Alzheimers Flashcards
AD
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
s/sx AD
memory loss
confusion
problems recognizing people
difficulty w language
restlessness
agitation
wandering and repetitive statements
2 abnormal structures that are abundant in AD
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
screening labs for AD
CBC and sedimentation rate
chem panel
TSH
VDRL test for syphilis
UA
B12
CXR
ECG
CT - head
when is head CT or MRI appropriate
hx s/of mass or lesion
focal neurologic s/sx
dementia of abrupt onset
hx seizures or stroke
ACh [ ] are inc or dec in AD?
markedly decreased
anticholinergic AE pneumonic
blind as a bat (mydriasis)
dry as a bone
hot as a hare
mad as a hatter (depressed, irritable)
red as a beet
meds assoc w anticholinergic associated impairment
cimetidine
prednisolone
theophylline
Digoxin
nifedipine
lasix
ranitidine
isosorbide di
warfarin
OXYBUTYNIN
most common anticholinergic classes used that inc risk for dementia
TCAs, antihistamines first gen, bladder antimuscarinics
AD non pharm
memory book
well lit and quiet atmosphere
exercise programs
psych edu
day care
AChE - is
drugs
CI
donepezil
rivastigmine
galantamine
CI in pts w bradycardia or known cardiac conduction disease (incomplete heart block, sick sinus syndrome, syncope, falls, fractures etc.)
donepezil
dosing
use
pearl
AE
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
rivastigmine po
use
dosing
AE
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 :(
rivastigmine patch
use
dose
AE
mild - sev
4.6mg/d x1mo -> 9.5mg/d (13.3mg/d)
4.6 mg in mild-mod liver dysfunction
rivastigmine po to patch dosing
<6mg po –> 4.6mg patch
6-12mg po –> 9.5mg patch
galantamine
use
dosing IR vs ER
pearl
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
memantine
use
DDI
dose conversion IR to ER
dose adjustments?
used for mod-sev AD
DDI: drugs that alkalinize the urine
IR 10mg qd = ER 28mg qd
CrCl <30 : IR <5 and ER < 14
when can patient initiate Namzaric
namzaric (memantine/donepezil)
can initiate then stabilized on donepezil 10mg
how does memantine change trijectory of AD
it doesnt, only provides sx management
meds for mild-sev AD
donepezil, rivastigmine
meds for mild-mod AD
galantamine
meds for mod-sev AD
memantine
