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Flashcards in geri Deck (37):
1

Cure for Brain Aging might entail

(1) Termination of degeneration (2) Creation of new Neurons (3) Enable correct re-wiring

2

Immediate research goals for geriatric psychpharm

(1) Retard rate of decline (2) Prevent or retard onset

3

Potential issues with Geriatric PsychPharm

(1) Polypharmacy (2) Adverse Drug Reactions (3) Inappropriate Meds (4) No treatment (5) Non-compliance (6) Impaired drug metabolism

4

% of older adults in population and % of prescriptions given to older adults

13% in population--recieve 30% of all prescriptions

5

General principle in prescribing drugs

Start low and go slow

6

Reason for start low and go slow

Often the elemination half-lives are longer in older people which means they stay in the body longer. Repeated dosages can lead to a high steady state.... Especially with sedative-hypnotics, these effects can dribble over into the following day causing continued impairment

7

Common problem for diagnosis in depression and anxiety

Underdiagnoses

8

Main drugs to avoid for older patients

(1) Ones that cause cognitive inhibition (2) Unwated sedation (3) Bizarre Behaviors

9

BPSD

Behavioral and Psychological Symptoms of Dementia

10

Typical treatment for BPSD

Atypical antipsychs [Abilify best]

11

BPSD Symptoms

Agitation, aggression, noncompliance with care, psychosis, depressive symptoms, inappropriate sexual behavior, sleep disturbances

12

Problem with prescription of antipsychs in geriatic

Many eldery patients are placed in anti-psychs without any clear reasoning (no diagnoses psychosis or dementia)

13

Depression and Older

65+ account for 20% of all suicides with a high completion rate. Best treatment: antidepressants/psychotherapy

14

Non-prescription approaches to some aging related problems

(1) Exercise (2) Healthy diet (3) Deep breathing (4) Omega 3 FA (5) Cogntitive behavioral therapy (6) Vitamins D,E, Q10 (7) Yoga laughter

15

Why side effects result

(1) Polymorbidity can lead to polypharmacy which can cause side effect (2) Decreased organ function can cause changes in pharmacodynamics and decrease homeostatic functions... which can cause side effects

16

Trend between number of drugs and ADR's

More drugs= more ADR

17

Trend between # of prescribing physicians and ADRs

More physcians= more ADR

18

Prevalance of Parkinson's Disease

1% of people 65-69

19

Cause of Parkinson's Disease

Symptoms result from a deficency in the # and functioning of DA-secreting neurons in the substantia nigra

20

What are two DA pathways in vertebrate brain?

Substantial Nigra for motor and DA from VTA from fortal lobes and limbic systems

21

Three approaches to treating PD

(1) Replace DA using precursors (2) Deminish breakdown of DA (3) DA receptor agonist

22

Clinical symptoms of 80% DA loss

Bradykinesia, muscle rigidity, resting tremor, impaired postural balance

23

Potential enviornmental cause of PD

Tri-chloro ethylene

24

Process for how Dopa becomes Dopamine

Dopa can be impacted by the enzyme dopa decarboxylase into becoming Dopamine

25

Levodopa (Problem, Solution, Combination)

Problem is that Dopa is converted to Dopamine all around the body including the gut. THe solution is using a drug carbidopa which inhibits peripheral Dopa decarboxylase without impacting the brain's own reserves. A combination treatment is known as Sinemet with both carbidopa and Dopa.

26

COMT

catechol-o-methyltransferase

27

COMT inhibitors (purpose)

Seen as way to inhibit the conversion of Dopa into an innactive metabolite... WHich increase the on-time of the drug

28

Selective MAO-B Inhibitors (theoretical importance, drug used, efficacy)

Enzyme MAO exists in two forms (A and B). The MAO-B form is more selective for DA. Thus the drug used SELEGILINE is able to selectively and irresversibly inhibit MAO-B from breaking down the DA. This increase the bioavailability of DA.... allows for decreased amount of Levodopa/Carbidopa needed to control sympmtoms. It also stops the effects of levodopa from wearing off between dosages and increase length of time levodopa can continue to be fficacious

29

DA receptor agnoist (when used, types of drugs)

Used 1-5 years after starting levodopa therapy due to less response from the patient. Two drugs (Paramipexole and Ropinirole are marketed in the US)

30

Alezheimer's Disease (Structural changes, DIagnosis to Death time span, markers for postmortem assesment of AD)

There is characteristcally loss of cholinergic neurons that innervate the cortext and hippocampus...The time between symptom onset and death is 8-10 years..definitive diagnosis at atopsy is based on deposits of protein plaques (Beta amyloid) and neurofibrillatory tangles (abnormal microtubules)

31

AChE-1 (Name, Reason for use in AD, efficacy?, common drugs)

(1) acetyl Cholinesterase inhibition (2)AD associated with loss of cholinergic neurons (3)slow cognitive decline somewhat but no strong effects (4) Common drugs are donepizil (Aricept) and Galantamine (Razadyne.)

32

Memantine (what it is, reason for use, efficacy)

(1) Moderate affinity, non-competitive, NMDAR antagonist that can reduce clinical detereoration (2) It is an NMDAR antagonist because it is shown that elevanted glutamate can cause excitotoxcity via elevation of Ca2+

33

Non-prescription COnsiderations fo AD

(1) Vitamin E and NSAIDS (2) Omega-3-Fatty Acids

34

Gene associated with AD

ApoE4 variant

35

Huntington's DIsease (cause, symptoms, treatment type. treatment course)

(1) Mutation in Huntingtin gene (2)Affects mood. muscle coordination, cognitive decline, psychiatric problems (3) Treatment is symptomatic and not altering of the tcourse (4) Use of tetrabenazine which decreases monoamine function.... it decreases excessive movements...SSRI's also useful for the psych symptoms

36

ALS (name, nickname, cause, risk factors, Drug)

(1) Amyotropic Lateral Sclerosis (2) Lou Gerig's DIsease (3) Insecticides, pesticides, smoking and service in the military (4) Riluzole ...increase survival time by 2-3 months

37

Multiple Sclerosis (theorized cuase, typical symptoms, drug action)

(1) Thought to reflect a chronic autoimmune attack on myelin in the brain, spinal chord and optic nerve (2) Motor problems, visual problems, cognitive dysfunction, emotional changes (3) Interferon beta works by increasing suppressor T-Cell function...Drugs can reduce severity and frequency of relapses and slow accumulation of disability.