Medications

Question 1

Benefits to using atypicals over typical a

Answer 1

-better evidence base for efficacy and safety
-less Parkinsonism
-less EPS
-less TD
-lower risk of NMs

Question 2

When do you start AchI/ contraindications?

Answer 2

-dx of dementia made
-no absolute contraindications!
-no contraindications for chol.: cardiac,PUD,
-no contra. For memantine:
Cr clearance of <30

Question 3

How to monitor AchI tx

Answer 3

• use a measure of cognition
• use global measure of overall function

Question 4

Antidepressants with highest bleeding risk

Answer 4

Paroxetine
Sertraline
Escitalopram
Fluoxetine
Clomipramine

Vs

Buproprion
Mirtazapine
Nortriptyline

Question 5

RF for GI bleed with SSRI

Answer 5

Concurrent NSAID, anticoagulant or anti platelet
High SSRI antidepressant
Previous GI bleed
Liver cirrhosis
Older age

Question 6

List age related dynamic changes

Answer 6

-increased Bbb perm
-less ach
-less DA receptors
-increase MAO
-decreased baroreceptor response (more orthostasis)

Question 7

Kinetic chnages (age related and not)

Answer 7

-volume of distribution change
-decreased gastric acid
-decreased mesenteric blood flow
-decline in renal function

Non age related
Polymorphisms in 450 enzymes
Polypharm
Diet
Smoking
Alcohol
Medical Comorbidities

Question 8

5 factors that make older adults more vulnerable to central adverse effects of anticholinergic meds

Answer 8

-Less central muscarinic receptors
Increased permeability to BBB
-cognitive impairment
-reduced drug metabolism and clearance
-drug drug interactions due to Polypharm