Dementia/Alzheimer's Flashcards
what is the most common dementia in the USA
Alzheimer’s Disease (AD)
name the types of dementia aside from Alzheimer’s Disease
- vascular dementia
- atypical dementias like Lewy Body dementia (LBD)
- dementia associated with Parkinson’s disease
- infections dementias
- genetic dementias like Pick’s disease
what causes vascular dementia
atherosclerotic vascular disease
what’s a hallmark symptom of Lewy Body dementia (LBD)
hallucinations
what causes infectious dementias
small viral particles called prions
what are the two types of infectious dementias?
- bovine spongiform encephalopathy (Mad Cow(
2. Creutzfeldt-Jakob
pathphys of Alzheimer’s
- death of cholinergic neurons/cholinergic deficit
- beta-amyloid plaque deposits between neurons
- neurofibrillary tangles inside neurons (collapse of tau proteins)
can drugs prevent dementia?
none yet proven
what are the two classifications of drugs for dementia
- cholinesterase inhibitors (AChEIs, ChEIs): inhibit ACh degrading enzyme so cholinergic
- NMDA-receptor antagonists
what are the first generation cholinesterase inhibitors (ChEIs)?
- tacrine (Cognex) ***no longer used
what are the second generation ChEIs?
- donepezil (Aricept)
- rivastigmine (Exelon and Exelon patch)
- galantamine (Razadyne, Razadyne ER)
AEs of ChEIs
- may exacerbate asthma, COPD and peptic ulcer disease
- may cause urinary outflow obstruction (worse if BPH)
- Pisa syndrome
what’s Pisa syndrome and as relates to ChEIs?
spasm of lower back than can occur with any ChEI drug; if develops cannot take ANY drug of this class AGAIN
drug-drug interactions of ChEIs
- anesthesia drug succinylcholine
- donepezil (Aricept) interacts with paroxeting (Paxil), steroids
- numerous with galantamine (Razadyne, Razadyne ER)
are NMDA-recept antagonists cholinergic?
no, antagonists for receptors thought to be overactive in dementia
what are the NMDA-receptor antagonists
menantine (Namenda)
AEs of menantine (Namenda)
- headache confusion fatigue somnolence dizziness
- dyspnea, cough
- constipation
- cannot use in severe renal impairment
drug-drug interactions of NMDA-receptor antagonists
- acetazolamide (Diamox), thiazide diuretics, aldosterone antagonist diuretics (triamterene), cimetidine, ranitidine, quinidine, nicotine
- other drugs that have NMDA antagonists effects (amatadine, ketamine, dextromethorphan)
CAM drugs for dementia
- gingko biloba (Efb)
- Hyperzine-A (club moss) - Chinese medicine, little info on toxicity/use
- melatonin - not effective as therapy and may cause dysphoria in elderly
- bright light therapy - possible modest benefit
describe important stuff for gingko biloba (Egb) as relates to dementia
- recent RCT showed no benefit for dementia
2. interaction - warfarin (dose adjustment) due to anti-platelet effects
3. AEs - bleeding, includes during surgery/spontaneous cerebral hemorrhages, cardiac palps, seizures
special concerns regarding drug therapy in dementia
- antipsychotics increase death rate in dementia patients, in Lewy body dementia antipsychs may be fatal
what are most adjunctive drugs in dementia for?
for behavioral/agitations management; all are off-label
what are the types of drugs used for behavioral ad adjuncts for dementia?
- ADs
- anxiolytics
- mood stabilizers like AEDs
- antipsychs
what special group of antipsychs has special interactions in patients with dementia? what are the AEs?
- second-generation atypical antipsychotics
2. T2DM and stroke
how is hypersexuality behavior in dementia treated?
off-label SSRIs, injectable progesterone, cimetidine (Tagamet)
what state nutritionally is in the brain in with AD? what can you give?
brain is hypometabolic, can give medical foods like Axona which is a powder dissolved in water daily with breakfast
MOA of medical foods/Axona
medium chain triglycerides metabolized in the liver to form beta-hydroxybutyrate (a ketone body) which is transported to brain as an alternate source of brain fuel
The movement disorder types
- Tremor (rhythmic oscillation around a joint) - three types intention (movement, seen in brainstem/cereb lesions or with alcohol/drugs), postural (during sustained posture aka benign familial tremor), or rest type
- chorea - irregula muscle jerks all over the body (ballismus is violent chorea)
- athetosis (athetoid movement) - slow and writhing
- dystonia - sustained abnormal posturing
- tics - sudden coordinated movements, repetitive and often face/head/shoulders, ***can be temporarily supressed voluntarily
what is Huntington’s chorea?
autosomal dominant genetic illness, progressive chorea and dementia onsets adulthood
what type of drugs is Huntington’s chorea treated with and why?
dopamine antagonists b/c path thought to be overactive dopaminergic pathways
name drugs used to treat Huntington’s chorea?
- orphan drug - tetrabenazine (Xenazine), currently only FDA approved therapy
- off-label - Reserpine (Serapes, Regroton)
- antipsychs - haloperidol (Haldol), perphenazine (Etrafon, Trilafon)
what’s MOA of tetrabenazine?
depletes dopamine by unknown mechanism (may reduce monoamine uptake by neurons needed to make dopamine)
what’s MOA of reserpine (Serapes, Regroton)
depletes cerebral dopamine
name a type of tic disorder
Tourette syndrome (TS) - autosomal dominant inheritance (variable penetrance), diagnosed in chldhood and progresses, vocal tics may have coprolalia with involuntary scatologic utterance, can be voluntarily supressed temporarily but break through again
drug therapy of Tourette syndrome
haloperidol, benzodiazepines, clonidine, carbamazepine and fluphenazine (Prolixin, an antipsych)
