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BNF CNS > Dementia > Flashcards

Dementia Flashcards

1
Q

most common form of dementia

A

Alzheimers

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2
Q

Non-drug treatment approaches to dementia

A

used in patients with cognitive symptoms e.g. group reminiscence therapy, cognitive rehabilitation therapy, occupational therapy

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3
Q

In cognitive impairment, what drug class should be avoided?

A

Anticholinergics due to their cognitive side effects

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4
Q

Examples of drugs with antimuscarinic effects

A

antidepressants (TCAS, Paroxetine), antihistamines, antipyschotics and urinary antispasmodics

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5
Q

What is the treatment for mild to moderate alzheimers?

A

monotherapy with an Ach inhibitor; either Donepezil, galatamine or Rivastigmine is first line. If contraindicated, memantine (NMDA antagonist)

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6
Q

Acetylcholinesterase inhibitor examples

A

Donepezil, Galatamine and Rivastigmine

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7
Q

What drug class is memantine?

A

NMDA (glutamate) antagonist

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8
Q

What is the drug of choice for severe alzhiemers disease

A

memantine

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9
Q

What drug treatment should be given to patients wiht mild to moderate dementia with lewy bodies?

A

Donepezil (UNL) or Rivastigmine (UNL)

If both Donepezil and Rivastimgmine are contracindicated, Galatamine can be considered

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10
Q

What medications can be considered in patients with severe dementia with Lewy bodies?

A

Donepezil or Rivastigmine

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11
Q

If an Acetylcholinesterase inhibitor is contraindicated in a patient with Lewy body dementia, what can be offered as an alternative?

A

Memantine

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12
Q

When should acetylcholinesterase inhibitors or memantine be considered in patients with vascular dementia?

A

Only if they have suspected co-morbid alzheimers disease, parkinsons disease dementia or dementia with lewy bodies

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13
Q

Are acetylcholinesterase inhibitors and memantine recommened for use in frontotemporal dementia or cognitive impairment caused by MS?

A

No!

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14
Q

What are the non cognitive symtoms of Dementia?

A

agitation, aggression, distress, psychosis

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15
Q

What is the MHRA warning associated with use of antipschotic drugs in elderly patients with dementia?

A

Increase risk of stroke and small risk of death

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16
Q

How should antipsychotic drugs be prescribed in patients with alzheimers?

A

Smallest possible dose for shortest time possible with 6 weekly reviews

17
Q

In what forms of demetia can antipschotics worsen the disease?

A

Lewy body and parkinsons dementia

18
Q

How can depression and anxiety associated with dementia be tackled?

A

CBT, multisensory stimulation, relaxation, animal assisted therapies
antidepressant should be reserved for thos with pre-existing severe MH problems

19
Q

What approaches can be taken to help wiht dementia associated sleep disturbances?

A

Sleep hygiene education, exposure to daylight, increase exercise and activity

20
Q

What time of the day should Donepezil be given?

A

night

21
Q

General side effects of Acetylcholinesterase inhibitors

A

GI disturbance, aggression, agigtation, reduced appetite, urinary incontinence, syncope, arrhythmia

22
Q

What is a serious side effect of Galatamine?

A

Serious skin reactions - including SJS amd acute generalized exanthematous pustulosis. Discontinue at firs tsigns of skin rash

23
Q

what are the indications for Rivastigmine?

A

Mild - moderate alzheimers + mild to moderate dementia in parkinsons

24
Q

What weight should Rivastigmine patches be used in caution with?

A

<50kg

25
Q

If swithcing from PO to patch therapy, when should the f irst patch be applied?

A

on the day following the last oral dose

26
Q

What dosage form of Rivastigmine is less likely to cause side effects?

A

Transdermal

27
Q

How should a Rivastigmine patch be applied?

A

To clean, dry, non hairy or irritated skin on the back, upper arm or chest removing after 24 hours and sitting a replacement patch in a different area ( avoid using the same area for 14 days)

28
Q

What warning label is associated with rivastigmine?

A

Take with food (21)

29
Q

side effects of Memantine?

A

Balance impaired, constipation, dizziness, HTN

30
Q

If a patient is already receiving Acetylcholinesterase inhibitor for Alzheimers but develops moderate - severe disease, what is the tx option?

A

Add in Memantine

BNF CNS (9 decks)

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