Cognitive Disorders

Question 1

only cholinesterase inhibitor that crosses BBB?

Answer 1

donepezil

Question 2

donepezil

Answer 2

• for tx of Alzheimer’s; cholinesterase inhibitor
• long 1/2 life = 1/d dosage
• s/e = N/V/D

Question 3

rivastigmine

Answer 3

• tx for Alzheimer’s (mild to moderate)
• s/e = N/V, headaches, anorexia
• must be given w/ food

Question 4

galatamine

Answer 4

• mild to moderate Alzheimer’s

- s/e = N/V/D, weight loss, anorexia

Question 5

memantine

Answer 5

• mild Alzheimer’s and vascular dementia
• removes NMDA toxicity = how it slows degeneration process
• s/e = dizziness, delusion, confusion, hallucination
• used in combo w/ cholinesterase inhibitors for advanced Alzheimer’s

Question 6

vitamin E supplements

Answer 6

• can slow/improve symptoms as prophylaxis
• use for pts at high risk for developing Alzheimer’s
• increased risk of death for pts w/ coronary disease

Question 7

frontotemporal dementia

Answer 7

• focal degeneration of frontal and temporal lobes
• problems w/ 5HT and DA systems; cholinergic system fine
• **abnormal tau or TDP43 protein aggregation

Question 8

what can’t you use cholinesterase inhibitors to tx frontotemporal dementia?

Answer 8

• in FTD the cholinergic system is spare
• so cholinesterase inhibitors will do nothing but cause you problems w/ a system that is functioning normally to being w/

Question 9

what would you use to tx frontotemporal dementia?

Answer 9

• SSRIs = sertraline, paroxetine, fluvoxamine

- anti-psychotics as a last resort at low doses = quetiapine, olanzapine, aripiprazole

Question 10

would bapineuzumab (beta-amyloid antibody) be effective in FTD tx?

Answer 10

• no b/c in FTD there are no beta-amyloid plaques; that’s a characteristic of Alzheimer’s
• in FTD the problem is tau proteins building up

Question 11

Lewy body dementia

Answer 11

• Parkinson’s

- tx w/ cholinesterase inhibitors = rivastigmine, donpenzil, galatamine

Question 12

tx for REM sleep disorders

Answer 12

• clonazepam

- quetiapine

Question 13

vascular dementia

Answer 13

• infarcts = chronic ischemia in periventricular areas
• usually from DM or lipid metabolism disorders
• tx w/ anti-HTN drugs = diuretics, ACE inhibitors, beta-blockers
• manage DM w/ statins; could give anti-platelet drugs or Ca-channel blockers

Question 14

drug-induced amnesia

Answer 14

• caused by date rape drug = rohypnol

- tx w/ midazolam, flunitrazepam

Question 15

methylhenidate

Answer 15

• tx of ADHD
• inhibits reuptake of norepi and DA
• s/e = weight loss, decreased appetite, insomnia, addiction, mania

Question 16

dextroamphetamine and lisdexamfetamine

Answer 16

• both for tx of ADHD (also narcolepsy)
• increase norepi and DA transmission in the brain
• s/e = MI, tachycardia, sudden cardiac arrest, seizures, anaphylaxis

Question 17

atomoxetine

Answer 17

• can be used to tx ADHD
• selective norepi reuptake inhibitor; can increase norepi transmission at synapses in brain
• s/e = prolong QT interval, seizures, priapism, sudden cardiac death, angioedema

Question 18

desipramine

Answer 18

• tx of depression and ADHD in kids
• blocks reuptake of norepi and serotonin in brain
• s/e = fatigue, dizziness, somnolence, sudden cardiac arrest, MI
• neuroleptic malignant syndrome = suicidal thoughts, hepatitis, jaundice

Question 19

clonidine and guanfacine

Answer 19

• tx of ADHD
• centrally-acting alpha-2 receptor agonist
• guanfacine s/e = peeling of skin, xerostoma, bradyarrhythmias
• clonidine s/e = AV block, somnolence

Question 20

bupropion

Answer 20

• tx for ADHD, smoking cessation, bipolar
• inhibits reuptake of norepi and DA
• s/e = agitation, arthralgia, arrhythmias, xerostomia, suicidal thoughts, mania