Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Neuro Block Pharm > Dementia > Flashcards

Dementia Flashcards

1
Q

how is dementia characterized?

A 
Dementia is Characterized by a decline in cognition in at least one cognitive domain, such as:
o	Learning and memory
o	Language
o	Executive function
o	Complex attention
o	Perceptual-motor
o	Social cognition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dementia Must be ____ and represent a decline from previous level of function

A

acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Major dementia syndromes

A 
o	Alzheimer disease (AD)
o	Dementia with Lewy bodies (DLB)
o	Frontotemporal dementia (FTD)
o	Vascular (multi-infarct) dementia (VaD)
o	Parkinson disease with dementia (PDD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Alzheimer Disease (AD) has what hallmark pathologies associated with it?

A

o Amyloid plaques
o Neurofibrillary tangles of tau protein
o Loss of cortical neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Alzheimer Disease (AD) Leads to reduced cerebral content of choline acetyltransferase, which leads to a decrease in ______ synthesis and impaired cortical cholinergic function. - Involves other neurotransmitters including glutamate and 5-HT.

A

acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

primary desired outcome when treating patients with Alzheimer Disease (AD)

A

symptomatically treat cognitive difficulties and preserve function as long as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Secondary desired outcome when treating patients with Alzheimer Disease (AD

A

treat the psychiatric and behavioral sequelae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

do current treatments for AD prolong life, cure AD, halt or reverse the pathophysiologic processes?

A

NO

Current treatments DO NOT prolong life, cure AD, halt or reverse the pathophysiologic processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Alzheimer Disease (AD) targets of therapy

A

o Improve cholinergic transmission within the CNS

o Prevent excitotoxic actions caused by overstimulation of NMDA-glutamate receptors in select brain areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

patients with Alzheimer Disease (AD) Should be managed initially with ______ instead of medications

A

behavioral interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

examples of behavioral interventions for patients with Alzheimer Disease

A

o Maintain consistent, structured environment with appropriate stimulation level
o Provide frequent reminders, explanations, and orientation cues
o Avoid confrontation: remain calm, firm, and supportive when patient becomes upset
o Reduce choices and avoid complex tasks
o Consider vision and hearing impairments- can accelerate agitation and aggression
o Maintain general health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

which test has Better sensitivity, MoCA or MMSE?

A

MoCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is an Abnormal score for MoCA testing?

A

<26

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the maximum MMSE score?

A

30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what MMSE score suggests mild dementia

A

20 to 24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what MMSE score suggests moderate dementia

A

13 to 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what MMSE score indicates severe dementia

A

Less than 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are MILD scores for MoCA, MMSE, and CDR?

A

MoCA-12-16
MMSE-19-26
CDR-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are MODERATE scores for MoCA, MMSE, and CDR?

A

MoCA-4-11
MMSE-10-18
CDR-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are SEVERE scores for MoCA, MMSE, and CDR?

A

MoCA-<4
MMSE-<10
CDR-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

in a patient with Mild to moderate disease, consider starting with ________.

A

cholinesterase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

in a patient with Moderate to severe disease consider using/adding ________.

A

NMDA antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Acetylcholinesterase (AChE) is an enzyme that breaks down ACh in the_____.

A

synapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

AChE Inhibitors drugs used to treat Alzheimer Disease

A

o Donepezil
o Rivastigmine
o Galantamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Donepezil, Rivastigmine, Galantamine all have similar ______.

A

Similar efficacy and ADR profile

26
Q

AChE Inhibitors: ADRs

A
  • GI: n/v/d
  • Anorexia and weight loss:
  • Bradycardia and hypotension
  • Sleep disturbances: insomnia, vivid dreams
  • Other cholinergic ADRs as we’ve previously discussed
27
Q

AChE Inhibitors should be avoided in patients that have issues with what things?

A

should be avoided in patients with baseline issues or known cardiac conduction system disease (meds that can be problematic with this: BB, CCB, anti arrhythmics)

28
Q

Which neurons degenerate to cause AD?

A

Acetylcholine and glutamate

29
Q

What is the hallmark of dementia?

a. Psychosis
b. depression
c. cognitive decline
d. CNS excitation

A

c. cognitive decline

30
Q

what is most common ADR with AChE inhibitors?

