Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GPhC Exam > CNS: Dementia and Parkinsonism > Flashcards

CNS: Dementia and Parkinsonism Flashcards

1
Q

What is dementia?

A

a progressive, irreversible clinical syndrome with a range of cognitive and behavioural symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some cognitive symptoms of dementia? (2)

A

Memory loss

Issues with reasoning/communication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some behavioural symptoms of dementia? (2)

A

Inability to carry out basic tasks

Change in personality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common type of dementia?

A

Alzheimer’s dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some common types of dementia (5)?

A 
Alzheimer's 
Lewy-body dementia
Vascular dementia
Mixed dementia
Frontotemporal dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which commonly prescribed drug classes should be avoided in patients with dementia? (4)

A

Drugs with antimuscarinic effects, e.g.

Antidepressants, antihistamines, antipsychotics, antispasmodics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drug class is first line for treatment for Alzheimer’s disease?

A

Acetylcholinesterase inhibitors (AChEIs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the three AChEIs used as first line treatment for mild to moderate Alzheimer’s?

A

Donepezil
Galantamine
Rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the STOPP criteria for all AChEIs? (4)

A

Heart block
Unexplained syncope
Persistent bradycardia
Concurrent treatment with drugs that reduce heart rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can be used in patients with moderate Alzheimer’s if AChEIs are not tolerated or contraindicated?

A

Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the first line treatment for patients with severe Alzheimer’s?

A

Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If patients on an AChEI for mild Alzheimer’s deteriorate, what drug can be added?

A

Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Can medicines for dementia be prescribed in primary care/by a non-specialist?

A

Yes - addition of memantine to patient already on AChEIs

No - newly diagnosed patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why shouldn’t AChEIs be discontinued in patients with moderate Alzheimer’s?

A

Doing so can worsen cognitive function substantially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the first line drugs for mild, moderate and severe lewy-body dementia? (2)

A

Donepezil

Rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should galantamine be considered in lewy-body dementia?

A

When treatment with donepezil or rivastigmine is not tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should memantine be considered for use in lewy-body dementia?

A

When AChEIs are contraindicated or not tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should drug treatment be considered for patients with vascular dementia?

A

When they also have another form of dementia (Alzheimer’s, Parkinson’s or lewy-body)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What treatment is available for patients with frontotemporal dementia or cognitive impairment caused by MS?

A

None at the moment - AChEIs and memantine are not recommended in this group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some cholinergic side effects? (8)

Remember: DUMBBELS

A 
Diarrhoea
Urination
Muscle weakness/cramps
Bronchospasm
Bradycardia
Emesis (vomiting)
Lacrimation (teary eyes)
Salivation/sweating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should antipsychotics be offered to patients with dementia? (2)

A

If they are at risk of harming themselves/others

If they are severely distressed due to hallucinations, delusions or agitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What did an MHRA report conclude about elderly dementia patients on antipsychotics? (2)

A

There is an increased risk of stroke and a small increase in risk of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How should antipsychotics in dementia patients be prescribed? (3)

A

Starting with the lowest effective dose
For the shortest time possible
With 6-weekly reviews

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is important to consider in Parkinson’s and lewy-body dementia patients re: antipsychotics?

A

Antipsychotics can worsen motor features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What four psychological treatments can be considered in dementia patients suffering with depression/anxiety?

A

CBT
Multisensory stimulation
Relaxation
Animal-assisted therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What should be offered to dementia patients with sleep disturbances? (3)

A

Sleep hygiene education
Exposure to daylight
Increasing exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the mechanism of action for memantine?

A

It is an NMDA glutamate receptor antagonist - limiting Ca2+ influx into the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What role does glutamate play in Alzheimer’s dementia?

A

Glutamate plays a role in membrane excitability and synaptic transmission

too much glutamate → too much Ca2+ being let into the post-synaptic nerve → cell bursts and dies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are three main points for donepezil?

A

Take at bedtime
There is a rare risk of neuroleptic malignant syndrome (increased risk when taken with antipsychotics)
It is long acting, so usually only given once a day

30
Q

What are two main points for rivastigmine?

A

Monitor body weight

Interrupt treatment if dehydration (due to D+V) occurs

31
Q

How does galantamine differ from rivastigmine and donepezil?

A

It has nicotinic receptor agonist effects, as well as being an AChEI

32
Q

What should patients on galantamine be warned of?

A

Serious skin reactions (e.g. SJS) - patients should stop taking and seek medical advice immediately

33
Q

What is Parkinson’s disease?

A

A progressive, neurodegenerative condition caused by death of dopaminergic cells in the substantia nigra

34
Q

What are some motor symptoms of Parkinson’s? (5)

A 
Hypokinesia (less movement)
Bradykinesia (slow movement)
Rigidity
Tremor at rest
Postural instability
35
Q

What are some non-motor symptoms of Parkinson’s? (6)

A 
Dementia
Sleep disturbances
Changes in speech and language
Swallowing issues
Weight loss
Bladder/bowel dysfunction
36
Q

How often should patients with Parkinson’s be reviewed?

