geri

Question 1

Cure for Brain Aging might entail

Answer 1

(1) Termination of degeneration (2) Creation of new Neurons (3) Enable correct re-wiring

Question 2

Immediate research goals for geriatric psychpharm

Answer 2

(1) Retard rate of decline (2) Prevent or retard onset

Question 3

Potential issues with Geriatric PsychPharm

Answer 3

(1) Polypharmacy (2) Adverse Drug Reactions (3) Inappropriate Meds (4) No treatment (5) Non-compliance (6) Impaired drug metabolism

Question 4

% of older adults in population and % of prescriptions given to older adults

Answer 4

13% in population–recieve 30% of all prescriptions

Question 5

General principle in prescribing drugs

Answer 5

Start low and go slow

Question 6

Reason for start low and go slow

Answer 6

Often the elemination half-lives are longer in older people which means they stay in the body longer. Repeated dosages can lead to a high steady state…. Especially with sedative-hypnotics, these effects can dribble over into the following day causing continued impairment

Question 7

Common problem for diagnosis in depression and anxiety

Answer 7

Underdiagnoses

Question 8

Main drugs to avoid for older patients

Answer 8

(1) Ones that cause cognitive inhibition (2) Unwated sedation (3) Bizarre Behaviors

Question 9

BPSD

Answer 9

Behavioral and Psychological Symptoms of Dementia

Question 10

Typical treatment for BPSD

Answer 10

Atypical antipsychs [Abilify best]

Question 11

BPSD Symptoms

Answer 11

Agitation, aggression, noncompliance with care, psychosis, depressive symptoms, inappropriate sexual behavior, sleep disturbances

Question 12

Problem with prescription of antipsychs in geriatic

Answer 12

Many eldery patients are placed in anti-psychs without any clear reasoning (no diagnoses psychosis or dementia)

Question 13

Depression and Older

Answer 13

65+ account for 20% of all suicides with a high completion rate. Best treatment: antidepressants/psychotherapy

Question 14

Non-prescription approaches to some aging related problems

Answer 14

(1) Exercise (2) Healthy diet (3) Deep breathing (4) Omega 3 FA (5) Cogntitive behavioral therapy (6) Vitamins D,E, Q10 (7) Yoga laughter

Question 15

Why side effects result

Answer 15

(1) Polymorbidity can lead to polypharmacy which can cause side effect (2) Decreased organ function can cause changes in pharmacodynamics and decrease homeostatic functions… which can cause side effects

Question 16

Trend between number of drugs and ADR’s

Answer 16

More drugs= more ADR

Question 17

Trend between # of prescribing physicians and ADRs

Answer 17

More physcians= more ADR

Question 18

Prevalance of Parkinson’s Disease

Answer 18

1% of people 65-69

Question 19

Cause of Parkinson’s Disease

Answer 19

Symptoms result from a deficency in the # and functioning of DA-secreting neurons in the substantia nigra

Question 20

What are two DA pathways in vertebrate brain?

Answer 20

Substantial Nigra for motor and DA from VTA from fortal lobes and limbic systems

Question 21

Three approaches to treating PD

Answer 21

(1) Replace DA using precursors (2) Deminish breakdown of DA (3) DA receptor agonist

Question 22

Clinical symptoms of 80% DA loss

Answer 22

Bradykinesia, muscle rigidity, resting tremor, impaired postural balance

Question 23

Potential enviornmental cause of PD

Answer 23

Tri-chloro ethylene

Question 24

Process for how Dopa becomes Dopamine

Answer 24

Dopa can be impacted by the enzyme dopa decarboxylase into becoming Dopamine

Question 25

Levodopa (Problem, Solution, Combination)

Answer 25

Problem is that Dopa is converted to Dopamine all around the body including the gut. THe solution is using a drug carbidopa which inhibits peripheral Dopa decarboxylase without impacting the brain’s own reserves. A combination treatment is known as Sinemet with both carbidopa and Dopa.

Question 26

COMT

Answer 26

catechol-o-methyltransferase

Question 27

COMT inhibitors (purpose)

Answer 27

Seen as way to inhibit the conversion of Dopa into an innactive metabolite… WHich increase the on-time of the drug

Question 28

Selective MAO-B Inhibitors (theoretical importance, drug used, efficacy)

Answer 28

Enzyme MAO exists in two forms (A and B). The MAO-B form is more selective for DA. Thus the drug used SELEGILINE is able to selectively and irresversibly inhibit MAO-B from breaking down the DA. This increase the bioavailability of DA…. allows for decreased amount of Levodopa/Carbidopa needed to control sympmtoms. It also stops the effects of levodopa from wearing off between dosages and increase length of time levodopa can continue to be fficacious

Question 29

DA receptor agnoist (when used, types of drugs)

Answer 29

Used 1-5 years after starting levodopa therapy due to less response from the patient. Two drugs (Paramipexole and Ropinirole are marketed in the US)

Question 30

Alezheimer’s Disease (Structural changes, DIagnosis to Death time span, markers for postmortem assesment of AD)

Answer 30

There is characteristcally loss of cholinergic neurons that innervate the cortext and hippocampus…The time between symptom onset and death is 8-10 years..definitive diagnosis at atopsy is based on deposits of protein plaques (Beta amyloid) and neurofibrillatory tangles (abnormal microtubules)

Question 31

AChE-1 (Name, Reason for use in AD, efficacy?, common drugs)

Answer 31

(1) acetyl Cholinesterase inhibition (2)AD associated with loss of cholinergic neurons (3)slow cognitive decline somewhat but no strong effects (4) Common drugs are donepizil (Aricept) and Galantamine (Razadyne.)

Question 32

Memantine (what it is, reason for use, efficacy)

Answer 32

(1) Moderate affinity, non-competitive, NMDAR antagonist that can reduce clinical detereoration (2) It is an NMDAR antagonist because it is shown that elevanted glutamate can cause excitotoxcity via elevation of Ca2+

Question 33

Non-prescription COnsiderations fo AD

Answer 33

(1) Vitamin E and NSAIDS (2) Omega-3-Fatty Acids

Question 34

Gene associated with AD

Answer 34

ApoE4 variant

Question 35

Huntington’s DIsease (cause, symptoms, treatment type. treatment course)

Answer 35

(1) Mutation in Huntingtin gene (2)Affects mood. muscle coordination, cognitive decline, psychiatric problems (3) Treatment is symptomatic and not altering of the tcourse (4) Use of tetrabenazine which decreases monoamine function…. it decreases excessive movements…SSRI’s also useful for the psych symptoms

Question 36

ALS (name, nickname, cause, risk factors, Drug)

Answer 36

(1) Amyotropic Lateral Sclerosis (2) Lou Gerig’s DIsease (3) Insecticides, pesticides, smoking and service in the military (4) Riluzole …increase survival time by 2-3 months

Question 37

Multiple Sclerosis (theorized cuase, typical symptoms, drug action)

Answer 37

(1) Thought to reflect a chronic autoimmune attack on myelin in the brain, spinal chord and optic nerve (2) Motor problems, visual problems, cognitive dysfunction, emotional changes (3) Interferon beta works by increasing suppressor T-Cell function…Drugs can reduce severity and frequency of relapses and slow accumulation of disability.