Dementia Flashcards
most common form of dementia
Alzheimers
Non-drug treatment approaches to dementia
used in patients with cognitive symptoms e.g. group reminiscence therapy, cognitive rehabilitation therapy, occupational therapy
In cognitive impairment, what drug class should be avoided?
Anticholinergics due to their cognitive side effects
Examples of drugs with antimuscarinic effects
antidepressants (TCAS, Paroxetine), antihistamines, antipyschotics and urinary antispasmodics
What is the treatment for mild to moderate alzheimers?
monotherapy with an Ach inhibitor; either Donepezil, galatamine or Rivastigmine is first line. If contraindicated, memantine (NMDA antagonist)
Acetylcholinesterase inhibitor examples
Donepezil, Galatamine and Rivastigmine
What drug class is memantine?
NMDA (glutamate) antagonist
What is the drug of choice for severe alzhiemers disease
memantine
What drug treatment should be given to patients wiht mild to moderate dementia with lewy bodies?
Donepezil (UNL) or Rivastigmine (UNL)
If both Donepezil and Rivastimgmine are contracindicated, Galatamine can be considered
What medications can be considered in patients with severe dementia with Lewy bodies?
Donepezil or Rivastigmine
If an Acetylcholinesterase inhibitor is contraindicated in a patient with Lewy body dementia, what can be offered as an alternative?
Memantine
When should acetylcholinesterase inhibitors or memantine be considered in patients with vascular dementia?
Only if they have suspected co-morbid alzheimers disease, parkinsons disease dementia or dementia with lewy bodies
Are acetylcholinesterase inhibitors and memantine recommened for use in frontotemporal dementia or cognitive impairment caused by MS?
No!
What are the non cognitive symtoms of Dementia?
agitation, aggression, distress, psychosis
What is the MHRA warning associated with use of antipschotic drugs in elderly patients with dementia?
Increase risk of stroke and small risk of death
How should antipsychotic drugs be prescribed in patients with alzheimers?
Smallest possible dose for shortest time possible with 6 weekly reviews
In what forms of demetia can antipschotics worsen the disease?
Lewy body and parkinsons dementia
How can depression and anxiety associated with dementia be tackled?
CBT, multisensory stimulation, relaxation, animal assisted therapies
antidepressant should be reserved for thos with pre-existing severe MH problems
What approaches can be taken to help wiht dementia associated sleep disturbances?
Sleep hygiene education, exposure to daylight, increase exercise and activity
What time of the day should Donepezil be given?
night
General side effects of Acetylcholinesterase inhibitors
GI disturbance, aggression, agigtation, reduced appetite, urinary incontinence, syncope, arrhythmia
What is a serious side effect of Galatamine?
Serious skin reactions - including SJS amd acute generalized exanthematous pustulosis. Discontinue at firs tsigns of skin rash
what are the indications for Rivastigmine?
Mild - moderate alzheimers + mild to moderate dementia in parkinsons
What weight should Rivastigmine patches be used in caution with?
<50kg
If swithcing from PO to patch therapy, when should the f irst patch be applied?
on the day following the last oral dose
What dosage form of Rivastigmine is less likely to cause side effects?
Transdermal
How should a Rivastigmine patch be applied?
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)
What warning label is associated with rivastigmine?
Take with food (21)
side effects of Memantine?
Balance impaired, constipation, dizziness, HTN
If a patient is already receiving Acetylcholinesterase inhibitor for Alzheimers but develops moderate - severe disease, what is the tx option?
Add in Memantine
