Alzheimers Flashcards
What is the pathophysiology of Alzheimer’s disease?
It is the formation of beta amyloid and neurotic plaques in the hippocampus and cerebral cortex
How do patients with Alzheimer’s brain present on scans?
They show signs of atrophy is a high uptake of the cortical regions
What are the risk factors to developing Alzheimer’s disease?
Diabetes, depression, stress, less cognitive activity, head, trauma, orthostatic hypotension, hypertension, in midline, reduced education, poor BMI management, and hypohomocyteanemia
What are the two approved drug classes to treat dementia
Acetylcholine esterase inhibitors and NMDA receptor agonists
What are the acetylcholine esterase inhibitors used in Alzheimer’s?
Donepezil rivastigmine, and galantamine
How do the ACHEIs work in Alzheimer’s disease?
They increase the amount of postsynaptic acetylcholine which enhances its transmission
How does galantamine work in Alzheimer’s disease?
Modulates the nicotinic acetylcholine receptors
How does Rivastigmine work to treat Alzheimer’s?
It inhibits butylcholinesterase
When are acetylcholine estetrace inhibitors indicated?
For mild to moderate dementia
Off label use is moderate to severe dementia vascular dementia, or mixed dementia’s
What are the adverse effects of acetylcholineesterase inhibitors?
G.I. upset, headache, abnormal dreams, dizziness, seizures, bradycardia, syncope, second-degree AV block, Rhinitis and extrapyramidal symptoms
What three drug classes do ACHEI interact with
First generation antihistamines, tricyclic, antidepressants, and typical antipsychotics
What is the NMDa antagonist used in Alzheimer’s
Memantine
What is the benefit of using NMDA receptor antagonist
They modulate the effects of glutamate and showed none of the undesirable effects associated with the other drugs in that category
When are the MND a receptor antagonist indicated
Only in severe dementia
What are the two types of unilateral migraines?
With aura or without aura
Aura is more common than women typically in adolescence and peak prevalence age is 40 years old
What are the acute/abortive medication’s used to treat migraines
NSAIDs Triptons lamiditan ergot alkaloids, opioids and barbiturates
What are the medications used for prophylactic and prevention of migraines?
Antidepressants, beta blockers anticonvulsant and CGRP antagonists
What are the antidepressants used for migraines?
Amitriptyline and venlafaxine
What are the beta blockers used for migraines?
Metoprolol and propanolol
What are the anti-convulsants used for migraines?
Valproate and topiramate
What are the CGRP antagonist used to treat migraines
Ends in mab or ant
What two anti-emetics can be used as monotherapy for acute migraines
Metoclopramide and prochlorperazine
What two meds are really effective for acute migraines by IV
Ketoroalac
What are the small molecule calcitonin gene related peptide receptor antagonist used to treat migraines
Atogepant and rimegepant
Which two Tripton drugs are available as a nasal spray for migraines
Sumatriptan and zolmitriptin
How did Tripton’s work to Aleve migraines?
They caused vasoconstriction and inhibit the release of vasodilator mediators, which is believed to trigger migraines, and therefore relieves the pressure to abort a migraine
What types of headaches is sumatriptan indicated in
They are an acute/abortive method for migraine and cluster headaches
What are the adverse effects of sumatriptan?
Injection site reaction, paresthesia, dizziness, drowsiness, sedation, hypertension, chest neck, and jaw, pain, hot, or cold sensation, and flushing
Which medication is a five – HT1D agonist
Sumatriptan
What is the fungus called that primarily grows on rye plants and produces alkaloids that cause egotism in humans that consume them
Claviceps purpurea
What is the prototype that is administered as a nasal spray for ergot alkaloids
Dihydroergotamine
What are the adverse effects of DHE?
Teratogenic, nausea, vomiting, diarrhea, hallucinations, andprolonged vasoconstrictions
What is the antidote for DHE when patients experience prolonged vasoconstriction?
Nitroprusside
What migraine medication should you avoid using antihypertensives with?
Ergotamine
Which medication cannot be taken for 24 hours before or after ergotgamine because if it’s vasoconstrictive effects
Triptan
What class are Triptans
Serotonin five – HT1B
What is the downside for CGRP antagonist?
They cost about $6900 a year and are not covered by most insurances
True or false serum CGRP levels are elevated during migraine episodes
True
