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Pharmacology > Dementia/Alzheimer's > Flashcards

Dementia/Alzheimer's Flashcards

1
Q

what is the most common dementia in the USA

A

Alzheimer’s Disease (AD)

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2
Q

name the types of dementia aside from Alzheimer’s Disease

A
  1. vascular dementia
  2. atypical dementias like Lewy Body dementia (LBD)
  3. dementia associated with Parkinson’s disease
  4. infections dementias
  5. genetic dementias like Pick’s disease
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3
Q

what causes vascular dementia

A

atherosclerotic vascular disease

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4
Q

what’s a hallmark symptom of Lewy Body dementia (LBD)

A

hallucinations

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5
Q

what causes infectious dementias

A

small viral particles called prions

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6
Q

what are the two types of infectious dementias?

A
  1. bovine spongiform encephalopathy (Mad Cow(

2. Creutzfeldt-Jakob

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7
Q

pathphys of Alzheimer’s

A
  1. death of cholinergic neurons/cholinergic deficit
  2. beta-amyloid plaque deposits between neurons
  3. neurofibrillary tangles inside neurons (collapse of tau proteins)
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8
Q

can drugs prevent dementia?

A

none yet proven

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9
Q

what are the two classifications of drugs for dementia

A
  1. cholinesterase inhibitors (AChEIs, ChEIs): inhibit ACh degrading enzyme so cholinergic
  2. NMDA-receptor antagonists
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10
Q

what are the first generation cholinesterase inhibitors (ChEIs)?

A
  1. tacrine (Cognex) ***no longer used
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11
Q

what are the second generation ChEIs?

A
  1. donepezil (Aricept)
  2. rivastigmine (Exelon and Exelon patch)
  3. galantamine (Razadyne, Razadyne ER)
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12
Q

AEs of ChEIs

A
  1. may exacerbate asthma, COPD and peptic ulcer disease
  2. may cause urinary outflow obstruction (worse if BPH)
  3. Pisa syndrome
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13
Q

what’s Pisa syndrome and as relates to ChEIs?

A

spasm of lower back than can occur with any ChEI drug; if develops cannot take ANY drug of this class AGAIN

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14
Q

drug-drug interactions of ChEIs

A
  1. anesthesia drug succinylcholine
  2. donepezil (Aricept) interacts with paroxeting (Paxil), steroids
  3. numerous with galantamine (Razadyne, Razadyne ER)
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15
Q

are NMDA-recept antagonists cholinergic?

A

no, antagonists for receptors thought to be overactive in dementia

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16
Q

what are the NMDA-receptor antagonists

A

menantine (Namenda)

17
Q

AEs of menantine (Namenda)

A
  1. headache confusion fatigue somnolence dizziness
  2. dyspnea, cough
  3. constipation
  4. cannot use in severe renal impairment
18
Q

drug-drug interactions of NMDA-receptor antagonists

A
  1. acetazolamide (Diamox), thiazide diuretics, aldosterone antagonist diuretics (triamterene), cimetidine, ranitidine, quinidine, nicotine
  2. other drugs that have NMDA antagonists effects (amatadine, ketamine, dextromethorphan)
19
Q

CAM drugs for dementia

A
  1. gingko biloba (Efb)
  2. Hyperzine-A (club moss) - Chinese medicine, little info on toxicity/use
  3. melatonin - not effective as therapy and may cause dysphoria in elderly
  4. bright light therapy - possible modest benefit
20
Q

describe important stuff for gingko biloba (Egb) as relates to dementia

A
  • 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
21
Q

special concerns regarding drug therapy in dementia

A
  • antipsychotics increase death rate in dementia patients, in Lewy body dementia antipsychs may be fatal
22
Q

what are most adjunctive drugs in dementia for?

A

for behavioral/agitations management; all are off-label

23
Q

what are the types of drugs used for behavioral ad adjuncts for dementia?

A
  1. ADs
  2. anxiolytics
  3. mood stabilizers like AEDs
  4. antipsychs
24
Q

what special group of antipsychs has special interactions in patients with dementia? what are the AEs?

A
  1. second-generation atypical antipsychotics

2. T2DM and stroke

25
Q

how is hypersexuality behavior in dementia treated?

A

off-label SSRIs, injectable progesterone, cimetidine (Tagamet)

26
Q

what state nutritionally is in the brain in with AD? what can you give?

A

brain is hypometabolic, can give medical foods like Axona which is a powder dissolved in water daily with breakfast

27
Q

MOA of medical foods/Axona

A

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

28
Q

The movement disorder types

A
  1. 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
  2. chorea - irregula muscle jerks all over the body (ballismus is violent chorea)
  3. athetosis (athetoid movement) - slow and writhing
  4. dystonia - sustained abnormal posturing
  5. tics - sudden coordinated movements, repetitive and often face/head/shoulders, ***can be temporarily supressed voluntarily
29
Q

what is Huntington’s chorea?

A

autosomal dominant genetic illness, progressive chorea and dementia onsets adulthood

30
Q

what type of drugs is Huntington’s chorea treated with and why?

A

dopamine antagonists b/c path thought to be overactive dopaminergic pathways

31
Q

name drugs used to treat Huntington’s chorea?

A
  1. orphan drug - tetrabenazine (Xenazine), currently only FDA approved therapy
  2. off-label - Reserpine (Serapes, Regroton)
  3. antipsychs - haloperidol (Haldol), perphenazine (Etrafon, Trilafon)
32
Q

what’s MOA of tetrabenazine?

A

depletes dopamine by unknown mechanism (may reduce monoamine uptake by neurons needed to make dopamine)

33
Q

what’s MOA of reserpine (Serapes, Regroton)

A

depletes cerebral dopamine

34
Q

name a type of tic disorder

A

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

35
Q

drug therapy of Tourette syndrome

A

haloperidol, benzodiazepines, clonidine, carbamazepine and fluphenazine (Prolixin, an antipsych)

Pharmacology (7 decks)

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