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NAPLEX > Alzheimer's Disease > Flashcards

Alzheimer's Disease Flashcards

0
Q

What’s the most common type of dementia?

A

Alzheimer’s dx

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1
Q

What is dementia?

A

A Grp of sx affecting intellectual and social abilities severely enough to interfere with daily functioning.

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2
Q

Which one of the tools used is NOT a diagnostic tool for AD? Whats it used for?

A

Mini-Mental State Exam (MMSE)

Score < 24 indicates dementia or some type of memory disorder

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3
Q

When is a definitive diagnosis of the actual cause and type of made?

A

From an autopsy

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4
Q

List the sx of AD?

A

Memory loss

Difficulty communicating

Inability to leant or remember new info

Difficulty with planning and organizing

Poor coordination and motor functions

Personality changes

Inappropriate behavior

Paranoia, agitation, hallucination

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5
Q

Describe the pathophysiology of AD?

A

Neuritic plaques and tangles in brain tissue -> neuron signaling is interrupted

Alteration of neurotransmitters eg. Decreased Acetylcholine

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6
Q

List the drugs that can worsen dementia?

A

Peripheral anticholinergics (includi incontinence & IBS drugs)

Central anticholinergics (benztropine)

Antihistamines & antiemetics

Antipsychotics

Barbiturates

Benzodiazepines

Skeletal muscle relaxants

Other CNS depressants

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7
Q

What’s the mainstay of AD tx?

A

Acetylcholinesterase inh eg. donepezil

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8
Q

How is Acetylcholinesterase inh eg. donepezil used in AD tx?

A

Alone OR with Memantine (for more advance dx)

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9
Q

What’s the key pearl of use of Acetylcholinesterase inh eg. donepezil?

A

Although pts may not improve clinically, they may have a slower clinical progression vs. if they were not on therapy

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10
Q

What should be monitored for when Acetylcholinesterase inh eg. donepezil is used?

A

Both improvement and SE

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11
Q

How does one combat the nausea associated with Acetylcholinesterase inh eg. donepezil?

A

Timing may be modified to QHS

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12
Q

What can be used to treat associated depression of AD?

A

Sertraline (Zoloft)

Citalopram (Celexa)

Escitalopram (Lexapro)

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13
Q

What can be used to treat delusion/anger ass. with AD?

A

Antipsychotics

But they increase the risk of death in elderly pts (increased stroke) and provides little benefits

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14
Q

List the natural pdts used for dementia

A

Vit E

Ginkgo biloba

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15
Q

What’s the concern with the use of ginkgo biloba for AD?

A

Can INCREASE bleeding risk

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16
Q

What class of drugs should be avoided in AD pts?

A

Drugs with anticholinergic properties ( or the lowest, useful dose be used)

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17
Q

MOA of Acetylcholinesterase inh

A

Inhibits CENTRALLY-active acetylcholinesterase, the enzyme responsible for hydrolysis (breakdown) of ach -> increase ACh.

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18
Q

List drugs that are Acetylcholinesterase inh.

A

Donepezil (Aricept)

Rivastigmine (Exelon, Exelon patch)

Galantamine (Razadyne, Razadyne ER)

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19
Q

What’s the brand name for donepezil?

A

Aricept

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20
Q

What’s the dose for Donepezil (Aricept) for:

Mild-mod dx

Advanced dx

A

Mild-mod dx = 5-10mg QHS

Advanced dx = 23mg QHS

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21
Q

What med is often used in combo with donepezil (Aricept)?

A

Memantine

22
Q

What’s the brand name for Rivastigmine?

A

Exelon, Exelon patch

23
Q

What’s the dose for Exelon? Exelon patch?

A

Exelon = 1.5-6mg BID

Patch = 4.6, 9.5, 13.3mg/ 24hr patch

Liquid = 2mg/ml

24
Q

What’s the brand name for Galantamine?

A

Razadyne, Razadyne ER

25
Q

What’s the dose of Galantamine (Razadyne) (tab and liq)? Razadyne ER?

