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Pre-reg > Dementia > Flashcards

Dementia Flashcards

1
Q

Name 3 drugs used for mild-moderate dementia
and their respective SE.
What class of drug are they?

A
  1. donepezil - neuroleptic malignant syndrome
  2. rivastigamine - GI side effects
  3. galantamine - stevens johnsons syndrome

acetylcholinesterase inhibitors - inhibit the breakdown of acetylcholine, increasing the levels

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2
Q

what are the parasympathetic SE associated with acetylcholinesterase inhibitors? DUMB BELS

A

Diarrohoea
Urinary incontinence
Muscle weakness
Bradycardia

Bronchospasam
Emesis
Lacrimation (flow of tears)
Salivation

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3
Q

what action should you take if a pateint presents with parasympathetic side effects?

A

stop the treatment
treat dehydration
ammend dose

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4
Q

what drug is given for worsening/severe dementia?

A

memantine

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5
Q

what drugs can be used to manage aggression in dementia patients?

A

benzodiazepines, antipsychotics

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6
Q

why is levodopa given with carbidopa/bensaerzide?

A

to rpevent breakdown before it crosses into the brain

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7
Q

what are the 3 side effects with initial treatment of levodopa?

A
  1. impulse disorders - gambling, binge eating, hypersexuality
  2. sudden onset of sleep
  3. red urine
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8
Q

what do you use to treat sudden onset of sleep with levodopa?

A

modafinil

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9
Q

name 3 non-ergot derived dopamine receptor agonists

A

pramipexole
ropinirole
rotigotine

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10
Q

name 3 SE of non-ergot derived dopamine receptor agonists

A

impulse disorders
sudden onset of sleep
hypotension

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11
Q

what class of PD drug is most likely to cause impulse disorders?

A

non-ergot dervied dopamine receptor agonists

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12
Q

what is used to treat hypotension caused by non-ergot derived dopamine agonists?

A

minodrin

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13
Q

give 2 examples of MAO B Is

A

rasagiline, selegiline

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14
Q

what are the 2 key interactions patients on MAO B Is need to be counselled on?

A
  1. hypertnesive crisis if given with phenlyephrine
  2. interacts with tyramine rich rich foods to cause hypertneisve crisis
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15
Q

name some foods rich in tyramine

A

mauture cheese
salami
tofu
marmite
yeasts

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16
Q

if a patient develops dyskinesia but is optimised on l-dopa what are the options for adjuvant therapy?

A
  1. adding a monoamine oxidase B inhibitor or non-ergot dopamine agonist
  2. adding a COMT inhibitor
17
Q

name 2 COMT inhibitors and what are their SEs?

A
  1. entacapone - red/brown urine
  2. tolcapone - hepatotoxic

both increase sympathetic SE = increase risk CVD events (tachycardia, fast breathing)

18
Q

a patients motor symtpoms are uncontrolled with a non-ergot derived DA agonist and levodopa, what is an alternative adjuct therapy?
give 2 examples

A

ergot derived dopamine agonists
carbergoline, bromocriptine

19
Q

what are the side effects of ergot derived dopamine agonists you need to counsel patients on?

A

pulmonary reactions = SOB, chest pain, cough
pericardial reactions = chest pain

20
Q

T/F. You can withdraw patients PD meds abruptly?

A

false

21
Q

what intervention could you make if a patient is having off periods?

A

switch to modified release

22
Q

whats the first and second line treatment for nocutnal akinesia?

A

1st = levodopa or oral dopaine agonists
2nd = rotigotine

23
Q

what are the postive and negative symptoms of SZ?

A

postive = delusions, hallucinations, disorganisaiton
negative = poor hygeine, neglect, social withdrawl

24
Q

name 5 2nd generation antipsychotics

A

aripiprazole, olanzapine, clozapine, risperidone, quetiapine

25
Q

name 3 group 1 antipsychotics (1st gen, phenothiazines)
what does their side effect profile look like?

A

levomepromazine
promazine
chlorpromazine

SE = most sedation, moderate antimuscarininc, EPSEs

26
Q

name a group 2 antipsychotic, whats its SE profile?

A

pericyazine
SE = moderatr sedation, least EPSEs

27
Q

what group of antipsychotics has the most EPSEs?
give 3 examples

A

1st gen, group 3 antipsychotics
e.g. = fluphenazine, prochlorperazine, trifluoperazine

28
Q

what is it bad to sue antipsychotics in PD?

A

becuase antipsychotics reduce the levels of dopamine whereas in PD you want to increase the amount of DA

29
Q

in which antipsychotic is hyperprolactinamie least likely?

A

aripiprazole

30
Q

which antipsychotic has the least side effects?

A

aripiprazole

31
Q

what antipsychotics have the highest risk of CV effects?

A

haloperidol, pimozide

32
Q

what antipsychotics have the highest risk of hyperglycaemia? CiROQ

A

Clozapine
Risperidone
Olanzapine
Quetiapine

33
Q

what antipsychotics cause the most weight gain?

A

clozapine, olanzapine

34
Q

whats the management for neuroleptic malignant syndrome with antipsychotics?

A

stop treatment
treat with bromocriptine
should resolve in 5 - 7 days

35
Q

what are the monitoring and intervals for antipsychotics?
(weight, fasting glucose HbA1c, ECG, BP, FBC + U&E + LFTS)

A

weight = at start, weekyl for 6/52, at 12 weeks, at 1 year, then annually

fasting glucose, HbA1c, lipids = at start, at 12 weeks at 1 year, then annually

ECG = before initiation

BP = at start, at 12 weeks, at 1 year, then annually

FBC = start then yearly

36
Q

when can a pt try cloazpine?

A

when 2+ antipsychotics have been tried for 6 - 8 weeks ( one has to be a 2nd gen)

37
Q

how many doses does a patient have to miss before clozapine is restarted by a specailsit?

A

more then 2

38
Q

what are the monitoring requirements for clozapine?

A

leucocytes
weekly for 18/52
fortnightly for 1 year
then monthly until stop
once stopped do 1 month after

39
Q

what are the 3 main side effects of clozapine? MAG

A
  1. myocardidits, cardiomyopathy (report and stop on tachycardia)
  2. neutropenia and agranulocytosis
  3. constipation - refer to A&Em

Pre-reg (47 decks)

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