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Pharmacy Pre-Reg 2020/2021 > Chapter 4 - Dementia > Flashcards

Chapter 4 - Dementia Flashcards

1
Q

What is dementia?

A

A progressive clinical syndrome characterised by a range of cognitive and behavioural changes

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2
Q

What are the main types of dementia?

A

Alzheimer’s Disease
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia

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3
Q

What is early onset dementia?

A

Dementia that occurs before 65 years

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4
Q

What usually causes vascular dementia?

A

Cardiovascular disease, which causes a reduced blood supply to the brain

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5
Q

What condition is Dementia with Lewy Bodies often associated with?

A

Parkinson’s Disease

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6
Q

How is dementia usually diagnosed?

A

Based on symptoms and a clinical assessment tool

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7
Q

What are the symptoms of dementia?

A

Cognitive symptoms
Memory problems
Disorientation
Difficulty carrying out daily tasks

Behavioural problems
Aggression 
Agitation
Depression/anxiety 
Sleep disorders 
Psychosis
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8
Q

Which dementia has a stepwise pattern with regards to the severity of symptoms?

A

Vascular dementia

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9
Q

What additional symptoms may be seen with Dementia with Lewy Bodies that aren’t seen in other types of dementia?

A

Parkinsonian motor features

E.g. Bradycardia, shuffling gait, rigidity

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10
Q

What medications can cause cognitive decline?

A 
Anticholinergics e.g. TCAs
Anticonvulsants e.g. phenytoin, phenobarbital 
Antipsychotics e.g. haloperidol 
Analgesics e.g. NSAIDs, opioids
Benzodiazepines 
Corticosteroids
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11
Q

What is an example of an assessment tool for dementia?

A

MMSE

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12
Q

What are the 5 principles of the mental capacity act 2005

A 
Assume capacity 
Maximise decision making capacity 
Freedom to make seemingly unwise decisions
Best interests of the patient 
Least invasive option
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13
Q

What is a power of lasting attorney?

A

A document where a person can nominate someone else to make certain decisions on their behalf when they are unable to do so themselves

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14
Q

What is advanced decision making?

A

Allows for people who understand the implications of their decisions to state their treatment wishes in advance

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15
Q

Where should treatments for the cognitive symptoms of dementia be initiated?

When can they be issued in primary care?

A

Secondary care by a specialist

They can then be continued in primary care under a shared care agreement

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16
Q

What is anticholinergic burden and what are the effects of this?

A

The cumulative effect of taking one or more medications with a high anticholinergic activity

Effects include increased risk of falls, delerium, cognitive decline and possibly dementia

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17
Q

What are some examples of drugs that significantly increase the anticholinergic burden?

A

Amitriptyline
Antihistamines e.g. chlorphenamine
Antipsychotics e.g. olanzapine, quetiapine
Urinary antispasmodics e.g. solifenacin, tolteridone, oxybutynin
Hyoscine

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18
Q

What drugs are used for the cognitive symptoms associated with dementia, and for which type of dementia are they licensed in?

A

Donepezil
Rivastigmine
Galantamine
Memantine

Licensed in Alzheimer’s, but also used in some other types of dementia, e.g. dementia with Lewy Bodies

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19
Q

What are some side effects associated with donepezil, rivastigmine, galantamine and memantine?

A

Nausea, dizziness, headache, muscle stiffness, tremor, bradycardia, hypotension (may increase the risk of falls)

20
Q

What is the relationship between acetylcholine and dementia?

A

Ach is the chemical transmitter for the brain cells that run the memory system

In dementia, the production of Ach in the neurones is reduced

21
Q

What drugs are used in mild Alzheimer’s Disease?

A

AchE Inhibitors

22
Q

What drugs are used in moderate Alzheimer’s Disease?

A

First line - AchE Inhibitors

If these are not effective, add on memantine

If these are contraindicated use memantine alone

23
Q

What drugs are used in severe Alzheimer’s Disease?

A

First line - memantine

24
Q

What can happen if you discontinue AchE Inhibitors?

A

Worsening cognitive function

25
Q

What drugs are used in dementia with Lewy bodies?

A

First line - donepezil, rivastigmine

If these aren’t tolerated:
Mild to moderate disease - galantamine
Severe disease - memantine

26
Q

When should AchE Inhibitors be given in vascular dementia?

A

Only if there is coexisting Alzheimer’s, Parkinson’s of dementia with Lewy bodies

27
Q

What drugs are usually used in vascular dementia?

A

Aspirin or clopidogrel

28
Q

Do we use AchE inhibitors or memantine in frontotemporal dementia?

A

No

29
Q

When should antipsychotics be used in dementia?

A

If the patient is at risk at harming themselves or others, or if they are distressed, agitated, experiencing delusions or hallucinations

30
Q

What is the MRHA warning associated with the use of antipsychotics in dementia?

A

Increases risk of stroke and small increased risk of death

31
Q

Which type of dementia can be worsened by antipsychotics?

A

Dementia with Lewy Bodies (and Parkinson’s disease)

32
Q

What antipsychotics are used in dementia?

A

Haloperidol

Lorazepam

33
Q

What are the options for depression in dementia?

A

Preferably non-drug options e.g. CBT

Antidepressants can be used if there’s coexisting mental health problems

34
Q

What options are there for the sleep disturbances associated with dementia?

A

Sleep hygiene

35
Q

What is the mechanism of donepezil?

A

Reversible AchE Inhibitor

36
Q

What is the dose of donepezil?

A

Initially 5mg daily for 1 mont

Then increased if necessary to 10mg daily

37
Q

At what time should donepezil be given and why?

A

At night

Because it can cause dizziness
It can be taken in the morning if necessary, e.g. if it causes nightmares

38
Q

What are the cautions of AchE Inhibitors?

A

Asthma, COPD
Seizures
Risk of peptic ulcers

39
Q

What is a potentially life threatening side effect of donepezil?

A

Neuroleptic Malignant Syndrome (NMS)

Symptoms include muscle rigidity, hyperthermia, alternating consciousness

40
Q

How are rivastigmine patches used?

A

Apply to clean, dry, non-hairy skin
Leave on for 24 hours
Remove the patch
Apply the next one in a different location

41
Q

When using rivastigmine patches, should you:

a) apply the new patch before removing the old one
b) remove the old patch before applying the new one?

A

b) remove the old patch before applying the new one

42
Q

When using rivastigmine patches, how long should you avoid using the same patch of skin for?

A

14 days

43
Q

When should rivastigmine be stopped, and how should it be restarted?

A

If GI effects occur

If stopped for more than 3 days, the dose will need to be re-titrated

44
Q

What is the mechanism of rivastigmine and galantamine?

A

AchE Inhibit

Some nicotinic receptor agonist properties

45
Q

When should galantamine be discontinued?

A

When a rash occurs

Could be:
Steven Johnson’s Syndrome
Erythema multiforme
Acute generalised exanthematous pustulosis

46
Q

What is the dose of memantine?

A

5mg OD
Increased of steps of 5mg every week
Usual maintenance 20mg

47
Q

What are the cautions of memantine?

A

Epilepsy, history of convulsions

Pharmacy Pre-Reg 2020/2021 (18 decks)

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