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Therapeutics > Dementia/Alzheimer's Disease > Flashcards

Dementia/Alzheimer's Disease Flashcards

1
Q

What are the primary patho features of Alzheimer’s?

A
  1. neurofibrillary tangles (tau protein)
  2. beta amyloid plaques
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2
Q

What is the association between anticholinergics and dementia?

A

exposure to anticholinergics in the 10 years prior to diagnosis is associated with dementia

risk does NOT diminish even if the drug is stopped

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3
Q

What agents are indicated for mild Alzheimer’s?

A
  1. donepezil (Aricept)
  2. rivastigmine (Exelon)
  3. galantamine (Razadyne)
  4. lecanemab (Leqembi)
  5. donanemab (Kisunla)
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4
Q

What is required for a patient to start mAb therapy for Alzheimer’s?

A

mild cognitive impairment WITH confirmed presence of beta amyloid patho

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5
Q

What agents are indicated for moderate Alzheimer’s?

A
  1. donepezil (Aricept)
  2. rivastigmine (Exelon)
  3. galantamine (Razadyne)
  4. memantine (Namenda)
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6
Q

What agents are indicated for severe Alzheimer’s?

A
  1. donepezil (Aricept)
  2. rivastigmine (Exelon)
  3. memantine (Namenda)
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7
Q

What Alzheimer’s agent is available as a patch?

What is the benefit of it’s patch formulation?

A

rivastigmine (Exelon)

less GI upset compared to PO formulation

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8
Q

What are the class ADR of AChE inhibitors?

A

SLUDGE (cholingeric)

Sialorrhea
Lacrimation
Urination
Defecation
GI (diarrhea)
Emesis

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9
Q

List the AChE inhibitor Alzheimer’s agents:

A
  1. donepezil (Aricept)
  2. rivastigmine (Exelon)
  3. galantamine (Razadyne)
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10
Q

What is the MOA for memantine (Namenda)?

A

NMDA receptor antagonist

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11
Q

What are the class CI for AChE inhibitors?

A

baseline bradycardia/known cardiac conduction system disease

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12
Q

Which Alzheimer’s agents have NO CYP metabolism?

A
  1. rivastigmine (Exelon)
  2. memantine (Namenda)
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13
Q

What is the purpose of using Nazmaric (memantine ER + donepezil) over just donepezil or memantine?

A

produces slower decline than donepezil alone

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14
Q

What is required to initiate Nazmaric (memantine ER + donepezil)?

A

stabilization on 10 mg donepezil dose

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15
Q

What is the BBW for mAbs indicated for Alzheimer’s?

A

ARIA and increased risk in ApoE4 homozygotes

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16
Q

How do you decrease the risk of ARIA for lecanemab (Leqembi) & donanemab (Kisunla)?

A

titrate does slowly and frequently monitor MRI for ARIA

17
Q

What mAbs have an indication for Alzheimer’s?

A
  1. lecanemab (Leqembi)
  2. donanemab (Kisunla)
18
Q

What is ARIA?

ARIA-E?

ARIA-H?

A

amyloid related imaging abnormalities

cerebral EDEMA

cerebral microHEMORRHAGES

19
Q

How is lecanemab (Leqembi) dosed?

What is it for?

A

weight based IV infusion every 2 weeks

mild cognitive impairment w/ presence of beta amyloid

20
Q

How is donanemab (Kisunla) dosed?

What is it for?

A

IV infusion every 4 weeks

mild cognitive impairment w/ presence of beta amyloid

21
Q

Where can rivastigmine (Exelon) patches be applied?

A

back, chest or arm

22
Q

What agents (classes) should be avoided in patients with Alzheimer’s when managing their mood or sleep?

A

anticholinergics, benzos & sedative/hypnotics

23
Q

What antipsychotics can be used for agitation in dementia?

A
  1. aripiprazole
  2. olanzapine
  3. quetiapine
  4. risperidone
  5. brexipiprazole
24
Q

What agent is indicated for treatment of agitation associated with dementia due to Alzheimer’s disease?

A

brexipiprazole (Rexulti)

25
Q

How is brexipiprazole (Rexulti) administered for agitation associated with dementia due to Alzheimer’s disease?

A

NOT USED PRN

daily dosing 0.5 mg-3 mg (titrated)

26
Q

What is the frequency of gradual dose reduction?

A

within 1st year of LTC admission
- attempt GDR in 2 separate quarters at least 1 mo apart

after 1st year
- attempt GDR annually

27
Q

What agents does gradual dose reduction guidelines apply to?

A

antipsychotics

sedative/hypnotics

other CNS active meds (antidepressants, mood stabilizers)

Therapeutics (17 decks)

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