Brainscape's Knowledge GenomeTM

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


See full index

Therapeutics III > Dementia - Block 2 > Flashcards

Dementia - Block 2 Flashcards

1
Q

What is the difference between delirium and dementia?

A

Delirium: attention and awareness, acute, reversible
Dementia: memory and cognitive function, slow, irreversible

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

What are the causes of delirium?

A
  1. Illness
  2. Infection
  3. Med
  4. Metabolic disorders
  5. Vitamin def
  6. Alcohol
  7. Hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Meds that can cause delirium?

A
  1. TCA
  2. Antihistamines
  3. Antipsych
  4. Benzo
  5. Sedatives
  6. Antiparkins
  7. Alcohol
  8. CS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is dementia?

A

Chronic syndrome of cognitive deficits that effect memory, intellectual, and behavioral functions

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

What are the types of dementia?

A

AD
VD
Lewy body
Parkinson

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

Chronic progressive neurodegenerative disorder that results from neurofibrillary tangles or beta amyloid plaques that interfere with cholinergic transmission and other neurochemical changes in the brain

A

AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A form of dementia that typically presents with Parkinsonian features as well as symptoms such as falls and hallucinations

A

LBD

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

Most common type of dementia? Prevalence?

A

AD; increases with age, affect women > men

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

What is the patho behind AD?

A
  1. Neurofibrillary tangles from hyperphosphorylated tau proteins
  2. Neuritic plaques from b-amyloid1-42
  • Loss in dendrites and synapses
  • Neuronal atrophy
  • Loss of cortical neurons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

WHat are the neuochemical changes in AD?

A

Cholinerigc: decrease Ach -> cognitive and memory deficits
Glutaminergic: decrease glutamate -> cognitive and memory deficits
Serotonergic: Degeneration of serotonergic nuclei due toneurofibrillary tangles -> behavioral changes and psychosis
Noradrenergic: affects info processing

Changes in 5-HT and NE -> depression

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

What is the genetic predisposition of early and later onset of AD?

A

Early: APP-chromosone 21
* Presenillin 1 (chromosone 1 and 14)

Later: >65YO
* ApoE4 (chromosone 19)

Down’s syndrome who live lon will most likely develop AD

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

What are the RF of AD?

A

1. Increased age
2. Down’s syndrome
3. Cormorbidities
4. Depression
5. Decreased brain activity

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

What are the clinical presentations of AD?

A

Onset: gradual
Progression: progressive
Age:
* Early: ≤65YO
* Late: ≥65 YO

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

What are the warning signs of AD?

A
  1. Memory loss
  2. Challenges in solving problems
  3. Difficulty completing familiar tasks
  4. Confusion
  5. Visual and spatial unawareness
  6. Problems with speaking and writing
  7. Misplacing things
  8. Poor judgement
  9. Social withdrawl
  10. Mood/personality changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the classification of mild AD?

A

MMSE: 21-30
* Cofusion
* Memory loss
* Personality changes
* Disorientaton

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

What is the classification of moderate AD?

A

MMSE: 10-20
* difficulty in completing everyday tasks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the classification of severe AD?

A

MMSE: ≤10
* Loss in speech
* Loss in appetite
* Loss in bladder control
* Caregiver dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do we diagnose or cassify AD?

A

DSM-V TR: lists the causes and functional thresholds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

WHat are your types of screening tools for cognitive impairment?

A
  1. Mini-cog
  2. MIS
  3. GPCOG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the issues of diagnosing AD?

A
  1. Insidious onset
  2. MUST ensure the problems are NOT due to other causes
  3. Important to diagnose or confirm diagnosis of AD as early as possible
  4. Diagnosis of exclusion (probable AD) until autopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the elements of a diagnostic work-up for AD?

A
  1. Cognitive family and med hx
  2. Mental status test (MMSE)
  3. Physical and neurological exams
  4. Lab
  5. Brain imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most commonly used mental status test?

A

MMSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the MMSE?

A

30 point test assessing orientation, memory, attention, recall, and lanuage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is FAQ?

A

Assessment of activities of daily living (completion of normal tasks)

Dependent in 3 or more activies -> impairment

0-30 possible score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the clock draw test?

