Dementia Flashcards
dementia - % diagnosed
50% are never diagnosed or treated
dementia - reversible causes
D- drugs**, delirium emotions, E - endocrine
M - metabolic disturbance eye, E - ear impairments
N - nutritional disorder
T - toxicity, trauma, tumor
I - infectious cause alcohol,
A - arteriosclerosis
Psychiatric symptoms occur in what proportion of patients with dementia?
20%
alzheimers (achhooo with alzheimers)
Neuritic plaques form Neurofibrillary tangles in neurons
Cholinergic neurotransmitter abnormality
Acetylcholinesterase Inhibitors for alzheimers - ex.
Donepezil (Aricept®)
Rivastigmine (Exelon®)
Galantamine (Razadyne®)
Donepril (Aricept®)
is the only treatment approved by the FDA for all stages of Alzheimer’s disease: mild, moderate, and severe
is a centrally acting reversible acetylcholinesterase inhibitor
main therapeutic use is in the palliative treatment of Alzheimer’s disease
when to take aricept? (Dad at night once a day)
once a day, with or without food, taken at bedtime. if pt as insomia, then can be taken in the am.
aricept - if you miss doses
if a patient stops taking donepezil for 7 or more days
in row, consult the provider before starting again. The patient may need to start at a lower dose to decrease the risk of side effects.
Donepezil (Aricept®) - how quickly does it work?
may take a few weeks
GALANTAMINE HBR (Razadyne®) (alzheimers)
can be used with other therapies to increase effectiveness
GALANTAMINE HBR (Razadyne®) - how to take? (I galantly need food twice a day)
with food, 2x a day. drink fluids. dose usually titrated up.
(NMDA)- receptor antagonist - ex (MDMA meme)
Memantine (Namenda®)
Memantine (Namenda®) (Don MUST be with mermaids)
titrate up, can take up to 28 days. watch renal functions. ADMINISTER with aricept.
Ergoloid - Alzheimers (my ego is a little off)
Action: It is believed to increase blood flow to the brain. It is a combination of 3 ergot alkaloids.
Use: Used to treat mild problems with mood, memory, concentration, or behavior in the elderly.
Namzaric (don and namenda)
combo of aricept and namenda
Namzaric - dosing
with or without food, around bedtime,
Acetylcholine is a
neurotransmitter, which is a chemical released by a nerve cell or neuron.
Acetylcholine - fast or slow?
Acetylcholine serves excitatory and inhibitory functions, which means that ACh can speed up or slow down nerve signals. In the central nervous system, its function is mainly excitatory
ach - the heart?
pacemaker rate by increasing potassium and decreasing calcium and sodium movement. As the pacemaker slows, so does your heart rate
When monitoring a patient who is taking a cholinergic drug, the nurse will watch for which cardiovascular effect?
bradycardia
Cholinesterase inhibitor side effects (Achhoo slows down my heart and makes my COPD worse)
brady, seizures, difficulty voiding, worsening COPD
A patient with Alzheimer’s disease accidentally took 2 weeks’ worth of a cholinergic medication. He is brought to the emergency department, is going into shock, and experiencing severe hypotension and vomiting. The nurse will expect which initial treatment?
Administration of atropine
The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer’s disease. She was diagnosed 3 months ago, has mild memory loss, and will be
receiving donepezil. What is the drug’s expected action?
May help to improve the symptoms of Alzheimer’s disease
Before administering an anticholinergic for the treatment of dementia, it is most important that the nurse assess the patient for a history of (sneeze on glaucoma)
glaucoma
Vascular Dementia - how fast?
