Exam 1 - Dementia Flashcards
What are other sources of cognitive impairment that can lead to dementia?
depression, B12 deficiency, NPH, hypothyroidism, infections
What is the cholinergic hypothesis?
concentrations of acetylcholine are markedly decreased in Alzheimer’s disease and restoration may reduce the severity of cognitive loss
What are the adverse effects of anticholinergics? (5)
blind as a bat, dry as a bone, mad as a hatter, hot as a hare, red as a beet
What are the adverse effects of anticholinergics using SLUDGE acronym?
sialorrhea, lacrimation, urination, defecation, GI (emesis, diarrhea), emesis
What are alternatives to oxybutynin? (4)
darifenacin, solifenacin, tolterodine, trospium
Which acetylcholinesterase inhibitor is most likely to cause vivid dreams?
donepezil (Aricept)
What are adverse effects of acetylcholinesterase inhibitors?
headache, insomnia, cardiac, anorexia and weight loss
What are contraindications for acetylcholinesterase inhibitors?
bradycardia/cardiac conduction system disease
What is the dosing for donepezil (Aricept)?
5/10/23 mg qhs
What is the dosing for rivastigmine (Exelon)?
6-12 mg bid
What is the only acetylcholinesterase inhibitor not metabolized by CYP enzymes?
rivastigmine (Exelon)
Which acetylcholinesterase inhibitor is most likely to cause GI upset (unless in patch form)?
rivastigmine (Exelon)
Which acetylcholinesterase inhibitor is CNS-selective but competitive?
galantamine (Razadyne)
What is the dosing for galantamine (Razadyne)?
4 mg bid
Which acetylcholinesterase inhibitor is safe to use in patients with renal and hepatic impairment?
donepezil (Aricept)
What is the MOA of memantine (Namenda)?
NMDA receptor antagonist
What is memantine (Namenda) approved for?
moderate to severe stages of AD
What drug’s clearance is affected by alkaline urine?
memantine (Namenda)
What are cautions for memantine (Namenda) use? (2)
seizure disorder and cardiovascular disease
What is the dosing for memantine (Namenda) IR?
5 mg/d, titrate up by 5 mg/d until 20 mg
What is the dosing for memantine (Namenda) ER?
7 mg/d, titrate up by 7 mg/d until 28 mg
What is the renal adjustment for memantine (Namenda)?
CrCL < 30 = 5 mg/d up to 14 mg
What is a requirement for starting Namzaric (memantine ER + donepezil)?
must start donepezil first and reach 10 mg before starting
What is the dosing for aducanumab?
titrate to 10 mg/kg IV q 4 weeks
What is a BBW for aducanumab?
ARIA
How long does lecanemab delay dementia disease progression?
seven months
What is the dosing for lecanemab?
10 mg/kg IV for 2 weeks