A

CDT of 4 approximates a MMSE of near 30 or mild cognitive impairment
CDT of 2 suggests moderate impairment with MMSE scores in high teens.
CDT of 1 reflects moderate-to-severe scores on MMSE (low teens)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the therapeutic goals of AD?

A

Slow the progression of the dx:
1. Enhance QoL
2. Improve the ability to complete ADLs
3. Improve mood and behavior
4. Slow down cognitive loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When do we treat AD?

A

ASAP to maximize maintenance of cognitive function to carry ou ADLs
* Continue tx till they are bedridden or unable to carry out ADLs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the tx of AD?

A

Cognitive sx: AChEIs, NMDA receptor blockers
Behavioral sx: Non-pharm, pharm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are yor AChEIs?

A

Donepizil (Aricept)
Rivastigimine (Exelon)
Galantamine (Razadyne)

30
Q

Donepizil

PiT, CI, Dosing, ADR

A

PiT: mild-severe AD
CI: CV, asthma/copd, bleeding, sz, low body weight (<50kg)
Dosing: PO, patch, ODT
* Initial: 5 mg PO QD for 1 month
* Maintenance: May increase 10 mg after 4-6 weeks x 3 months, Increase 23 mg after 3 months

ADR: N/V/D, weight loss/anorexia, insomnia, bradycardia

31
Q

Does donepezil require dosage adjustment?

A

No, only for hemodialysis (2.3 mg -> 5mg)

32
Q

What are the counseling points for donepeziL?

A
  1. QHS to decrease nausea
  2. QAM if insomnia occurs
  3. Do NOT crush or chew the 23 mg tablets
  4. Let the ODT dissolve on your tongue then follow with water
  5. If patch falls off or a dose is missed, apply a new patch immediately and then replace this patch 7 days later to start a new one-week cycle.
33
Q

Rivastigmine

PiT, Dosing, ADR

A

PiT:Mild-mod AD 9(PO, patch)
* Severe AD (patch)

Dosing: PO 2-4 weeks dose adjustment, 4 weeks for patch
* If dosing is interrupted for > 3 days, re-titrate
* BID
* No dosage adj PO, hepatic adj for patch (4.6mg)

ADR:
* N/V/D, anorexia
* Insomnia
* Bradycardia

34
Q

Counseling points for rivastigmine?

A

PO: Take w/ food

Patch:
* less ADR
* QD same time everydaya
* Upper and lower back, chest, upper arm
* Rotate application site
* Don’t cut patches

35
Q

Galantamine

PiT,Dosing, ADR

A

PiT: mild-moderater AD
Dosing: 4 weeks adj
* IR BID, ER QD
* Hepatic and renal adj

ADR:
* N/V/D, anorexia
* Insomnia
* Bradycardia

36
Q

COunseling points for Galantamine?

A

Take w/ food
Oral solution may be mixed wih liquid, drink immediately

37
Q

Memantine

PiT, Dosing, ADR

A

PiT: mod-severe dementia
Dosing: QW adj
* Renal adj, avoid hemodialysis

ADR: D/Constipation, confusion, dz, HA, hyper-hypotension, coughing

38
Q

Counseling points for memantine?

A
  1. Take w or w.o food

ER: don’t crush or chew,
* Can be opened and sprinkled on applesauce

Oral solution:
* Do NOT mix with other liquids
* Use dosing device provided
* Squirt slowly into the corner of the mouth

39
Q

Namzaric

PiT, Dosing, Counseling

A

Mematnine + Donepezil
PiT: Mod-severe dementia
Dosing: weekly adj
* Renal adj for 5-29 mL/min

Counseling:
* Give with or without food
* Do NOT crush or chew
* May be opened and sprinkle on applesauce; take immediately

40
Q

What are you beta-amyloid mAb?