A

Every 6-12 months

37
Q

Who should Parkinson’s patients inform about their diagnosis? (2)

A

The DVLA and their car insurer

38
Q

What non-pharmacological treatment should be offered to patients with Parkinson’s? (3)

A

Physiotherapy
Speech and language therapy
Occupational therapy

39
Q

What is the first line treatment for motor symptoms that affect quality of life in Parkinson’s?

A

Levodopa with carbidopa (co-careldopa) OR with benserazide (co-beneldopa)

40
Q

Why does levodopa need to be given either either carbidopa or benserazide?

A

Carbidopa and benserazide inhibit peripheral metabolism of levodopa, increasing its chances of reaching the brain

41
Q

What are the first line treatment options for motor symptoms that DO NOT affect quality of life in Parkinson’s? (3)

A

Levodopa
Non-ergot derived dopamine receptor antagonists
MOA-B inhibitors

42
Q

How do non-ergot derived dopamine receptor agonists work?

A

They mimic dopamine and directly stimulate dopamine receptors

43
Q

What are three examples of non-ergot derived dopamine receptor antagonists?

A

Ropinirole
Pramipexole
Rotigotine

44
Q

How do MOA-B inhibitors work?

A

They inhibit the breakdown of dopamine in the synaptic cleft

45
Q

What are two examples of MAO-B inhibitors?

A

Selegiline

Rasagiline

46
Q

What ADRs should Parkinson’s patients be warned about before treatment? (3)

A

Excessive sleepiness/sudden onset of sleep
Psychotic symptoms
Impulse control disorders
(more common with non-ergot derived dopamine receptor antagonists)

47
Q

Which Parkinson’s medication is associated with more motor complications?

A

Levodopa - response fluctuations and dyskinesia (on and off periods)

48
Q

Which drug class is more effective in improving overall motor performance?

A

Levodopa > non-ergot derived dopamine receptor antagonists

49
Q

Why should abrupt withdrawal of antiparkinsonian drugs be avoided? (2)

A

Abrupt withdrawal may increase the risk of acute akinesia or neuroleptic malignant syndrome

50
Q

What antiemetic medication can be given to patients with Parkinson’s and why?

A

Domperidone (does not cross BBB ∴ does not cause extrapyramidal side effects)

51
Q

What should happen when a patient with Parkinson’s develops dyskinesia or motor fluctuations? (2)

A

Specialist advice should be sought before changing their therapy
Adjunct therapy is considered

52
Q

What can be given to patients with Parkinson’s who require adjunct therapy with levodopa?

A 
Non-ergot dopamine receptor agonists (e.g. ropinirole)
MOA-B inhibitors (e.g. rasagiline)
COMT inhibitors (-capone)
53
Q

When should ergot-derived dopamine receptors be considered as adjunct therapy?

A

Only when symptoms are not adequately controlled with a NON-ergotic dopamine receptor antagonist

54
Q

Why aren’t ergot-derived dopamine receptor agonists preferred over non-ergot derived?

A

They cause fibrotic reactions (patients should be warned of pulmonary, retroperitoneal and pericardial side effects)

55
Q

What is an example of a ergot-derived dopamine receptor antagonist?

A

Bromocriptine

56
Q

When should amantadine be considered?

A

When dyskinesia is not adequately managed by modifying existing therapy

57
Q

What drug can be offered to patients with advanced Parkinson’s?

A

Apomorphine (with domperidone started 2 days and discontinued ASAP)

58
Q

What advice is given by the MHRA to patients on apomorphine and domperidone?

A

Assess cardiac risk factors and monitor ECG (can cause QT prolongation)

59
Q

What are four important side effects of dopaminergic drugs?

A

Excessive daytime sleepiness
Impulse control disorders
Motor complications
End-of-dose deterioration

60
Q

Which drug class of antiparkinsonian medication is more likely to cause side effects?

A

Dopamine receptor agonists

61
Q

Have you taken a break today?

A

Don’t ignore the question - you won’t remember anything if you don’t take regular breaks 🥺

62
Q

What foods are thought to cause hypertension when taken with MAO-B inhibitors?

A

Tyramine-rich foods (e.g. mature cheese, fermented food)

63
Q

What drugs should be avoided by patients who are taking MAO-B inhibitors?

A

Anything that can cause hypertension

64
Q

What are two examples of COMT inhibitors?

A

Entacapone

Tolcapone

65
Q

How do COMT inhibitors work?

A

By inhibiting COMT they limit the metabolism of dopamine/levodopa

66
Q

What should patients who use tolcapone be made aware of?

A

Signs of liver toxicity e.g. dark urine, pruritus, N&V

it’s hepatotoxic

67
Q

What should patients using entacapone be made aware of?

A

It can make the colour of urine reddish-brown

68
Q

What is co-careldopa gel indicated for?

How is it administered?

A

Advanced Parkinson’s with severe motor fluctuations and hyper- or dyskinesia
Via a portable pump directly to the duodenum or upper jejunum

69
Q

What should happen if a patient develops a problematic impulse control disorder? (2)

A

Dopamine receptor agonist therapy should be reduced and stopped
Patients should be monitored for symptoms of dopamine agonist withdrawal

70
Q

What are some examples of impulsive control disorders? (4)

A

Hypersexuality
Gambling
Excessive spending
Binge eating

GPhC Exam (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions