Alzheimer's Disease Flashcards by jennifer hunter

What’s the most common type of dementia?

Alzheimer’s dx

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

Mini-Mental State Exam (MMSE)

Score < 24 indicates dementia or some type of memory disorder

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

From an autopsy

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List the sx of AD?

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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Describe the pathophysiology of AD?

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

Alteration of neurotransmitters eg. Decreased Acetylcholine

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List the drugs that can worsen dementia?

Peripheral anticholinergics (includi incontinence & IBS drugs)

Central anticholinergics (benztropine)

Antihistamines & antiemetics

Antipsychotics

Barbiturates

Benzodiazepines

Skeletal muscle relaxants

Other CNS depressants

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What’s the mainstay of AD tx?

Acetylcholinesterase inh eg. donepezil

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

Alone OR with Memantine (for more advance dx)

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

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

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

Both improvement and SE

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

Timing may be modified to QHS

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What can be used to treat associated depression of AD?

Sertraline (Zoloft)

Citalopram (Celexa)

Escitalopram (Lexapro)

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

Antipsychotics

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

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List the natural pdts used for dementia

Vit E

Ginkgo biloba

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

Can INCREASE bleeding risk

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What class of drugs should be avoided in AD pts?

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

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MOA of Acetylcholinesterase inh

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

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List drugs that are Acetylcholinesterase inh.

Donepezil (Aricept)

Rivastigmine (Exelon, Exelon patch)

Galantamine (Razadyne, Razadyne ER)

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What’s the brand name for donepezil?

Aricept

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

Mild-mod dx

Advanced dx

Mild-mod dx = 5-10mg QHS

Advanced dx = 23mg QHS

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

Memantine

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What’s the brand name for Rivastigmine?

Exelon, Exelon patch

What’s the dose for Exelon? Exelon patch?

Exelon = 1.5-6mg BID

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

Liquid = 2mg/ml

What’s the brand name for Galantamine?

Razadyne, Razadyne ER

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

Galantamine (Razadyne) = 4-12mg bid Liq = 4mg/ml solution ER = start at 8mg daily, then increase to 16-24mg

When is Acetylcholinesterase inh usually used?

Mild-moderate dx In combo (with Memantine) for mod-severe AD

What are the SE of Acetylcholinesterase inh?

GI side effects - N/V/ loose stools Bradycardia Fainting Insomnia

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

Given at QHS

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

Rivastigmine (Exelon) & Galantamine (Razadyne) are BID

Which Acetylcholinesterase inh should be taken with food?

Rivastigmine (Exelon)

What can be recommended to decrease GI side effects?

Exelon patch Aricept ODT

MOA of Memantine?

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

What's the brand name of Memantine?

Namenda Namenda XR

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

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

What formulation of Memantine should be used with food?

Nemanda XR should be used with food or drink

List meds used for AD that should be taken with food

Rivastigmine (Exelon) Memantine (namenda XR)

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

True

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

5-10mg bid (titrate weekly)

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

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

How can namenda be switched to namenda XR?

Can switch from10mg bid to 28mg daily. Begin XR the next day (not same day)

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

Dizziness Constipation Headache

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

Beta blockers Diltiazem, verapamil Digoxin

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

Antipsychotics Antihypertensives Alpha blockers Skeletal muscle relaxant Hypnotics Opioids

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

Risk of fall

How is Donepezil (Aricept) titrated?

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

How soon should acetylcholinesterase inh be titrated?

After about 4 weeks

Why is Donepezil (Aricept) started at night?

To combat ass. nausea

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

Upper/lower back Upper arm Chest

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

Do not use the same site within 14 days

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

Skin that is hairy, oily, irritated, broken, scarred or calloused Any area where cream, lotion, or power has been recently applied Under tight clothes

When should the applied patch be removed?

After 24 hrs

How should the Exelon (rivastigmine) patch be removed?

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

How should oral liquid Memantine (namenda) be used?

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

What is dementia?

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