Dementia Flashcards
Name 3 drugs used for mild-moderate dementia
and their respective SE.
What class of drug are they?
- donepezil - neuroleptic malignant syndrome
- rivastigamine - GI side effects
- galantamine - stevens johnsons syndrome
acetylcholinesterase inhibitors - inhibit the breakdown of acetylcholine, increasing the levels
what are the parasympathetic SE associated with acetylcholinesterase inhibitors? DUMB BELS
Diarrohoea
Urinary incontinence
Muscle weakness
Bradycardia
Bronchospasam
Emesis
Lacrimation (flow of tears)
Salivation
what action should you take if a pateint presents with parasympathetic side effects?
stop the treatment
treat dehydration
ammend dose
what drug is given for worsening/severe dementia?
memantine
what drugs can be used to manage aggression in dementia patients?
benzodiazepines, antipsychotics
why is levodopa given with carbidopa/bensaerzide?
to rpevent breakdown before it crosses into the brain
what are the 3 side effects with initial treatment of levodopa?
- impulse disorders - gambling, binge eating, hypersexuality
- sudden onset of sleep
- red urine
what do you use to treat sudden onset of sleep with levodopa?
modafinil
name 3 non-ergot derived dopamine receptor agonists
pramipexole
ropinirole
rotigotine
name 3 SE of non-ergot derived dopamine receptor agonists
impulse disorders
sudden onset of sleep
hypotension
what class of PD drug is most likely to cause impulse disorders?
non-ergot dervied dopamine receptor agonists
what is used to treat hypotension caused by non-ergot derived dopamine agonists?
minodrin
give 2 examples of MAO B Is
rasagiline, selegiline
what are the 2 key interactions patients on MAO B Is need to be counselled on?
- hypertnesive crisis if given with phenlyephrine
- interacts with tyramine rich rich foods to cause hypertneisve crisis
name some foods rich in tyramine
mauture cheese
salami
tofu
marmite
yeasts
if a patient develops dyskinesia but is optimised on l-dopa what are the options for adjuvant therapy?
- adding a monoamine oxidase B inhibitor or non-ergot dopamine agonist
- adding a COMT inhibitor
name 2 COMT inhibitors and what are their SEs?
- entacapone - red/brown urine
- tolcapone - hepatotoxic
both increase sympathetic SE = increase risk CVD events (tachycardia, fast breathing)
a patients motor symtpoms are uncontrolled with a non-ergot derived DA agonist and levodopa, what is an alternative adjuct therapy?
give 2 examples
ergot derived dopamine agonists
carbergoline, bromocriptine
what are the side effects of ergot derived dopamine agonists you need to counsel patients on?
pulmonary reactions = SOB, chest pain, cough
pericardial reactions = chest pain
T/F. You can withdraw patients PD meds abruptly?
false
what intervention could you make if a patient is having off periods?
switch to modified release
whats the first and second line treatment for nocutnal akinesia?
1st = levodopa or oral dopaine agonists
2nd = rotigotine
what are the postive and negative symptoms of SZ?
postive = delusions, hallucinations, disorganisaiton
negative = poor hygeine, neglect, social withdrawl
name 5 2nd generation antipsychotics
aripiprazole, olanzapine, clozapine, risperidone, quetiapine
name 3 group 1 antipsychotics (1st gen, phenothiazines)
what does their side effect profile look like?
levomepromazine
promazine
chlorpromazine
SE = most sedation, moderate antimuscarininc, EPSEs
name a group 2 antipsychotic, whats its SE profile?
pericyazine
SE = moderatr sedation, least EPSEs
what group of antipsychotics has the most EPSEs?
give 3 examples
1st gen, group 3 antipsychotics
e.g. = fluphenazine, prochlorperazine, trifluoperazine
what is it bad to sue antipsychotics in PD?
becuase antipsychotics reduce the levels of dopamine whereas in PD you want to increase the amount of DA
in which antipsychotic is hyperprolactinamie least likely?
aripiprazole
which antipsychotic has the least side effects?
aripiprazole
what antipsychotics have the highest risk of CV effects?
haloperidol, pimozide
what antipsychotics have the highest risk of hyperglycaemia? CiROQ
Clozapine
Risperidone
Olanzapine
Quetiapine
what antipsychotics cause the most weight gain?
clozapine, olanzapine
whats the management for neuroleptic malignant syndrome with antipsychotics?
stop treatment
treat with bromocriptine
should resolve in 5 - 7 days
what are the monitoring and intervals for antipsychotics?
(weight, fasting glucose HbA1c, ECG, BP, FBC + U&E + LFTS)
weight = at start, weekyl for 6/52, at 12 weeks, at 1 year, then annually
fasting glucose, HbA1c, lipids = at start, at 12 weeks at 1 year, then annually
ECG = before initiation
BP = at start, at 12 weeks, at 1 year, then annually
FBC = start then yearly
when can a pt try cloazpine?
when 2+ antipsychotics have been tried for 6 - 8 weeks ( one has to be a 2nd gen)
how many doses does a patient have to miss before clozapine is restarted by a specailsit?
more then 2
what are the monitoring requirements for clozapine?
leucocytes
weekly for 18/52
fortnightly for 1 year
then monthly until stop
once stopped do 1 month after
what are the 3 main side effects of clozapine? MAG
- myocardidits, cardiomyopathy (report and stop on tachycardia)
- neutropenia and agranulocytosis
- constipation - refer to A&Em
