Exam 1: Dementia

Question 1

Medications for memory

Answer 1

ACHEi
Memantine
anti-amyloid (new)

Question 2

treatment for behavior

Answer 2

non-pharm
antidepressants
anxiolytics
antipsychotics (BBW)
antiepileptic drugs

Question 3

treatment for sleep changes

Answer 3

TCA
benzo
sedative/hypnotics
antipsychotics (BBW)

Question 4

ACHEi cholinergic ADR

Answer 4

SLUDGE
Salivation
Lacrimation
Urination
Defecation
GI
Emesis

Question 5

ACHEI CNS ADR

Answer 5

headache, insomnia, vivid dreams

Question 6

ACHEi Cardiac ADR

Answer 6

bradycardia, syncope, heart block, hypotension

Question 7

AVOID PROPANOLOL WITH

Answer 7

Donepezil, rivastigmine, galantamine ,

Question 8

ACHEi GI ADR

Answer 8

anorexia, weight loss

Question 9

ACHEI contraindication

Answer 9

baseline bradycardia

Question 10

Donepezil use

Answer 10

mild-severe AD
5/10/23 mg
no renal/hepatic adjustment
less GI ADR
more sleep disturbances
not too pricy

Question 11

Donepezil PKPD

Answer 11

long half life 72h
CYP 2D6, 3A4 substrate

Question 12

Donepezil ADR

Answer 12

bradycardia
rhabdomyolysis/neuroleptic malignant syndrome (RARE)

Question 13

Rivastigmine capsule use

Answer 13

mild-severe AD
mild-moderate Parkinsons

Question 14

Rivastigmine capsule dosing

Answer 14

start low go slow - poor tolerability
1.5 mg BID, increase by 3mg Q2w

Question 15

Rivastigmine capsule ADR

Answer 15

GI disturbances during dose adjustment
- food increases AUC/helps w. upset

Question 16

Rivastigmine capsule PKPD

Answer 16

Not metabolized by CYP2D6/3A4
short half life 2hr

Question 17

Rivastigmine patch use

Answer 17

mild-severe AD

Question 18

Rivastigmine patch dose

Answer 18

4.6mg/24h increase to 13.3mg
low dose if hepatic impariment/low body weight <50kg

Question 19

Rivastigmine patch ADR

Answer 19

site reactions
less GI upset

Question 20

Galantamine use

Answer 20

mild-moderate AD
not for ESRD or severe hepatic

Question 21

Galantamine PKPD

Answer 21

moderate half life
metabolized by 2D6 3A4

Question 22

ACHEi rules

Answer 22

d/c other anticholinergic drugs
Monitor ADR
reduce if intolerable
switch agent
if nausea, w/food or QHS

Question 23

Memantine use

Answer 23

NMDA receptor antagonist
for memory
mod-severe AD

Question 24

memantine PK

Answer 24

long half-life
no food effect
CL reduced by alkaline urine (watch diet changes)

Question 25

memantine cautions

Answer 25

seizure disorder CV disease

Question 26

Memantine ADR

Answer 26

CV CNS: Confusion, dizziness GI: constipation urinary incontinence

Question 27

Memantine ER + Donepezil combo use

Answer 27

must be titrated to/stable on donepezil 10mg before starting

Question 28

aducanumab use

Answer 28

expedited approval MCI or mild dementia due to AD

Question 29

Lecanemab

Answer 29

full approval "disease modifying"

Question 30

Donamemab

Answer 30

expected approval soon

Question 31

ARIA

Answer 31

H = hemorrhages E = edema dose titration reduces risk loss of vessel integrity by removal of amyloid plaques resolves in 4 months of detection

Question 32

amyloid mab caution

Answer 32

ARIA hypersensitivity

Question 33

antipsychotics BBW

Answer 33

risk of death + CV side effects use lowest dose/shortest duration

Question 34

Antipsychotic efficacy

Answer 34

1. risperidone 2. apriprazole 3. olanzapine 4. quetiapine

Question 35

GDR

Answer 35

gradual dose reduction for antipsychotics, sedatives/hypnotics, and other CNS medications Within 1 year of admission attempt annually