Alzheimer's Disease Flashcards
what are the clinical uses of anti cholinesterase drugs
1) reverse non-depolarising neuromuscular-blocking durgs at the end of operations (neostigmine used with atropine to limit parasymp-mimetic)
2) treat MG (neostigmine or pyridostigmine)
3) test for MG - distinguishes between cholinergic crisis and myasthenic crisis (edrophonium)
4) alzheimers disease (donepezil, galantamine, rivastigmine)
5) Glaucoma (ecothiophate eye drops)
what are the autonomic effects of anti cholinesterase drugs
bradycardia hypotension excessive secretions bronchoconstriction gastrointestinal hypermotility decr in intraocular pressure
where does physostigmine (which is used to treat MG) occur naturally
in the Calabar bean
what is memantine
a weak NMDA receptor antagonist aiming to reduce excitotoxicity
briefly describe the process of excitotoxicity
activation of NMDA rise in intracellular Ca activation of proteases formation of free radicals formation of nitric oxide (high levels bad) overwhelms mitochondrial function
in which conditions would you be cautious with the use of anti-cholinergics
cardiac arrhythmias epilepsy asthma history of bleeding (PUD) prostatism
what are the potential side effects of memantine
dizziness headache constipation somnolence hypertension
what is the ICD 10 diagnostic criteria for dementia
acquired impairment in memory for at least 6 months plus impairments in one of:
- executive funcitoning
- language
-praxis
- gnosis
these impairments must be severe enough to interfere with work, social activities or relationships
what must a person be able to do in order to have capacity
understand
retain
use
communicate
what are the different types of capacity
admission treatment finances testamentary place of residence may retain capacity for one and lose capacity for another
what is lasting power of attorney
a nominated individual when the person STILL HAS capacity
becomes legal once capacity is LOST and LPA is registered with the court of protection
makes decisions for health and welfare, and finances and property
what must a person have to have financial capacity
knowledge of income and expenses
ability to handle everyday financial transactions
ability to delegate financial wishes
what are the matters surrounding driving and dementia
it is OUR responsibility to ADVISE the patient to tell the DVLA and INSURANCE upon diagnosis
may also advise against driving
which is the only anti-psychotic licensed for the treatment of dementia related behavioural disturbances
risperidone
which receptor is stimulated by LSD
5HT2A
risperidone is designed to antagonise this receptor in order to reduce hallucinations
