergies: Penicillin
PMH: Depression, general anxiety disorder, overactive bladder
1/18 Meds:
Fluoxetine 40 mg daily
Buspirone 15 mg BID
Ditropan XL 5 mg daily
Ativan 0.5 mg BID PRN anxiety
Diphenhydramine 25 mg QHS PRN sleep
At a follow-up visit 1 year later, JY’s symptoms have progressed to moderate disease. She’s now taking donepezil 10 mg QHS. Which of the following tx changes is appropriate?
a. Increase the donepezil dose to 20 mg QHS
b. Add Namzaric to her regimen
c. Add Exelon to her regimen
d. D/c donepezil and start Namzaric
e. D/c donepezil and provide no further tx (this is tx failure)
d
-Higher doses of Aricept are available for advanced Alzheimer’s Disease, but the dose is 23 mg.
-Namzaric (donepezil/memantine) can be used in pts who are stable on 10 mg of donepezil.
A pt receives a score of 20 on an MMSE. Which med is likely to be initiated?
a. Levodopa/Carbidopa
b. Trihexylphenidyl
c. Donepezil
d. Entacapone
e. Darifenacin
c