A

N/V/D

31
Q

If a patient is tolerating an AChE inhibitor, how long would you wait to see if it is effective?

a. 1 week
b. 1 month
c. 2 months
d. 6 months

A

c. 2 MONTHS

32
Q

what is recommended to reserve use for more moderate to severe dementia?

a. Memantine
b. Donepezil
c. Rivastigmine
d. Galantamine

A

Memantine

33
Q

if you are wanting to prescribe AChE Inhibitors, you should Avoid concurrent use of ______.

A

anticholinergic medications

34
Q

AChE Inhibitors Gradual dose titration should be over _____.

A

months

35
Q

Factors influencing drug choice for AChE Inhibitors

A 
o	Cost
o	Ease of use
o	Patient tolerability
o	Safety issues such as DDIs
o	Provider experience
36
Q

what AChE Inhibitors is typically used first line due to fewer DDIs

A

Rivastigmine: fewer DDIs due to no CYP450 metabolism –>commonly used first line

37
Q

how can you monitor AChE Inhibitors effectiveness?

A

Use MoCA as well as caregiver impressions of change
o Also can use recall of four-word list at 30 seconds and 5 minute along with semantic fluency (e.g., naming as many animals as possible in one minute)
o MMSE is not specific enough

38
Q

when pts are on AChE Inhibitors you should have patient Follow-up at ______to assess tolerance and response

A

3-6 months

39
Q

when pts are on AChE Inhibitors you should have patient Follow-up Every______ once on a stable dose

A

6-12 months

40
Q

what drug is a NMDA Receptor Antagonists used for treating AD

A

Memantine

41
Q
  • N-methyl-D-aspartate (NMDA) receptors can be activated by excitatory neurotransmitters like _________.
A

glutamate and aspartate

42
Q

this drug blocks nearly all NMDA receptors and is severely psychotoxic

A

phencyclidine (PCP)

43
Q

Memantine ADRs

A

o Confusion, agitation, restlessness, hallucinations- May be indistinguishable from AD symptoms

o HTN, constipation, HA, cough

44
Q

Recommendations support the management of vascular brain disease and its associated risk factors as part of AD treatment. if vascular brain disease is present, recommend _______ therapy

A

low-dose ASA

45
Q

Recommendations support the management of vascular brain disease and its associated risk factors as part of AD treatment
If present, recommend low-dose ASA therapy.

What are some non drug therapy options?

A

o Physical, mental, social activity
o Low-fat, low-cholesterol diet
o Manage weight, BP, cholesterol, and glucose

46
Q

AD patients exhibit a decline in ability to metabolize glucose in the brain. what is the name of a medical food you can prescribe patients?

A

Caprylidene (Axona)

47
Q

Caprylidene is a Formulation of caprylic ______.

A

triglyceride

48
Q

what antioxidant has been shown to be helpful with patients that have AD?

A

Vitamin E

49
Q

Benefits of Vitamin E are likely modest and could be offset by combination therapy with _______.

A

memantine

50
Q

Vitamin E has Reasonable intervention with mild-moderate disease at ______ IU daily

A

2000

51
Q

Selegiline Has antioxidant properties but has not been shown to be helpful yet in__.

A

AD

52
Q

ginkgo biloba has been Extensively studied with some positive results when using a specific extract , what is the extract?

A

EGb 761

53
Q

ginkgo biloba Can have significant ADRs especially potent ___________.

A

antiplatelet effects

54
Q

what are some Behavioral Symptoms that are Extremely common in dementia and should be screened at every visit?

A 
o	Aggression
o	Delusions
o	Hallucinations
o	Wandering
o	Depression
o	Sleep disturbances
o	Sexually inappropriate behavior
55
Q

what are some Common paranoid delusions AD patients tend to have?

A

o House is being invaded
o Personal objects have been misplaced or stolen
o Family members have been replaced by impostors (Capgras syndrome)
o Spouse has been unfaithful

56
Q

visual hallucinations early in course suggests Dementia with _______?

A

Lewy bodies

57
Q

Elderly patients who become depressed are at increased risk for developing _______.

A

dementia

58
Q

when dementia patients have agitation and paranoia what antidepressant may be warranted?

A

citalopram (Celexa)

59
Q

what kinds of nonpharmacologic management should you start with when a dementia patients is suffering from sleep disorders?

A

Sleep hygiene, daytime physical activity, avoid naps, limiting evening beverages, avoid EtOH and caffeine in evening, delaying bed time

60
Q

sleep disorders in dementia patients have many causes including what 4 things?

A

o Depression and/or anxiety
o Decreased daytime physical activity
o Nocturia
o ADRs of medications

*Neuro Block Pharm (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions