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Roomies Collab Deck 2: Endocrinology and NeuroPsych > Dementia > Flashcards

Dementia Flashcards

1
Q

Dementia is a progressive clinical syndrome characterised by a range of cognitive and behavioural symptoms that can include ___________ loss, problems with ____________ and __________, a change in ____________, and a reduced ability to _______________

A

memory loss

reasoning and communication

personality

carry out daily activities such as washing or dressing

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2
Q

What are the types of dementia? (5)

A
  1. Alzheimer’s (most common)
  2. Vascular
  3. Lewy Body dementia
  4. Mixed
  5. Frontotemporal
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3
Q

What are the aims of treatment in the management of dementia? (3)

A
  1. Promote independence
  2. Maintain function
  3. Manage symptoms
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4
Q

What are the non-drug treatment options in the management of mild-moderate dementia presenting with COGNITIVE symptoms? (4)

A
  1. Opportunity to participate in group cognitive stimulation program
  2. Group reminiscence therapy (use of life stories to improve psychological well-being)
  3. Cognitive rehabilitation
  4. Occupational therapy
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5
Q

Which drugs should be avoided in patients with dementia? (4)

A

Drugs that are associated with an increased antimuscarinic (anticholinergic) burden and therefore cognitive impairment

  1. Some antidepressants (TCAs)
  2. Antihistamines (chlorphenamine, promethazine)
  3. Antipsychotics (olanzapine, quetiapine)
  4. Urinary antispasmodics (solifenacin succinate, tolterodine)
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6
Q

In patients with mild-moderate Alzheimer’s, monotherapy with which drugs is first line? (3)

A

Acetylcholinesterase inhibitors:

  1. Donepezil
  2. Galantamine
  3. Rivastigmine

**In newly diagnosed patients, drug treatment should only be initiated under the advice of a specialist clinician experienced in the management of Alzheimer’s disease

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7
Q

In patients with moderate Alzheimer’s in whom acetylcholinesterase inhibitors are not tolerated or contraindicated, what drug may be used as an alternative?

A

Memantine

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8
Q

What is the drug of choice for patients with severe Alzheimer’s?

A

Memantine

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9
Q

In patients already receiving an acetylcholinesterase inhibitor to treat Alzheimer’s disease, the addition of _______________ should be considered if they develop moderate or severe disease

A

memantine

In this case, memantine can be initiated in primary care without the advice of a specialist clinician

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10
Q

Can acetylcholinesterase inhibitor treatment be discontinued in patients with moderate Alzheimer’s disease if disease severity improves?

A

Treatment discontinuation should not be based on disease severity alone;

In patients with moderate Alzheimer’s disease, discontinuing acetylcholinesterase inhibitor treatment can cause a substantial worsening in cognitive function

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11
Q

What drugs should be given to patients with mild-moderate Lewy body dementia? (2)

A

(Both unlicensed)

  1. Donepezil
  2. Rivastigmine

*galantamine (unlicensed) can be considered ONLY if treatment with the other two is not tolerated

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12
Q

Which 2 drugs may be considered for the management of severe Lewy Body dementia?

A
  1. Donepezil
  2. Rivastigmine

Both unlicensed

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13
Q

What drug may be considered as an alternative in patients with Lewy Body dementia in whom acetylcholinesterase inhibitors are contra-indicated or not tolerated?

A

Memantine (unlicensed)

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14
Q

Acetylcholinesterase inhibitors [unlicensed indication] or memantine hydrochloride [unlicensed indication] should only be considered in patients with vascular dementia if…?

A

they have suspected co-morbid:

  • Alzheimer’s disease
  • Parkinson’s disease dementia
  • dementia with Lewy bodies
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15
Q

In which two groups of patients are acetylcholinesterase inhibitors and memantine hydrochloride NOT recommended?

A
  1. Frontotemporal dementia

2. Cognitive impairment caused by MS

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16
Q

What is the mechanism of action of memantine?

A

Glutamate receptor antagonist (blocks NMDA receptors)

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17
Q

Patients with dementia should be offered psychosocial and environmental interventions such as ____________ and management of __________ and __________ to reduce distress

A

Counseling

Pain

Delirium

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18
Q

What is the role of antipsychotics in the management of dementia?

A

Antipsychotic drugs should only be offered to patients with dementia if they are either at risk of harming themselves or others, or experiencing agitation, hallucinations or delusions that are causing them severe distress

19
Q

Antipsychotic drugs should only be offered to patients with dementia if they are…? (2)

A
  1. at risk of harming themselves or others

2. experiencing agitation, hallucinations or delusions that are causing them severe distress

20
Q

The CHM/MHRA has reported (2009) an increased risk of ________ and a small increased risk of ________ when antipsychotic drugs are used in elderly patients with dementia.

A

Stroke

death

The balance of risks and benefits should be carefully assessed, including any previous history of stroke or transient ischaemic attack and any risk factors for cerebrovascular disease such as hypertension, diabetes, smoking, and atrial fibrillation

21
Q

In the management of dementia, antipsychotic drugs should be used at the lowest effective dose and for the shortest time possible, with a regular review at least every ___ weeks

A

6

22
Q

Antipsychotics can worsen which two subtypes of dementia?

A
  1. Lewy body dementia
  2. Parkinson’s disease dementia

May cause severe antipsychotic sensitivity reactions in some cases

23
Q

What is the role of antidepressants in the management of dementia?

