Flashcards in Alzheimer's Disease Deck (54):
What is dementia?
A Grp of sx affecting intellectual and social abilities severely enough to interfere with daily functioning.
What's the most common type of dementia?
Which one of the tools used is NOT a diagnostic tool for AD? Whats it used for?
Mini-Mental State Exam (MMSE)
Score < 24 indicates dementia or some type of memory disorder
When is a definitive diagnosis of the actual cause and type of made?
From an autopsy
List the sx of AD?
Inability to leant or remember new info
Difficulty with planning and organizing
Poor coordination and motor functions
Paranoia, agitation, hallucination
Describe the pathophysiology of AD?
Neuritic plaques and tangles in brain tissue -> neuron signaling is interrupted
Alteration of neurotransmitters eg. Decreased Acetylcholine
List the drugs that can worsen dementia?
Peripheral anticholinergics (includi incontinence & IBS drugs)
Central anticholinergics (benztropine)
Antihistamines & antiemetics
Skeletal muscle relaxants
Other CNS depressants
What's the mainstay of AD tx?
Acetylcholinesterase inh eg. donepezil
How is Acetylcholinesterase inh eg. donepezil used in AD tx?
Alone OR with Memantine (for more advance dx)
What's the key pearl of use of Acetylcholinesterase inh eg. donepezil?
Although pts may not improve clinically, they may have a slower clinical progression vs. if they were not on therapy
What should be monitored for when Acetylcholinesterase inh eg. donepezil is used?
Both improvement and SE
How does one combat the nausea associated with Acetylcholinesterase inh eg. donepezil?
Timing may be modified to QHS
What can be used to treat associated depression of AD?
What can be used to treat delusion/anger ass. with AD?
But they increase the risk of death in elderly pts (increased stroke) and provides little benefits
List the natural pdts used for dementia
What's the concern with the use of ginkgo biloba for AD?
Can INCREASE bleeding risk
What class of drugs should be avoided in AD pts?
Drugs with anticholinergic properties ( or the lowest, useful dose be used)
MOA of Acetylcholinesterase inh
Inhibits CENTRALLY-active acetylcholinesterase, the enzyme responsible for hydrolysis (breakdown) of ach -> increase ACh.
List drugs that are Acetylcholinesterase inh.
Rivastigmine (Exelon, Exelon patch)
Galantamine (Razadyne, Razadyne ER)
What's the brand name for donepezil?
What's the dose for Donepezil (Aricept) for:
Mild-mod dx = 5-10mg QHS
Advanced dx = 23mg QHS
What med is often used in combo with donepezil (Aricept)?
What's the brand name for Rivastigmine?
Exelon, Exelon patch
What's the dose for Exelon? Exelon patch?
Exelon = 1.5-6mg BID
Patch = 4.6, 9.5, 13.3mg/ 24hr patch
Liquid = 2mg/ml
What's the brand name for Galantamine?
Razadyne, Razadyne ER
What's the dose of Galantamine (Razadyne) (tab and liq)? Razadyne ER?
Galantamine (Razadyne) = 4-12mg bid
Liq = 4mg/ml solution
ER = start at 8mg daily, then increase to 16-24mg
When is Acetylcholinesterase inh usually used?
In combo (with Memantine) for mod-severe AD
What are the SE of Acetylcholinesterase inh?
GI side effects - N/V/ loose stools
How can Donepezil (Aricept) be given to combat nause?
Given at QHS
Donepezil (Aricept) is usually give ONCE daily...how are the other Acetylcholinesterase inh given?
Rivastigmine (Exelon) & Galantamine (Razadyne) are BID
Which Acetylcholinesterase inh should be taken with food?
What can be recommended to decrease GI side effects?
MOA of Memantine?
Blocks NMDA (N-methyl-D-aspartate) which INH GLUTAMATE from binding to NMDA receptors -> reduce abnormal activation
What's the brand name of Memantine?
What type of AD is Memantine (namenda, namenda XR) used for?
Mod-severe AD (alone or in combo with Donepezil (Aricept))
What formulation of Memantine should be used with food?
Nemanda XR should be used with food or drink
List meds used for AD that should be taken with food
Memantine (namenda XR)
T/F? Memantine XR (namenda XR) caps can be opened and sprinkled on applesauce for use?
What's the usual dose of Memantin (Namenda)? How often should it be titrated?
5-10mg bid (titrate weekly)
What's the usual dose of Memantin XR (Namenda XR)? How often should it be titrated?
28mg daily (start at 7mg daily and titrate weekly)
How can namenda be switched to namenda XR?
Can switch from10mg bid to 28mg daily.
Begin XR the next day (not same day)
What are the SE of Memantine (namenda; XR)?
Use caution with drugs that lower heart rate. What drugs fall under the category?
Use caution with drugs that cause dizziness. What drugs fall under the category?
Skeletal muscle relaxant
What's the concern with concurrent use with drugs that lower HR and cause dizziness?
Risk of fall
How is Donepezil (Aricept) titrated?
Starts at 5mg QHS -> increase to 10mg after about 4weeks
How soon should acetylcholinesterase inh be titrated?
After about 4 weeks
Why is Donepezil (Aricept) started at night?
To combat ass. nausea
For Exelon (rivastigmine) patch, where should it be applied?
For Exelon (rivastigmine) patch, how often should the patch site be rotated?
Do not use the same site within 14 days
For Exelon (rivastigmine) patch, what sites should be avoided?
Skin that is hairy, oily, irritated, broken, scarred or calloused
Any area where cream, lotion, or power has been recently applied
Under tight clothes
When should the applied patch be removed?
After 24 hrs
How should the Exelon (rivastigmine) patch be removed?
Don't touch sticky side. Fold patch in half with sticky sides together