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Pharmacology > Dementia > Flashcards

Dementia Flashcards

1
Q

Dementia

A

an acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert person, usually behavioral disturbances too

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2
Q

Diagnosis of dementia

A

DSM-V-TR, spouse, rating scales, autopsy, brain atrophy and neuronal loss (dec acteylcholine)

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3
Q

Risk factors of dementia

A

age, fam hx, hx of head trauma

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4
Q

Alzheimer’s disease

A

60-70% of all dementias, presence of B-amyloid and tau proteins, slow, progressive decline in cog ability, initial impairment w/ short term memory, difficulty learning new info, aphasia, impaired visuospacial fct

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5
Q

Lewy Body Dementia

A

Lewy body plaques, limbic and neocortical areas outside the substantia nigra, presents w/ fluctuations in alertness/attentian and confused states, visual hallucination are common, parkinsonia, orthostatic hypoTN, syncope

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6
Q

Vascular dementia

A

abrupt onset with stepwise, causal decline in cog function, based on vascular insults, language and memory retrieval difficulties, symptoms largely reliant on location of injury

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7
Q

parkinson’s dementia

A

pts w/ parkinson’s have 6x chance of dementia diagnosis, motor disturbances accompanies and often precedes symptoms, gait dysfunction, visual disturbances, frequent falls

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8
Q

What should you avoid when possible

A

antihistamine, oxybutnin, tolterodine, cyclobenzaprine, TCAs

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9
Q

AD treatment of cog sx

A

acetylcholinesterase inhibitors, NMDA antagonist

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10
Q

AD treatment of BPSD

A

non-pharm therapy, antipsychotics, antidepressants, antionvulsants/ mood stabilizers, benzos

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11
Q

Non-pharm treatment

A

exercise body/brain, mediterranean diet, music, orientation reinforcement, communication, attention to safety

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12
Q

Basic principles of care for AD

A

Keep requests and demands simple, avoid confrontation, remain calm, firm, supportive, frequent reminders, explanations, orientation cues, adjust to expectations, patience!

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13
Q

AChEI aimed to

A

increase acetylcholine, correct the cholinergic deficiency hypothesis of amnesia

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14
Q

Nucleus basalis of meynert

A

located in basal forebrain, principle site of cholinergic cell bodies for axons that project to the hippocampus, amygdala and throughout the neocortex, it is the degeneration of these cells that leads ot AD

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15
Q

MOA of AChEI

A

inhibit acetylcholinesterase, inhibit degradation of acetylcholine and thus increase acetylcholine concentrations in nerve synapses, doesn’t affect underlying neurodegenerative process

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16
Q

Efficacy of AChEIs

A

most effective when started early, used for mild to moderate, and moderate to severe AD; may see benefit for 1-3 years

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17
Q

ADRs of AChEIs

A

nausea, vomiting, diarrhea, wt loss, can exacerbate GI bleed

18
Q

AChEIs

A

Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Razadyne), combo Donepezil/Memantine (Namzaric)

19
Q

Donepezil (Aricept)

A

better tolerated and more convenient dosing, indicated for mild to severe AD, CNS selective, reversible inhibitor of AChE

20
Q

Dosing of Donepezil (Aricept)

A

5 mg qHS for 4-6 weeks, then increase to 10 mg qHS

21
Q

Rivastigmine (Exelon)

A

less tolerable compared to donepezil, less DI, CNS selective, pseudo-irreversible for AChE and BuChE, mild to severe AD and Parkinson’s dementia, hard on GI

22
Q

Rivastigmine (Exelon) patch

A

less GI SE, better for compliance, 4.6mg/24 hours (4 weeks, can titrate up) and 9.5mg/24 hours

23
Q

Galantamine (Razadyne)

A

reversible, competitive AChEI, more DIs, 3A4 & 2D6 metabolism, should not be used in severe renal and hepatic impairment, mild to moderate disease

24
Q

Memantine (Namenda) effects

A

block Ca entry when extracellular glutamate is low, allows intracellular Ca levels to return to normal, when glutamate is increased in response to an action potential, glutamate displaces memantine, causing brief Ca entry

25
Q

Pathophysiolody of NMSA receptor in AD

A

activated state, slow but steady leakage of glutamate from the pre synaptic neuron keeps the NNMDA receptor in constantly activated state allows excess influx of Ca which leads to persistant neuroexcitation and cell death

26
Q

Memantine (Namenda) therapy

A

renally eliminated, ADRs: constipation, dizziness, HA, confusion, agitation, HTN; for mod to severe AD most often in combo w/ AChEI, 10 mg BID

27
Q

Memantine/ Donepezil (Namzaric)

A

mod to severe AD, 10 mg donepezil+ memantine 10 mg BID or 28 mg once daily

28
Q

Vitamin E

A

possiple protective effects, recent results of meta analysis suggests increase in all cuase mortality when dose >400 IU/day

29
Q

Ginko Biloba

A

antioxidant properties, questionable effectiveness, shown to stabilize of improve cog performance and social behavior for 6-12 months w/ uncomplicated AD, also antiplatelet effects (caution)

30
Q

Anti-inflammatory agents

A

epidemiological studies suggest possible protective effect by dec B amyloid plaque development, long term risks

31
Q

Lipid lowering agents

A

possible protective effect, statins dec B amyloid production in vitro, generally not recommended outside of reducing cholesterol

32
Q

Treating lewy body dementia

A

AChEIs considered DOC, avoid typical and atypical antipsychotics

33
Q

Treating vascular dementia

A

control vascular risk factors, HTN, DM, hyperlipidemia, PVD, stop smoking, AChEIs DOC

34
Q

Treating Parkinson’s dementia

A

AChEI show improvement in cognition, alertness, apathy, and aggression, may need to inc antiparkinsonian medications, can try memantine

35
Q

Common behavioral symptoms

A

psychotic, delusions, hallucinations, inappropriate behaviors, agitation, wandering, sexual behaviors, depression

36
Q

Treating BPSD non pharm

A

identify behavior, understand cause, adapt environment, remove triggers, orientation, treat pain, clear infections

37
Q

Adverse effects of antipsychotics

A

falls, fractures, delirium, oversedation, stroke

38
Q

approach to treatment of BPSD

A

reserve until non-pharm has failed, initiate low doses, monitor closely for efficacy, work w/ pt and caregiver to individualize and simplify the drug regimen, should not be long term

39
Q

Antipsychotics useful for

A

temporary agitation and delirium/psychosis

40
Q

Haloperidol (Haldol)

A

PO/IM, blocks post synaptic mesolimbic D1/D2 receptors, ADRs: extrapyramidal symptoms, QT prolongation, sedation, works quickly, not for parkinson’s

41
Q

Boxed warning with Haloperidol

A

increased risk of death

Pharmacology (61 decks)

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