A

Aducanumab (Aduhelm)

Lecanemab (Leqembi)

41
Q

Aducanumab

BBW, PiT, Dosing, ADR

A

BBW: ARIA
PiT: mild dementia only w/ confirmed amyloid beta patho
Dosing: every 4 weeks (min: 21 days)
ADR: ARIA, angioedema, Uticaria, HA, falls, diarrhea

42
Q

Lecanemab

BBW,PiT, Dosing, ADR, DDI

A

BBW: ARIA
PiT: mild dementia only
Dosing: every 2 weeks
ADR: ARIA, inj site rx, HA, skin rash, D/N/V, aaphylaxis, angioedema
DDI: antiplatelets and anticoags

43
Q

How much Vit E can be given to AD patients?

A

Should not exceed >400IU/d

43
Q

How often should you reassess dx progression?

A

6 months

43
Q

How is AChEIs assessed?

A

ADAS-cog in patients with mild-mod AD for up to 1 yr compared to those on placebo or not tx

43
Q

When would we switch someone from AChEIs?

A
  1. Intolerance
  2. Clear deterioration of symptoms over the first 6 months
  3. Loss of response over time
43
Q

How effective is AChEIs?

A
  1. Slows cognitve decline
  2. Delay nursing home placement
43
Q

What do we use in patients with AChEI intolerance?

A

Memantine

43
Q

When do we DC AChEI?

A

Once a patient is bedridden or unable to complete ADLs

43
Q

According to ADAS-cog what is considered clinically significant?

A

> 4 points/yr change

44
Q

What constitutes successful tx according to MMSE? Unsuccessful?

A

Successful: <2 point/yr decline
Un: >2-4 point decline after 1 year

45
Q

What are examples of non-cognitive sx?

A
  1. Psychotic (hallucinations, delusions)
  2. Anxiety/Depression
  3. Sleep disturbances
  4. Behavioral disturbances
46
Q

How do we decide on a treatment for non-cognitive symptoms?

A
  1. Do the symptoms prevent the patient from functioning?
  2. Do the symptoms pose harm to the patient or those around the patient?
  3. Can the symptoms be managed with non-drug interventions alone?
47
Q

What are non-pharm tx for non-cog sx?

A
  1. Teach caregivers to reduce behavioral disturbances
  2. Utilize 3 Rs (Repeat, Reassure, Redirect)
  3. Utilize familiar routine
  4. Register patient to Azheimer’s association safe return program
48
Q

What is the cornerstone of treating behavioral sx?

A

Non-pharm

49
Q

How do we manage patients with AD?

A
  1. Let patient be independent
  2. Focus on enjoyment not achievement
  3. Safety, simplificcation, rouine
50
Q

What are the pharm tx for behavioral sx?

A
  1. Antipsychotics
  2. Antidepressants
  3. Mood stabilizers
50
Q

What are traditonal antipsychotics?

A
  1. Holoperidol
51
Q

What are ex of atypical antipsychotics?

A

Quetiapine, Olanzapine, Risperidone, Ariprazole, Clozapine

52
Q

What type of antipsychotic is preferred?

A

Atypicals: better ADR profile, less anticholinergic effects

53
Q

What are antipsychotics good for treating?

A

Hallucinations, delusions, aggression, suspiciousness

54
Q

What are antipsychotics not effective in treating?

A

Wandering, cognitive sx

55
Q

BBQ for antipsychotics?

A

The use of antipsychotics for
“Dementia with Psychotic/Agitated Features” is an “off label” use

BBW: Increased risk of death, not approved for dementia-related psychosis, must show risk vs benefits

56
Q

Most commonly used antidepressant for AD?

A

SSRI: Fluoxetine, paroxetine, sertraline, escitalopram, citalopram

57
Q

What is the preferred tx for non-cog sx?

A

SSRI

58
Q

When would trazodone be used?

A

Insomnia

59
Q

When would mirtazapine be used?

A

Weight loss

60
Q

What type of anti-anxiety med is preferred in elderly?

A

Short-acting Benzo: Alprazolam, Lorazepam, Oxazepam

61
Q

When would mood stabilizers be used?

A

Add-ons for patients not responding to antipsychotics

62
Q

Ex of mood stabilizers?

A
  1. Carbamazepine
  2. Trazodone
  3. Gabapentin
  4. Valproate
63
Q

When are antidepressant used used?

A

Depression, apathy, insomnia, decreased appetite

Therapeutics III (40 decks)

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