CHAPTER 4: CNS: Dementia Flashcards
What is the non-pharmacological treatment for mild to moderate dementia with cognitive symptoms?
Structured group stimulation programmes
Can a GP initiate and supervise dementia pharmacological treatment?
No - specialist initiation and supervision
Which drugs are recommended to manage the cognitive symptoms of mild to moderate dementia due to Alzheimer’s disease?
- Donepezil
- Rivastigmine
- Galantamine
Donepizil, Rivastigmine and Galantamine all belong to which drug class?
Acetylcholinesterase inhibitors
What is the drug of choice to manage the cognitive symptoms severe Alzheimer’s disease?
Memantine
As well as in severe Alzheimer’s disease, when else is memantine suitable?
As an alternative to for patients with moderate Alzheimer’s disease when acetylcholinesterase inhibitors are contra-indicated or not tolerated
What is the drug of choice to manage the cognitive symptoms of vascular dementia?
Pharmacological treatment is not recommended
What is the treatment recommendation for patients with non-cognitive symptoms such as anxiety or delusions?
Non-pharmacological interventions such as multisensory stimulation or aromatherapy should be tried for less severe symptoms
Should patients with mild to moderate non-cognitive symptoms (anxiety, delusion etc) be prescribed antipsychotics?
NO
Should patients with severe non-cognitive symptoms (anxiety, delusion etc) be prescribed antipsychotics?
Yes, after careful consideration
In 2009, what did the MHRA report a clear increased risk of in elderly patients with dementia taking antipsychotic drugs?
Stroke (and death)
Before being prescribed an antipsychotic for severe non-cognitive symptoms of dementia, which risk factors for cerebrovascular disease should be considered? (4)
- History of stroke or TIA
- Diabetes
- Hypertension
- AF
Patients with DLB taking antipsychotics for non-cognitive symptoms should be assessed for severe untoward reactions such as?
Neuroleptic sensitivity reactions
Can acetylcholinesterase inhibitors and memantine also be used to treat non-cognitive symptoms of Alzheimer’s Disease and DLB?
Yes
Can acetylcholinesterase inhibitors be used in vascular dementia?
No, not recommended
As well as for severe non-cognitive symptoms (anxiety, delusions etc), when else can antipsychotics be used in dementia?
To manage behavioural symptoms of violence, aggression and extreme agitation
Benzodiazepines can be used to manage behavioural symptoms of violence, aggression and extreme agitation. Through which routes can the be administered?
- Oral
- Intramuscular
- IV (special circumstances
For the intramuscular administration of benzodiazepines to manage behavioural symptoms of violence, aggression and extreme agitation, which are the ones recommended? (3)
- Lorazepam
- Haloperidol
- Olanzapine
Are diazepam and chlorpromazine recommended for behavioural symptoms of violence, aggression and extreme agitation?
NO
Acetylcholinesterase inhibitors can cause unwanted dose-related cholinergic effects, give some symptoms of this (5)
- Excessive sweating
- Involuntary defaecation and urination
- Increased production of saliva
- Bradycardia
- Hypotension
Which serious skin reaction has galantamine been associated with?
Steven-Johnson Syndrome
What should patients be counselled to do if they experience any skin reactions while taking galantamine?
Stop taking and seek medical advice
What is a side effect of rivastigmine less associated with transdermal administration?
GI effects
What should happen if a patient taking rivastigmine experiences GI effects?
Drug should be witheld then re-titrated (if necessary) on resolution
