Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Neurology > Pharm - Cognitive Disorders > Flashcards

Pharm - Cognitive Disorders Flashcards

1
Q

Alzheimer’s Dementia

A

• May start with mitochondria dysfunction, the change in ATP causes an excessive phosphorylation of the tau protein. Accumulation of Amyloid Beta. The amyloid plaques accumulate and cause an activation of microglia and subsequent release of pro-inflammatory cytokines. The cytokine and inflammatory response causes the death of neuron.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Alzheimer’s Dementia

Agitation / aggression

A

Atypical anti psychotic drugs (risperidone, lanzepine, quetiapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Alzheimer’s Dementia

Depression

A 
SSRIs (sertraline, fluoxetine) preferred 
Tricyclic antidepressants (use with caution)(nortryptyline, tryptyline)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Alzheimer’s Dementia

Psychosis

A

Hallucinations
Quetiapine, olanzepine, risperidone

Delusions
Atypical anti psychotic drugs
Haloperidol

Haloperidol – a typical antipsychotic, high profile of pyramidal side effects
akinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Alzheimer’s Dementia

Sleep disorders

A

Treated with H1 blockers (promethazine) Sedatives, promethazine etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Alzheimer’s Dementia

Dimentia

A

Cholinesterase inhibitors (increase ACh, boosting cholinergic transmission) ONLY MILD TO MODERATE DEMENTIA

Donepezil,(must cross BBB)
Well tolerated
Relatively lower affinity for peripheral cholinesterase
Long plasma T ½ (once a day dosing)
Improves cognition
Cholinergic side effects may appear (diarrhea, nausea and vomiting

Rivastigmine
Effective in patients with mild to moderate AD
Toxicity: Significant nausea vomiting, head aches, anorexia
Must be administered with food

Galatamine
Slows the decline in cognition
Improves quality of daily activity
GI disturbances (anorexia, vomiting nausea diarrhea and weight loss)
Effective  in mild to moderate AD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Frontotemporal Dementia (FTD)

A

Focal degeneration of the temporal and frontal lobes
Prevalence: 50 to 60 years,

Abnormalities with 5HT and Dopamine, cholinergic system conserved

Characterize by changes in personality, social behavior or language, progressing to global dementia affecting cognitive domains

Some patients may show extrapyramidal or motor neuron involvement
Abnormal tau or pathologic TDP43 protein aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Frontotemporal Dementia

Treatment

A

SSRI
sertraline, paroxetine, and fluvoxamine improve anxiety, eating disorders and impulsive repetitive behavior

Anti psychotic agents (only as a last resort)
Atypical anti psychotic agents at low doses
Quetiapine, olanzepine and aripiprazole

Cholinesterase inhibitors (not effective in FTD). Why? The Cholinergic system is spared

Would drugs such as Bapineuzumab (Aβ antibody) be effective in FTD? Why or why not? No because there is no development of amyloid plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lewy Body Dementia

Clinical manifestation

A

Visual hallucinations
Parkinsonism, Cognitive fluctuations, Dystonia
Sleep disorders, Neuroleptic sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lewy Body Dementia

Treatment

A

Cholinesterase inhibitors
Rivastigmine, donpenzil, galatamine

Atypical anti psychotic drugs
Anti Parkinson’s drugs
Others: REM sleep disorders (Clonzepam, quetiapine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vascular Dementia
2nd only to Alzheimer
Characteristics

A

Large artery infarcts (cortical & sub cortical locations)

Small artery infarctions (exclusively sub cortical esp. to basal ganglia, caudate, thalamus internal capsule)

Chronic ischemia in the periventricular areas
Risk factors: Diabetes, disorders of lipid metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of dementia

A

Rivastigmine
Donepezil
Galantamine
Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of Delirium

A

Antipsychotics

Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The most direct cognitive disorders include:

A

Amnesia
Dementia
Delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Attention-deficit/hyperactivity disorder (ADHD)

A

(Clinical) Manifestations
Inattention, hyperactive, impulsive behavior, seemingly in constant motion
Easily distracted, excessively talkative

Blame it on the mother risk factors:
Risk factors
Maternal drug use during pregnancy (alcohol, smoking)
Premature birth, genetics
Maternal exposure to environmental toxins e.g. poly chlorinated biphenyls (PCPs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of ADHD

A

methylphenidate, dextroamphetamine, lisdexamfetamine

17
Q

Methylphenidate

A

Treatment of ADHD

Mechanism of action: acts on the brain stem arousal system, inhibits reuptake of norepinephrine and dopamine
Clinical applications: Effective for management of attention deficit hyperactivity disorder
Adverse effects: May cause weight loss, decrease appetite, insomnia, addiction and
- mania

18
Q

Treatment of ADHD

Dextroamphetamine and lisdexamfetamine

A

Mechanism of action: sympathomimetic, increase norepinephrine and dopamine transmission in the brain.
Clinical applications: ADHD and narcolepsy
Adverse effects : may cause myocardial infarct, tachycardia, sudden cardiac arrest, seizures, anaphylaxis etc

19
Q

Treatment of ADHD

Atomoxetine:

A 
selective norepinephrine (NE) reuptake inhibitor only, may increase transmission at NE synapses in the brain
Indicated for management of ADHD
May prolong QT interval, seizures, priapism, sudden cardiac death, angioedema etc
20
Q

Treatment of ADHD

Desipramine

A

block reuptake of norepinephrine and serotonin in the brain
Used for the management of depression and ADHD in children

May cause fatigue, dizziness, somnolence, cardiac complications (including sudden cardiac arrest, myocardial infarction)

Neuroleptic malignant syndrome has been reported, suicidal thoughts, hepatitis and jaundice

21
Q

Treatment of ADHD

Clonidine and guanfacine

A

Clonidine and guanfacine: centrally-acting 2 adrenergic receptor agonist

Clinical applications: used for management of ADHD adjuncted with other treatment options

May cause bradyarrhythmias, peeling of skin (guanfacine), atrioventricular block (clonidine), xerostomia, somnolence (clonidine)

22
Q

Treatment of ADHD

Bupropion

A

Bupropion: weakly inhibits neuronal reuptake of norepinephrine and dopamine (but not serotonin reuptake)

Clinical uses: smoking cessation assistance, bipolar disorders, and ADHD

May cause agitation, arthralgia, arrhythmias, xerostomia, suicidal thoughts, mania and Stevens-Johnson syndrome

23
Q

Delirium

A

Definition
Acute, transient fluctuating disturbances in attention, and consciousness level
Causes
Drugs (#1 alcohol abuse), anti emetic, anti histamines, anti cholinergic, psychoactive drugs and opioids)
Idiopathic in about 10 to 20% of patient

Encephalitis, meningitis, thiamin or vitamin B12 deficiency
Withdrawal syndromes: alcohol, barbiturates and opioids

24
Q

Delirium Treatment

A

Remove aggravating factors (e.g. stopping drug, treating infection)
Maintain a well lit, stable and quiet with visual cues for patient orientation e.g. clocks, calendar family photos etc

Haloperidol to decrease agitation and improve psychotic symptoms
Risperidone , olanzapine (fewer extrapyramidal adverse effect)
Lorazepam may also be used (tranquilizer that brings down aggitation)

Clinical Neurology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions