Alzheimers

Question 1

AD

Answer 1

brain atrophy with ventricular enlargement
degeneration of cholinergic and other neurons
absent or minimal vascular disease
neuronal loss, neurofibrillary tangles, senile plaques, accumulation of beta amyloid

Question 2

s/sx AD

Answer 2

memory loss
confusion
problems recognizing people
difficulty w language
restlessness
agitation
wandering and repetitive statements

Question 3

2 abnormal structures that are abundant in AD

Answer 3

beta amyloid plaques - dense deposits of protein and cellular material that accumulate outside and around nerve cells
neurofibrillary tangles - twisted fibers that build up inside nerve cell

Question 4

screening labs for AD

Answer 4

CBC and sedimentation rate
chem panel
TSH
VDRL test for syphilis
UA
B12
CXR
ECG
CT - head

Question 5

when is head CT or MRI appropriate

Answer 5

hx s/of mass or lesion
focal neurologic s/sx
dementia of abrupt onset
hx seizures or stroke

Question 6

ACh [ ] are inc or dec in AD?

Answer 6

markedly decreased

Question 7

anticholinergic AE pneumonic

Answer 7

blind as a bat (mydriasis)
dry as a bone
hot as a hare
mad as a hatter (depressed, irritable)
red as a beet

Question 8

meds assoc w anticholinergic associated impairment

Answer 8

cimetidine
prednisolone
theophylline
Digoxin
nifedipine
lasix
ranitidine
isosorbide di
warfarin
OXYBUTYNIN

Question 9

most common anticholinergic classes used that inc risk for dementia

Answer 9

TCAs, antihistamines first gen, bladder antimuscarinics

Question 10

AD non pharm

Answer 10

memory book
well lit and quiet atmosphere
exercise programs
psych edu
day care

Question 11

AChE - is
drugs
CI

Answer 11

donepezil
rivastigmine
galantamine
CI in pts w bradycardia or known cardiac conduction disease (incomplete heart block, sick sinus syndrome, syncope, falls, fractures etc.)

Question 12

donepezil
dosing
use
pearl
AE

Answer 12

mod - sev AD!!
5mg po hs or am x 4-6 weeks then 10mg po qd x3mo then 23mg po wd

metabolized by 2D6 and 3A4!
AE: bradyc, rhabdomyolysis, NMS

Question 13

rivastigmine po
use
dosing
AE

Answer 13

mild-sev AD
1.5mg po BID, inc 3mg/d q2wk MDD 6-12 mg DIV BID
AE: GI (MAJOR) leads to a lot of D/C
halflife 2 hr - lots of fluctiatoins :(

Question 14

rivastigmine patch
use
dose
AE

Answer 14

mild - sev
4.6mg/d x1mo -> 9.5mg/d (13.3mg/d)
4.6 mg in mild-mod liver dysfunction

Question 15

rivastigmine po to patch dosing

Answer 15

<6mg po –> 4.6mg patch
6-12mg po –> 9.5mg patch

Question 16

galantamine
use
dosing IR vs ER
pearl

Answer 16

mild-mod AD
IR: 4mg BID x4wk then 8mg then 12mg
ER: 8mg/d x4wk then 16mg then 24mg
CrCl <60 : <12mg!!!
metabolized by 2D6 and 3A4

Question 17

memantine
use
DDI
dose conversion IR to ER
dose adjustments?

Answer 17

used for mod-sev AD
DDI: drugs that alkalinize the urine
IR 10mg qd = ER 28mg qd

CrCl <30 : IR <5 and ER < 14

Question 18

when can patient initiate Namzaric

Answer 18

namzaric (memantine/donepezil)
can initiate then stabilized on donepezil 10mg

Question 19

how does memantine change trijectory of AD

Answer 19

it doesnt, only provides sx management

Question 20

meds for mild-sev AD

Answer 20

donepezil, rivastigmine

Question 21

meds for mild-mod AD

Answer 21

galantamine

Question 22

meds for mod-sev AD

Answer 22

memantine