A

Galantamine (Razadyne) = 4-12mg bid

Liq = 4mg/ml solution

ER = start at 8mg daily, then increase to 16-24mg

26
Q

When is Acetylcholinesterase inh usually used?

A

Mild-moderate dx

In combo (with Memantine) for mod-severe AD

27
Q

What are the SE of Acetylcholinesterase inh?

A

GI side effects - N/V/ loose stools

Bradycardia

Fainting

Insomnia

28
Q

How can Donepezil (Aricept) be given to combat nause?

A

Given at QHS

29
Q

Donepezil (Aricept) is usually give ONCE daily…how are the other Acetylcholinesterase inh given?

A

Rivastigmine (Exelon) & Galantamine (Razadyne) are BID

30
Q

Which Acetylcholinesterase inh should be taken with food?

A

Rivastigmine (Exelon)

31
Q

What can be recommended to decrease GI side effects?

A

Exelon patch

Aricept ODT

32
Q

MOA of Memantine?

A

Blocks NMDA (N-methyl-D-aspartate) which INH GLUTAMATE from binding to NMDA receptors -> reduce abnormal activation

33
Q

What’s the brand name of Memantine?

A

Namenda

Namenda XR

34
Q

What type of AD is Memantine (namenda, namenda XR) used for?

A

Mod-severe AD (alone or in combo with Donepezil (Aricept))

35
Q

What formulation of Memantine should be used with food?

A

Nemanda XR should be used with food or drink

36
Q

List meds used for AD that should be taken with food

A

Rivastigmine (Exelon)

Memantine (namenda XR)

37
Q

T/F? Memantine XR (namenda XR) caps can be opened and sprinkled on applesauce for use?

A

True

38
Q

What’s the usual dose of Memantin (Namenda)? How often should it be titrated?

A

5-10mg bid (titrate weekly)

39
Q

What’s the usual dose of Memantin XR (Namenda XR)? How often should it be titrated?

A

28mg daily (start at 7mg daily and titrate weekly)

40
Q

How can namenda be switched to namenda XR?

A

Can switch from10mg bid to 28mg daily.

Begin XR the next day (not same day)

41
Q

What are the SE of Memantine (namenda; XR)?

A

Dizziness

Constipation

Headache

42
Q

Use caution with drugs that lower heart rate. What drugs fall under the category?

A

Beta blockers

Diltiazem, verapamil

Digoxin

43
Q

Use caution with drugs that cause dizziness. What drugs fall under the category?

A

Antipsychotics

Antihypertensives

Alpha blockers

Skeletal muscle relaxant

Hypnotics

Opioids

44
Q

What’s the concern with concurrent use with drugs that lower HR and cause dizziness?

A

Risk of fall

45
Q

How is Donepezil (Aricept) titrated?

A

Starts at 5mg QHS -> increase to 10mg after about 4weeks

46
Q

How soon should acetylcholinesterase inh be titrated?

A

After about 4 weeks

47
Q

Why is Donepezil (Aricept) started at night?

A

To combat ass. nausea

48
Q

For Exelon (rivastigmine) patch, where should it be applied?

A

Upper/lower back

Upper arm

Chest

49
Q

For Exelon (rivastigmine) patch, how often should the patch site be rotated?

A

Do not use the same site within 14 days

50
Q

For Exelon (rivastigmine) patch, what sites should be avoided?

A

Skin that is hairy, oily, irritated, broken, scarred or calloused

Any area where cream, lotion, or power has been recently applied

Under tight clothes

51
Q

When should the applied patch be removed?

A

After 24 hrs

52
Q

How should the Exelon (rivastigmine) patch be removed?

A

Don’t touch sticky side. Fold patch in half with sticky sides together

53
Q

How should oral liquid Memantine (namenda) be used?

A

Use oral syringe to draw out solution

DO NOT mix with water or other liquids (swallow directly from syringe)

Rinse syringe with water after each use

NAPLEX (73 decks)

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