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NAPLEX 25 > Chapter 69: Alzheimer's Disease > Flashcards

Chapter 69: Alzheimer's Disease Flashcards

(51 cards)

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1
Q

What characterizes dementia?

A

Severe decline in cognition affecting intellectual and social abilities, leading to impaired functioning

Initial symptoms often include memory loss.

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2
Q

List some signs of dementia.

A
  • Memory loss
  • Difficulty planning and organizing
  • Getting lost in familiar places
  • Repeating words and information
  • Difficulty finding words for common objects
  • Inability to learn or remember new information
  • Apathy and social disengagement
  • Delusions and agitation
  • Poor coordination and motor function

These signs can vary in severity among individuals.

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3
Q

What are the types of dementia?

A

Alzheimer’s disease, vascular dementia, Lewy body dementia

Clinical findings help characterize the specific type of dementia.

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4
Q

Which type of dementia is the most common?

A

Alzheimer’s disease

Alzheimer’s disease has well-defined treatment options, although the benefits are modest.

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5
Q

What are the neuropathologic changes associated with Alzheimer’s disease?

A
  • Amyloid beta plaques
  • Tau tangles

These changes lead to the death of cholinergic neurons.

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6
Q

What neurotransmitter is decreased in Alzheimer’s disease?

A

Acetylcholine

The death of cholinergic neurons results in this decrease.

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7
Q

What are common assessment tools for diagnosing dementia?

A
  • Folstein Mini-Mental State Exam (MMSE)
  • Montreal Cognitive Assessment (MoCA)
  • DSM-5 criteria

DSM-5 stands for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

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8
Q

What are reversible causes of memory impairment that initial screenings should rule out?

A
  • Vitamin D deficiency
  • Vitamin B12 deficiency
  • Depression
  • Infection

Identifying reversible causes can help in appropriate treatment.

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9
Q

What methods do clinicians use to determine the type of dementia a patient has?

A
  • Pattern of neurological deficits (patient symptoms)
  • Findings on brain imaging

These methods help to differentiate between types of dementia.

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10
Q

What are anticholinergics used to treat?

A
  • Oxybutynin for incontinence,
  • Diphenhydramine for allergies or insomnia,
  • Benztropine or diphenhydramine for dystonic reactions.
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11
Q

Fill in the blank: A drug with high anticholinergic potency can cause _______.

A

acute cognitive impairment

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12
Q

What are some examples of antipsychotics that can worsen dementia?

A

Aripiprazole, chlorpromazine

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13
Q

Name the CNS depressants categories of drugs that can worsen dementia?

A
  • Barbiturates
  • benzodiazepines,
  • opioids,
  • hypnotics,
  • skeletal muscle relaxants

CNS depressants can impair cognitive function and contribute to worsening dementia.

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14
Q

What is a common barbiturate that may worsen dementia?

A

Phenobarbital

Barbiturates are sedative drugs that can affect memory and cognition.

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15
Q

List two examples of benzodiazepines that can worsen dementia.

A

Alprazolam, clonazepam

Benzodiazepines are often used for anxiety but can have negative effects on cognitive health.

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16
Q

What are some examples of opioids that can worsen dementia?

A

Hydrocodone, morphine

Opioids are pain medications that can lead to cognitive decline in vulnerable populations.

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17
Q

What are hypnotics that can worsen dementia?

A

Eszopiclone, zolpidem

Hypnotics are used to treat sleep disorders and may negatively impact cognitive function.

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18
Q

What types of drugs have anticholinergic effects that may worsen dementia?

A
  • Antiemetics,
  • antihistamines,
  • central anticholinergics,
  • peripheral anticholinergics,
  • tricyclic antidepressants

Anticholinergic drugs can interfere with cognitive processes.

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19
Q

Provide an example of an antiemetic that can worsen dementia.

A

Prochlorperazine

Antiemetics are used to treat nausea but can have cognitive side effects.

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20
Q

Name two antihistamines that can worsen dementia.

A

Diphenhydramine, doxylamine

Antihistamines are commonly used for allergies but can impair cognitive function.

