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Psychopharmacology > Lecture 24: Geriatric Psychopharmacology > Flashcards

Lecture 24: Geriatric Psychopharmacology Flashcards

1
Q

what 3 things might a cure for alzheimer’s entail?

A
  1. terminate degeneration
  2. create new neurons
  3. enable correct rewiring
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2
Q

what age group is increasing the fastest?

A

the oldest old

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3
Q

since 1900, the % of Americans 65+ has ___, from _% to _%

A

tripled; 4.1 to 12.4

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4
Q

older adults make up _% of US population

A

13%

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5
Q

older adults account for _% of psychotropic prescriptions

A

25%

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6
Q

the average older adult takes __ medications daily and receives __ prescriptions per year

A

4.5, 13

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7
Q

older adults who are medically ill may be taking __ meds per day

A

9-10%

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8
Q

adverse drug reactions account for _% of all hospitalizations

A

10-30%

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9
Q

elimination half life might be __ as long

A

2x

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10
Q

sedative hypnotics, especially the long half life BZs, can be ___, causing what effects?

A

dementing

1. marked and prolonged loss of ability to form new memories

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11
Q

the motto

A

start low and go slow

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12
Q

% rate of inappropriate prescription use

A

20-40%

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13
Q

in patients taking 8+ meds, the incidence of inappropriate drug use is over _%

A

60%

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14
Q

most common inappropriate prescription

A

long lasting BZs

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15
Q

second most common inappropriate prescriptions

A

anticholinergic drugs (TCAs)

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16
Q

third most common inappropriate prescriptions (3)

A
  1. antihistamines
  2. skeletal muscle relaxants
  3. opioid narcotics
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17
Q

conclusion of inappropriate drug use

A

avoid drugs that cause cog inhibition, unwanted sedation, or bizarre behaviors/drug-induced delirium

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18
Q

standard medications for behavioral and psychological symptoms of dementia (BPSD)

A

atypical antipsychotic meds

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19
Q

BPSD symptoms (7)

A
  1. agitation
  2. aggression
  3. physical resistance/noncompliance
  4. psychosis
  5. depressive symptoms
  6. inappropriate sexual behavior
  7. sleep disturbances
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20
Q

what specific drug may be helpful for patients with BPSD?

A

abilify

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21
Q

only _% of seniors with depression see a mental health specialist each year

A

8%

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22
Q

adults 65+ account for _% of all suicides in the US

A

20%

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23
Q

what age group has the highest suicide completion?

A

adults 65+

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24
Q

2nd most common degenerative disease after AD

A

parkinson’s

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25
Q

PD occurs in _% of people 65-69 years old

A

1%

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26
Q

possible cause of PD

A

deficiency in number and function of DA-secreting neurons in SN

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27
Q

5 PD symptoms

A
  1. bradykinesia
  2. muscle rigidity
  3. resting tremor
  4. impaired postural balance
  5. mask like face
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28
Q

clinical symptos of PD occur when about __% of DA neurons are lost

A

80%

29
Q

four pharmacological approaches for PD

A
  1. DA replacement therapy
  2. dopa and DA breakdown inhibitors
  3. DA receptor agonists
  4. levodopa (L-dopa) precursor
30
Q

why can’t you simply supply DA to the brain?

A

does not cross BBB easily

31
Q

enzyme that turns dopa into dopamine

A

dopa decarboxylase

32
Q

problem with administering L-dopa

A

most of dopa is converted into nausea in body not brain, resulting in nausea and loss of brain precursor

33
Q

what does carbidopa do?

A

inhibits peripheral dopa decarboxylase without affecting enzyme in brain

34
Q

name of carbidopa available in combination with dopa

A

sinemet

35
Q

what does COMT do?

A

in GI tract and liver: converts dopa to inactive metabolite

36
Q

the half life and clinical effect of sinemet can be increased by adding what drug?

A

entacapone

37
Q

what does entacapone do?

A

inhibits COMT in the periphery but not in CNS

38
Q

COMT

A

catechol-o-methyltransferase

39
Q

combination of L-Dopa, carbidopa, and entacapone

A

Stalevo

40
Q

two types of MAO

A

MAO-A and MAO-B

41
Q

selegiline MoA

A

selectively and irreversibly inhibits MAO-B

42
Q

difference between MAO-A and MAO-B

A

MAO-B is more selective for DA; increases bioavailability of DA that remains

43
Q

3 benefitsof selective MAO-B inhibitors

A
  1. decreases dose of levodopa/carbidopa needed to control symptoms
  2. stops effects of levodopa/carbidopa from wearing off between doses
  3. increases length of time that l/c will continue to control symptoms
44
Q

how long after starting levodopa theory do patients become less responsive?

A

1-5 yrs

45
Q

two drugs that stimulate postsynaptic DA receptors directly

A

paramipexole and ropinirole

46
Q

most common neurodegenerative disease

A

AD

47
Q

cause of alzheimer’s

A

irreversible loss of cholinergic neurons that innervate cortex and hippocampus

48
Q

about __ american baby boomers will develop AD

A

10 million

49
Q

time between AD onset and death

A

8-10 years

50
Q

two definitive diagnostic markers in autopsy

A
  1. deposits of protein plaques

2. deposit of neurofibrillatory tangles (abnormal microtubules)

51
Q

MoA of most AD drugs

A

aim to restore cholinergic function; choinesterase inhibition

52
Q

two common AChE-I drugs

A

aricept (donepizil)

razadyne (galantamine)

53
Q

memantine MoA

A

moderate affinity, non competitive NMDAR antagonist; can reduce clinical deterioration in AD

54
Q

at high doses, memantine can cause ___

A

amnestic effects

55
Q

3 non prescriptions considerations for AD

A
  1. vitamin E
  2. NSAIDs
  3. omega 3 fatty acids
56
Q

__% of AD occurs in patients over 65 years

A

15-20%

57
Q

__% of AD occurs in patients over 80 years

A

45%

58
Q

genetic variant for AD

A

ApoE4

59
Q

huntington’s disease

A

rare degenerative disorder, caused by mutation in huntington gene (number of CAG/cytosine-adenine-guanine repeats in huntington gene)

60
Q

when does huntington’s become noticeable?

A

35-44

61
Q

treatment for huntington’s

A

tetrabenazine, decreases monoamine function

62
Q

tetrabenazine positive effect

A

decreases excessive movements (chorea)

63
Q

drug other than tetrabenazine that can be helpful for huntington’s

A

SSRIs

64
Q

lou gehrig’s disease

A

degeneration of upper and lower motor neurons leading to motor symptoms; amyotropic lateral sclerosis

65
Q

lou gehrig’s disease leads to death due to __ within __ years of diagnosis

A

respiratory failure

5 years

66
Q

3 risk factors for lou gehrig’s

A
  1. insecticides
  2. smoking
  3. service in military
67
Q

FDA approved drug for lou gehrigs

A

rilutek, increases survival time by 2-3 months

68
Q

multiple sclerosis

A

chronic autoimmune attack on myelin in brain, spinal cord, and optic nerve

69
Q

two drugs used for MS

A
  1. interferon beta; suppresses T-cell function

2. corticosteroids, prevent relapse

Psychopharmacology (22 decks)

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