MOC Exam#7 Flashcards
Characteristics of Neurocognitive Disorder with Lewy Bodies
- depression prior to onset of memory problems
- fluctuating cognitive performance
- visual hallucinations early in illness
- Parkinsonian symptoms in 70-90%
fluctuating cognitive performance is associated with Parkinson’s disease, Alzheimer’s disease. TRUE or FALSE
FALSE
Bipolar disorder, hirsutism, __________
Valproic acid
The four elements that must be proven present for malpractice to be found
The 4 D’s:
- duty
- dereliction
- damages
- direct cause
The best pharmacological treatment of illness anxiety disorder
- SSRI
- significant rates of remission
Hallmark symptoms of Lewy Body Disease
- vivid visual hallucintations
- fluctuations in levels of alertness (confusion)
- spontaneous Parkinsonism
- onset of cognitive symptoms within 1 year of motor symptoms
Hallmark of neurocognitive disorder due to frontotemporal lobar degeneratiion
-prominent behavioral problems
Rates of Alzheimer’s Disease with age
- 5%-8% over age 65y
- 15%-20% over age 75y
- 25%-50% over age 85y
Association between depression and Alzheimer’s Disease
- people with depression are more vulnerable to AD
- patients with AD tend to have fluctuation symptoms of depression unlike pts without AD
REM Sleep Behavior Disorder (RSBD)
- often associated with “synucleinopathies, Parkinson’s Dz, Lewy Body
- “acting out” on dreams due to lack of normal atonia associated with REM sleep
Features of neurocognitive disorder due to frontotemporal lobar degeneration (FTD)
- apathetic, lacking initiative without reporting depressed mood or anhedonia
- early changes in interpersonal and social behaviors without cognitive symptoms
Features of Creutzfeld-Jakob Disease
- rapidly progressive neurocognitive disorder
- caused by prion
- “spongiform encephalopathy”
- myoclonus
- EEG PERIODIC SHARP WAVE COMPLEXES
- MRI BASAL GANGLIA HYPERINTENSITIES
- CSF positive for protein 14-3-3
Decreased ceruloplasmin levels
- Wilson’s Dz
- disorder of copper metabolism causing hepatoxicity and neurotoxicity in young adults
Neurocognitive Disorders associations:
- Motor Slowing
- Constructional deficits
- Benefit from structural support/cueing
- Impaired semantic fluency and naming
- Perseverative, imitative, utilization behaviors
-Motor Slowing: LEWY BODY
-Constructional deficits: LEWY BODY
-Benefit from structural support/cueing: VASCULAR
-Impaired semantic fluency and naming: ALZHEIMER’S DISEASE
-Perseverative, imitative, utilization behaviors:
FRONTOTEMPORAL
Characteristics of SIADH
- normal to high blood volume
- low serum sodium
- inappropriate excretion of sodium
Psychotropic medications causing SIADH
- Tegretol (Carbamazepine)
- phenothiazines
- TCA’s
- MAOI’s
Which SGA’s are dosage adjustment for renal function recommended?
- Clozapine
- Paliperidone
- Risperidone
- Lurasidone
Which amyloid beta (Abeta) peptide is more pathogenic in Alzheimer’s disease?
Abeta1-42 is more proned to aggregation therefore more pathogenic
Lifetime risk of Alzheimer’s Disease
- at age 65y 9.1% for males, 17.2 % females
- at age 75y 10.2%, 18.5%
- at age 85y 12.1%, 20.3%
Preferred mood stabilizer for rapid-cycling bipolar disorder
-Valproic acid
Risk of SGA’s in elderly
- sensitivity to EPS
- increased risk of stroke
Changes in sleep/wake cylce associated with neurocognitive disorders
- increased fragmentation of sleep
- increased latency for onset of sleep
- decreased sleep efficiency
- decreased total sleep time
- decreased slow-wave sleep
- sleep cycle reversal
- napping during the day
- wandering
- disorientation
- sundowning
The only FDA approved combined oral contraceptive pill for treatment of PMDD
Drospirenone/ethinyl estradiol
Treatments for PMDD
- SSRI’s
- Drospirenone/ethinyl estradiol
Drowsiness the next day is a function of elimination half-life of sleep meds. List the elimination half-life of the following:
- Zaleplon
- Zolpidem
- eszopiclone
- Temazepam
- Flurazepam
- Zaleplon 1h
- Zolpidem 2.6h
- eszopiclone 6h
- Temazepam 8-22h
- Flurazepam 40-250h
Time needed to clear all alcohol once drinking has stopped
12 h
What are the maximum number of points on CIWA
67
CIWA scores and levels of withdrawal
8 or less- mild
9 to 15- moderate
greater than 16- severe
What are the single-day and weekly limits for alcohol use for a healthy adult male under 65 y
-no more than 4 drinks on any day and no more than 14 drinks per week
What are the single day and weekly limits for alcohol use for healthy men and women over age 65y
-no more than 3 drinks on any day and 7 drinks per week
