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neurology/psychiatry > alzheimer's disease > Flashcards

alzheimer's disease Flashcards

1
Q

compare and contrast multi-infarct (vascular) versus alzheimer’s type demetia

A

multi infarct: abrupt onset, step-wise deterioration, PMHx includes HTN/ASCVD, focal neural exam (specific part of brain)

Alzheimer’s: gradual onset, slow/progressive deterioration, non-cardiac disease, non-focal neural exam

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2
Q

what are reversible causes of cognitive impairment

A

drugs
depression
metabolic (changes in glucose, hyponatremia, hypercalcemia)

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3
Q

what drug classes are associated with cognitive impairment in the elderly

A

anticholinergics
anticonvulsants
antihistamines
antiparkinson
analgesics
cardiovascular
gastrointestinal
psychotropics

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4
Q

which anticholinergics have the highest risk

A

amitriptyline
atropine
benztropine
carisoprodol
dicyclomine
diphenhydramine
hydroxyzine
meclizine
oxybutynin

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5
Q

difference between dementia and delirium

A

dementia: decline in cognitive function over time, memory loss

delirium: short period of time (hours to days), acute change in level of consciousness, decline in cognition

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6
Q

risk factors for alzheimer disease

A

old age >65
female (2x more than male)
positive family history (apolipoprotein E4 allele)

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7
Q

in alzheimer disease, ________ neutrons are destroyed

A

acetylcholine-synthesizing

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8
Q

4 major alterations in AD

A

extracellular B-amyloid plaques (inflamm)
intracellular neurofibrillary tangles (tau protein)
degeneration of cholinergic neurons
cortical atrophy

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9
Q

what is the difference between activities of daily living (ADLs) and independent activities of daily living (IADLs)

A

ADLs: bathing, dressing, toileting, feeding, transferring, walking
IADLs: shopping, financial management, cooking, housework, telephone, driving

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10
Q

t/f the goal of pharmacologic treatment is to cure

A

false; goal is to improve QOL both of the patient and the family, improve mood/behavior

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11
Q

what are the two drug classes used for treatment of cognitive symptoms in AD

A

cholinesterase inhibitors
NMDA antagonist

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12
Q

which drugs are the cholinesterase inhibitors

A

tacrine (no longer)
donepezil
rivastigmine
galantamine

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13
Q

why is tacrine no longer marketed

A

hepatotoxicity

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14
Q

mechanism of cholinesterase inhibitors

A

inhibits acetylcholinesterase, preventing the hydrolysis of acetylcholine so thus increasing acetylcholine in the synaptic cleft

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15
Q

what are the drug interactions with cholinesterase inhibitors

A

anticholinergics
beta blockers
st john’s wort

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16
Q

side effects with donepezil

A

insomnia (dosing time)
nausea/diarrhea (dose related)

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17
Q

why is donepezil most commonly used/preferred

A

once daily dosing
less side effects

18
Q

dosing of donepezil

A

starts at 5 mg once daily given at bedtime without regard to meals
can increase to 10 mg after 4-6 weeks

19
Q

rivastigmine side effects

A

CNS: dizziness, headache
GI: n/v, diarrhea, anorexia, abdominal pain
patch can cause extrapyramidal symptoms like tremor

20
Q

dosing considerations with rivastigmine

A

more complex titration than donepezil
BID dosing (disadvantage)
PO administered with meals
Transdermal patch replaced q24 hours

21
Q

galantamine side effects

A

nausea vomiting diarrhea

22
Q

dosing considerations for galantamine

A

complex titration
dose adjust in renal/hepatic impairment
take with food

23
Q

which drug is a NMDA antagonist

A

memantine

24
Q

mechanism of memantine

A

blocks the effects of too much glutamate by binding to where Magnesium binds on the NMDA receptor

25
Q

side effects of memantine

A

dizziness, headache, somnolence, constipation, diarrhea, vomiting

26
Q

drug interactions with memantine

A

trimethoprim
increases concentrations of memantine, increasing risk of myoclonus, delirium

27
Q

when is mementine used for AD

A

moderate to severe
or add on therapy with donepezil

28
Q

dosing considerations for memantine

A

without regard to meals
complicated titration; adjusted in severe renal impairment

29
Q

what is the combination product available for moderate to severe AD

A

memantine + donepezil (namzaric)

30
Q

considerations for the combination memantine + donepezil product

A

drug interactions with anticholinergics, beta blockers, trimethoprim
give in evening without regard to meals
should be stabilized on donepezil 10 mg/day prior to starting

31
Q

what happens upon discontinuation of cholinesterase inhibitors

A

abrupt decline of cognition

32
Q

what are the disease modifying therapies for AD

A

anti-amyloid antibodies
aducanumab (removed from the market)
lecanemab

33
Q

what are side effects with the anti-amyloid antibodies

A

ARIA: amyloid related imaging abnormalities- potentially serious ADE that includes edema of the brain tissue and bleeding of the brain

34
Q

why might the anti-amyloid antibodies be a controversial treatment

A

patients are not a candidate for anticoagulation or antithrombotics when on therapy: because ARIA can cause hemorrhage in the brain. if patient has a stroke on it, can’t get thrombolytics. if they get Afib, can’t go on anticoagulation.

35
Q

considerations for lecanemab

A

prior to treatment, must confirm presence of amyloid beta pathology
medicare will cover for those in NIH studies

36
Q

when might pharmacotherapy be indicated for behavioral problems

A

hallucinations, delusions, agitation, aggression

37
Q

which drug classes might be used for behavioral symptoms

A

atypical antipsychotics
antidepressants (SSRIs)

38
Q

which atypical antipsychotics might be preferred

A

olanzapine, ziprasidone
mat be the least anticholinergic

39
Q

considerations when using atypical antipsychotics for behavioral symptoms in AD

A

SHORT TERM use
FDA warning for increased mortality in elderly patients with dementia
may prolong QT interval, metabolic effects

40
Q

which SSRIs may be used

A

citalopram, sertraline

recommended over TDAs (safety), venlafaxine, mirtazapine, bupropion not well studied

41
Q

should antiepileptics like carbamazepine or valproate be used for mood stabilizing properties?

A

steer clear; no real evidence

42
Q

should benzos be used?

A

NO!!! do not recommend. limited value. causes worsening gait, potential paradoxical reaction, physical dependence. reserve for acute very stressful episodes

neurology/psychiatry (22 decks)

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