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21
Q

What are central anticholinergics that may worsen dementia?

Study These Flashcards
A

Benztropine

Central anticholinergics are used in various conditions but can affect memory and cognition.

22
Q

List two peripheral anticholinergics that can worsen dementia.

Study These Flashcards
A

Oxybutynin, dicyclomine

These medications are often used for urinary issues but can have cognitive side effects.

23
Q

What is an example of a tricyclic antidepressant that can worsen dementia?

Study These Flashcards
A

Amitriptyline

Tricyclic antidepressants can have anticholinergic effects that impair cognitive function.

24
Q

Name three natural products used for Alzheimer’s disease.

Study These Flashcards
A

Acetyl-L-carnitine, ginkgo biloba, vinpocetine

These supplements are often explored for their potential cognitive benefits.

25
What may happen to a patient receiving drug treatment for Alzheimer's compared to no treatment?
Slower clinical decline ## Footnote Patients may maintain independence in feeding and using the bathroom longer.
26
What is the primary treatment for all stages of Alzheimer's disease?
Acetylcholinesterase inhibitors (e.g., donepezil) ## Footnote Recommended first line in patients with mild to moderate disease.
27
Fill in the blank: In moderate to severe Alzheimer's disease, _______ may be added or used alone.
Memantine ## Footnote Combination therapy is more effective
28
What are the two amyloid beta-directed antibodies for treating mild Alzheimer's disease?
* Aducanumab (Aduhelm) * Lecanemab (Leqembi) ## Footnote They reduce amyloid beta plaques but clinical benefit is not well defined.
29
What type of antidepressant can be used to treat depression and anxiety in dementia patients?
Sertraline ## Footnote This is one example of an antidepressant that may be utilized.
30
What is the only FDA-approved antipsychotic for treating agitation associated with Alzheimer's disease?
Brexpiprazole (Rexulti) ## Footnote Other antipsychotics like olanzapine and quetiapine may be used off-label.
31
What is the MOA of acetylcholinesterase inhibitors?
They inhibit centrally-active acetylcholinesterase, the enzyme responsible for hydrolysis of acetylcholine.
32
Name acetylcholinesterase inhibitors used for the treatment of a AD?
1. Donepezil 2. Rivastigmine 3. Galantamine
33
Donepezil brand namr for ODT and tablet formulation?
Aricept
34
Donepezil brand name for patch?
Adlarity
35
Donepezil + Memantine brand name?
Namzaric
36
What should Donepezil be taken and why?
At bedtime to reduce nausea
37
How often is Adlarity patch applied for how long?
once weekly for 24h
38
Rivastigmine brand name?
Exelon
39
How often is Rivastigmine applied?
once daily for 24hr
40
What are some warnings associated with acetylcholinesterase inhibitors?
* **Cardiac** effects: **bradycardia**, AV block, syncope * GI effects: **nausea, vomiting, diarrhea**, weight loss, anorexia * Skin reactions: allergic contact dermatitis, SJS
41
Warning associated with Donepezil?
QT prolongation
42
What are common side effects of acetylcholinesterase inhibitors?
Insomnia, dizziness.
43
What should be done if treatment with acetylcholinesterase inhibitors is interrupted for ≥ 3 days?
Retitrate from starting dose.
44
How is adlarity patch stored?
refrigerator
45
True/false: Exelon patch should be removed before MRI?
True
46
When can a patient start Namzaric?
When stable on donepezil 10mg
47
What is the mechanism of action for Memantine?
Prevents glutamate from binding to the NMDA receptor, preventing overstimulation and neuronal death.
48
Memantine Brand name?
Namenda
49
What are the common side effects of Memantine?
Generally well-tolerated; can cause dizziness, confusion, headache, constipation.
50
What should be noted about the ER capsule of memantine and Namzaric?
Do not crush or chew; capsules can be opened and sprinkled on applesauce.
51
What are some drug interactions with acetylcholinesterase inhibitors?
* Caution with drugs that lower heart rate (e.g., beta-blockers) * Anticholinergic drugs can reduce efficacy * Increased gastric acid secretion, caution with GI bleeding risk

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