A

antidepressants should be reserved for pre-existing severe mental health problems

24
Q

What are the preferred interventions for the management of mild-moderate depression and anxiety associated with mild-moderate dementia? (4)

A

Psychological treatments:

  1. CBT
  2. Multi sensory stimulation
  3. Relaxation
  4. Animal-assisted therapies

*antidepressants should be reserved for pre-existing severe mental health problems

25
Q

What is the recommended management of sleep disturbances associated with dementia? (3)

A

Patients should be offered non-drug treatment approaches:

  1. Sleep hygiene education
  2. Exposure to daylight
  3. Increasing exercise and activity
26
Q

List the main acetylcholinesterase inhibitors (6)

A
  1. Rivastigmine
  2. Physostigmine
  3. Pyridostigmine
  4. Neostigmine

Also

  1. Donepezil (reversible)
  2. Galantamine (reversible; also has nicotine receptor agonist properties)
27
Q

Which acetylcholinesterase inhibitors do NOT cross the BBB? (2)

A
  1. Neostigmine

2. Pyridostigmine

28
Q

Donepezil should be prescribed with caution in which patients? (5)

A
  1. Asthma
  2. COPD
  3. Sick sinus syndrome
  4. Supraventricular conduction abnormalities
  5. Susceptibility to peptic ulcers
29
Q

What are the common of very common side effects of Donepezil? (16)

A
  1. Aggression
  2. Agitation
  3. Decreased appetite
  4. Common cold
  5. GI disturbances (diarrhea, N/V)
  6. Dizziness
  7. Fatigue
  8. Hallucinations
  9. Headache
  10. Injury
  11. Muscle cramps
  12. Pain
  13. Skin reactions
  14. Sleep disorders
  15. Syncope
  16. Urinary incontinence
30
Q

What are the uncommon/rare but dangerous side effects of Donepezil? (5)

A
  1. GI hemorrhage
  2. Seizure
  3. Cardiac conduction disorders
  4. NMS and extrapyramidal symptoms
  5. Rhabdomyolysis
31
Q

Memantine monotherapy is recommended as an option for managing Alzheimer’s disease for people with (2)

A
  1. Moderate AD who are intolerant of or have a contraindication to other AChE inhibitors
  2. Severe AD
32
Q

What 3 AChE inhibitors are recommended as monotherapies for the management of mild-moderate AD?

A
  1. Donepezil
  2. Galantamine
  3. Rivastigmine
33
Q

What cautions should be used when prescribing galantamine? (5)

A
  1. Avoid in GI obstruction and whilst recovering from GI surgery
  2. Avoid in urinary outflow obstruction and whilst recovering from bladder surgery
  3. Cardiac disease including CHF, sick sinus syndrome, unstable angina
  4. COPD and severe asthma
  5. History of seizures
34
Q

What are the common or very common side effects of galantamine? (14)

A
  1. Decreased appetite, weight loss
  2. Arrhythmias
  3. Asthenia
  4. Depression
  5. GI discomfort, diarrhea, N/V
  6. Dizziness and drowsiness
  7. Falls
  8. Hallucinations
  9. Headache
  10. HTN
  11. Muscle spasms
  12. Skin reactions
  13. Syncope
  14. Tremor
35
Q

Caution is advised when prescribing Rivastigmine in which patients? (6)

A
  1. Bladder outflow obstruction
  2. Conduction abnormalities or sick sinus syndrome
  3. Duodenal or gastric ulcers
  4. History of asthma or COPD
  5. History of seizures
  6. Risk of fatal overdose with patch administration errors
36
Q

What are the common or very common side effects of Rivastigmine? (17)

A
  1. Psychological: Anxiety, depression, hallucinations, sleep disorders, confusion, nightmares
  2. Decreased appetite and weight loss
  3. Arrhythmias
  4. Asthenia
  5. Dehydration
  6. Dizziness, falls, drowsiness
  7. GI discomfort, N/V
  8. Headache
  9. Hyperhyrdosis and hypersalivation
  10. Skin reactions
  11. Movement disorders and Parkinsonism
  12. HTN or hypotension (with oral use)
  13. Tremor
  14. Syncope
  15. Urinary incontinence
  16. UTIs
  17. Gastric ulcer (with transdermal use)
37
Q

What are the rare but significant side effects of Rivastigmine? (5)

A
  1. AV block
  2. Pancreatitis
  3. Seizure
  4. Hepatitis
  5. GI hemorrhage (with oral use)
38
Q

What preparation of Rivastigmine is less likely to cause side effects?

A

Transdermal

39
Q

What are the monitoring requirements for Rivastigmine?

A

Monitor body weight

40
Q

Memantine should be prescribed with caution in which patients?

A

Patients with epilepsy, history of convulsions, or risk factors for epilepsy

41
Q

What are the common or very common side effects of memantine? (7)

A
  1. Impaired balance
  2. Constipation
  3. Dizziness and drowsiness
  4. Dyspnea
  5. Headache
  6. Hypersensitivity
  7. HTN
42
Q

What are the uncommon but important side effects of memantine? (6)

A
  1. VTE
  2. Seizure
  3. Pancreatitis
  4. Hepatitis
  5. Psychotic disorder
  6. HF
43
Q

Which two drugs should not be co-prescribed with memantine due to increased risk of CNS toxicity? (2)

A
  1. Amantadine

2. Ketamine

Roomies Collab Deck 2: Endocrinology and NeuroPsych (49 decks)

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