Lecture 24: Geriatric Psychopharmacology Flashcards
what 3 things might a cure for alzheimer’s entail?
- terminate degeneration
- create new neurons
- enable correct rewiring
what age group is increasing the fastest?
the oldest old
since 1900, the % of Americans 65+ has ___, from _% to _%
tripled; 4.1 to 12.4
older adults make up _% of US population
13%
older adults account for _% of psychotropic prescriptions
25%
the average older adult takes __ medications daily and receives __ prescriptions per year
4.5, 13
older adults who are medically ill may be taking __ meds per day
9-10%
adverse drug reactions account for _% of all hospitalizations
10-30%
elimination half life might be __ as long
2x
sedative hypnotics, especially the long half life BZs, can be ___, causing what effects?
dementing
1. marked and prolonged loss of ability to form new memories
the motto
start low and go slow
% rate of inappropriate prescription use
20-40%
in patients taking 8+ meds, the incidence of inappropriate drug use is over _%
60%
most common inappropriate prescription
long lasting BZs
second most common inappropriate prescriptions
anticholinergic drugs (TCAs)
third most common inappropriate prescriptions (3)
- antihistamines
- skeletal muscle relaxants
- opioid narcotics
conclusion of inappropriate drug use
avoid drugs that cause cog inhibition, unwanted sedation, or bizarre behaviors/drug-induced delirium
standard medications for behavioral and psychological symptoms of dementia (BPSD)
atypical antipsychotic meds
BPSD symptoms (7)
- agitation
- aggression
- physical resistance/noncompliance
- psychosis
- depressive symptoms
- inappropriate sexual behavior
- sleep disturbances
what specific drug may be helpful for patients with BPSD?
abilify
only _% of seniors with depression see a mental health specialist each year
8%
adults 65+ account for _% of all suicides in the US
20%
what age group has the highest suicide completion?
adults 65+
2nd most common degenerative disease after AD
parkinson’s
PD occurs in _% of people 65-69 years old
1%
possible cause of PD
deficiency in number and function of DA-secreting neurons in SN
5 PD symptoms
- bradykinesia
- muscle rigidity
- resting tremor
- impaired postural balance
- mask like face
clinical symptos of PD occur when about __% of DA neurons are lost
80%
four pharmacological approaches for PD
- DA replacement therapy
- dopa and DA breakdown inhibitors
- DA receptor agonists
- levodopa (L-dopa) precursor
why can’t you simply supply DA to the brain?
does not cross BBB easily
enzyme that turns dopa into dopamine
dopa decarboxylase
problem with administering L-dopa
most of dopa is converted into nausea in body not brain, resulting in nausea and loss of brain precursor
what does carbidopa do?
inhibits peripheral dopa decarboxylase without affecting enzyme in brain
name of carbidopa available in combination with dopa
sinemet
what does COMT do?
in GI tract and liver: converts dopa to inactive metabolite
the half life and clinical effect of sinemet can be increased by adding what drug?
entacapone
what does entacapone do?
inhibits COMT in the periphery but not in CNS
COMT
catechol-o-methyltransferase
combination of L-Dopa, carbidopa, and entacapone
Stalevo
two types of MAO
MAO-A and MAO-B
selegiline MoA
selectively and irreversibly inhibits MAO-B
difference between MAO-A and MAO-B
MAO-B is more selective for DA; increases bioavailability of DA that remains
3 benefitsof selective MAO-B inhibitors
- decreases dose of levodopa/carbidopa needed to control symptoms
- stops effects of levodopa/carbidopa from wearing off between doses
- increases length of time that l/c will continue to control symptoms
how long after starting levodopa theory do patients become less responsive?
1-5 yrs
two drugs that stimulate postsynaptic DA receptors directly
paramipexole and ropinirole
most common neurodegenerative disease
AD
cause of alzheimer’s
irreversible loss of cholinergic neurons that innervate cortex and hippocampus
about __ american baby boomers will develop AD
10 million
time between AD onset and death
8-10 years
two definitive diagnostic markers in autopsy
- deposits of protein plaques
2. deposit of neurofibrillatory tangles (abnormal microtubules)
MoA of most AD drugs
aim to restore cholinergic function; choinesterase inhibition
two common AChE-I drugs
aricept (donepizil)
razadyne (galantamine)
memantine MoA
moderate affinity, non competitive NMDAR antagonist; can reduce clinical deterioration in AD
at high doses, memantine can cause ___
amnestic effects
3 non prescriptions considerations for AD
- vitamin E
- NSAIDs
- omega 3 fatty acids
__% of AD occurs in patients over 65 years
15-20%
__% of AD occurs in patients over 80 years
45%
genetic variant for AD
ApoE4
huntington’s disease
rare degenerative disorder, caused by mutation in huntington gene (number of CAG/cytosine-adenine-guanine repeats in huntington gene)
when does huntington’s become noticeable?
35-44
treatment for huntington’s
tetrabenazine, decreases monoamine function
tetrabenazine positive effect
decreases excessive movements (chorea)
drug other than tetrabenazine that can be helpful for huntington’s
SSRIs
lou gehrig’s disease
degeneration of upper and lower motor neurons leading to motor symptoms; amyotropic lateral sclerosis
lou gehrig’s disease leads to death due to __ within __ years of diagnosis
respiratory failure
5 years
3 risk factors for lou gehrig’s
- insecticides
- smoking
- service in military
FDA approved drug for lou gehrigs
rilutek, increases survival time by 2-3 months
multiple sclerosis
chronic autoimmune attack on myelin in brain, spinal cord, and optic nerve
two drugs used for MS
- interferon beta; suppresses T-cell function
2. corticosteroids, prevent relapse
