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Geriatrics > Dementia Treatment > Flashcards

Dementia Treatment Flashcards

1
Q

What are the non-pharmacologic treatment of dementia?

A

Communication is kept simple and direct
Calmness, firmness, and supportiveness in times of difficulty
Consistent and calm envireonment
Use of frequent reminders, explanations and orientatons
Adjust as patient gradually declines

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2
Q

What are the treatments for cognitive sx?

A

Cholinesterase inhibitors and memantine

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3
Q

What are the treatments for non-cognitive sx?

A

Symptomatic psychiatric treatment

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4
Q

What are non-cognitive sx?

A

Psychosis and behavioral disturbances

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5
Q

What is the MOA of cholinesterase inhibitors?

A

Blocks the acetylcholinesterase enzyme on the post-synaptic membrane, that normally breaks down acetylcholine, allowing for more acetylcholine in the post-synaptic cleft

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6
Q

How does efficacy vary across the cholinesterase inhibitors?

A

It does not. Relatively similar across class

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7
Q

When do we recommend a trial of cholinesterase agents?

A

Patients with AD, vascular, mixed, Lewy Body, or Parkinson’s dementias

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8
Q

What are the common ADRs of cholinesterase inhibitors?

A

N/V/D
Anorexia
Can also cause incontinence, dizziness, and insomnia

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9
Q

What does vagotonic mean?

A

Causes bradycardia, heart block and syncope

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10
Q

What is donepezil indicated for?

A

Severe AD

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11
Q

What is rivastigmine indicated for?

A

PD

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12
Q

Which cholinesterase inhibitors are not metabolized via cyp450?

A

Rivastigmine

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13
Q

Which cholinesterase inhibitor must be renally adjusted?

A

Galantamine

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14
Q

What is memantine indicated for?

A

Moderate to severe AD; possibly effective for mild to moderate AD

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15
Q

What are common ADRs of memantine?

A

Dizziness
HA
Constipation
Somnolence

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16
Q

What is the brand name of the combination product donepezil/memantine?

A

Namzeric

17
Q

How is namzeric available?

A

10/14 mg (for CrCl 5-29)

10/28 mg ER

18
Q

What are therapeutic considerations for vascular disease?

A

BP control
Treatment of dyslipidemia, homocysteinemia, and hyoerglycemia
Low dose ASA

19
Q

What class of medications should be offered to patients with mild to moderate AD and may be helpful for patients with severe AD?

A

ChEIs

20
Q

Which class of medications should be considered for patients with mild to moderate dementia associated with PD?

A

ChEIs

21
Q

Which class of medications should be considered for patients with dementia with Lewy Bodies?

A

ChEIs

22
Q

Which class of medications may be considered in moderate and severe AD?

A

Memantine

23
Q

What type of dementia does memantine have limited evidence for?

A

Vascular

24
Q

When is combination therapy considered?

A

Moderate-severe dementia
Those who have not had great clinical benefit with monotherapy ChEI
Those who cannot tolerate ChEI

25
Q

When is combination therapy in mild dementia considered?

A

Patients who choose to take the added risk of ADRs and take on the extra cost for the potential added benefit

26
Q

What were the results of studies of ChEIs in VD?

A

Clinical benefit is uncertain

27
Q

Why are ChEIs used in VD?

A

Due to the high association with AD diagnosis

28
Q

What were the results of studies of memantine in VD?

A

Some benefit but few with short duration

29
Q

What are the benefits of using ChEIs in Lewy Body dementia?

A

May represent 1st line therapy as cholinergic deficits occur in this condition as well

30
Q

What does conflicting data show for the use of ChEIs in Lewy Body Disease?

A

Notes worsening cognitive function, REM sleep disorder, or Parkinsonism with these agents

31
Q

What does conflicting data show for the use of memantine in Lewy Body Disease?

A

Note worsening of delusions and hallucinations

32
Q

What is the cornerstone of dementia therapy in PD?

A

ChEIs

33
Q

How can ChEIs be discontinued in PD?

A

Should be tapered off to avoid sudden cognitive and neuropsychiatric sx

Geriatrics (15 decks)

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