Associated with CVA, HTN and A-Fib, abrupt onset of dementia - like 3 months
Lewy Body (my attention is lewy today)
Pronounced variation in attention and alertness, second to second
A nurse at an adult day center notes that many
patients are on (Aricept®). The function of this medication is to
Slow the progression of symptoms of Alzheimer’s
disease
The nurse is assessing a patient who has been taking a cholinergic drug for 3 days. The patient has flushed skin, orthostatic blood pressure changes, and is complaining of abdominal cramps and nausea. The nurse recognizes that the patient is most likely experiencing
early signs of a cholinergic crisis.
parkinson’s symptoms
Symptoms occur when about
dopamine stored in the substantia nigra of the basal ganglia is depleted
parkinson’s symptoms
Symptoms occur when about
dopamine stored in the substantia nigra of the basal ganglia is depleted
levodopa occur
“on- off phenomenon”
meds for parkinson’s
Anticholinergics
Block cholinergic receptors
Dopaminergics
Convert to dopamine Dopamine agonists
Stimulate dopamine receptors
MAO-B inhibitors
Inhibit MAO-B enzyme that interferes with dopamine
COMT inhibitors
Inhibit COMT enzyme that inactivates dopamine
Anticholinergics - parkinson’s
Action: inhibit release of acetylcholine. Decrease tremors and rigidity
Anticholinergics monitor for
increased pulse, decreased urine. increase fluid and fiber.
Anticholinergics - side effects
dry mouth, use ice chips, hard candy. sunglasses for photophobia.
Dopaminergics
◦ Carbidopa-levodopa (Sinemet®)
combo drug, carvadopa helps levadopa convert dopamine.
how long does levadopa work? (Dopy works for 5 - 10 years)
5 - 10 years
Amantadine (Symmetrel®) - Parkinson’s
Also antiviral drug for influenza A. Indirectly stimulates dopamine receptors. Taken alone or in combination with levodopa or anticholinergic
Amantadine (Symmetrel®) - works for how long? (Amanta only works for 6 - 12 months)
6-12 months
A patient with Parkinson’s disease is being treated with
carbidopa-levodopa®). The patient asks the nurse why (
Sinemet) he needs both agents. The nurse responds:
“The carbidopa helps the medication to reach
the brain.”
When teaching the patient about (carbidopa-Levodopa therapy, the nurse
should include which of the following instructions? (dizzy dope)
Get up slowly from a sitting or lying position to avoid faintness.
Which comment to the nurse indicates more teaching is needed for a patient taking carbidopa/levodopa? (get dope 3 times a day)
I know I need to take this drug once a day. (3 times a day)
Which side effect/adverse effect of carbidopa/levodopa does the nurse realize is most important to monitor? (the dope can’t swallow)
dysphagia
MAOIs
MAOIs break down catecholamines in the CNS, primarily in the brain
MAOI - food interactions
Does not elicit the “cheese effect” of the nonselective MAOIs used to treat depression (if 10 mg or less is used)
MAOI - use with other drugs?
Used in combination with levodopa or levodopa-carbidopa. Allows the dose of levodopa to be decreased
* Delays development of unresponsiveness to levodpatherapy
Selective MAOI Therapy: Selegiline- how effective? (Selene only effective about 50% of the time)
on 50 - 60%.
MAOI - dosing
Doses higher than 10mg/day may cause more severe adverse effects, such as hypertensive crisis
COMT Inhibitors (Parkinsons)
Inhibit COMT, the enzyme responsible for the breakdown of levodopa, the dopamine precursor
Tolcapone (Tasmar®)(Parkinsons) (Capone is our last resort bc he hurts our livers)
last resort - Requires monitoring of liver enzymes. Has caused severe liver failure
Selegiline (®) is a selective MAO disease, patients must avoid tyramine-containing foods. T or F
if it’s 10 mg or less, we don’t need to worry about it. (swiss cheese effect)
Antiparkinsonism
Nursing interventions - Monitor for (meds for parks makes me dizzy)
Monitor for orthostatic hypotension.
◦ Administer drug with low-protein foods.
◦ Avoid vitamin B6, alcohol, other depressants.
antiparkinsonism drugs - Nursing interventions - Monitor for (wear brown for parkinson’s)
◦ Do not abruptly discontinue.
◦ Warn of harmless brown discoloration of urine ands weat.
◦ Assess for suicidal tendencies.
◦ Assess symptom status and “on-off”phenomenon.
◦ Monitor blood cell counts, liver and kidney function.
COMT
watch out for liver
The nurse is teaching the patient being treated with an anticholinergic about dietary changes that might be necessary. What is the highest priority instruction for the patient?
D) “increase your intake of fluids while on this medication”
dope is what color?
dope is brown, of course
