Neurology Flashcards
1
Q
What is the mechanism of action of Avonex?
A
Suppresses t-cell proliferation, decreases BBB permeability
2
Q
What are warnings/precautions with Avonex and Betaseron?
A
Depression
Seizures
Albumin allergy
3
Q
What are common ADRs of Avonex and Betaseron?
A
flu-like symptoms, leukopenia, injection site reactions, depression
4
Q
What type of MS is Avonex approved for?
A
RRMS
5
Q
What type of MS is Betaseron approved for?
A
RRMS
SPMS with relapses
6
Q
What medications may help with flu-like symptoms caused by Avonex and Betaseron?
A
NSAIDs or ASA
7
Q
What labs should be checked with Avonex and Betaseron?
A
CBC and LFTs
8
Q
What is the mechanism of action of Copaxone?
A
Suppresses t-cell activation, reduces inflammation, demyelination, and axonal damage at the site of the MS lesion
9
Q
What type of MS is Copaxone indicated for?
A
RRMS
10
Q
What is the warning associated with Copaxone?
A
not for IV use
11
Q
What is the most common ADR associated with Copaxone?
A
flushing
12
Q
What is the mechanism of action of Cladribine?
A
Impairs DNA synthesis, which results in dose-dependent depletion of both B and T cells
13
Q
What type of MS is Cladribine approved for?
A
RRMS
active SPMS
14
Q
What is a BBW for Cladribine?
A
bone marrow suppression, neurotoxicity, renal toxicity, malignancy, risk of teratogenicity
15
Q
What is unique about Cladribine?
A
It has 2 courses administered 1 year apart max lifetime dose of 2.5mg/kg
16
Q
What type of MS is Mitoxantrone approved for?
A
SPMS
PRMS
and worsening RRMS
17
Q
What is unique about Mitoxantrone?
A
IV infusion Q3 months
Lifetime cumulative dose is 140mg/m^2
18
Q
What limits the use of Mitoxantrone?
A
cardiotoxicity
19
Q
What is a BBW of Mitoxantrone?
A
bone marrow suppression, cardio toxicity, secondary leukemia
20
Q
What is the mechanism of action of Fingolimod?
A
Reduces lymphocyte migration to the CNS
21
Q
What is a serious ADR of fingolimod?
A
bradycardia, macular retinal edema
22
Q
What type of MS is fingolimod approved for?
A
RRMS
23
Q
What should be monitored in patients on fingolimod?
A
ophthalmological exam
24
Q
When is Ozanimod contraindicated?
A
severe untreated sleep apnea
concomitant MAOI use
25
What is a clinical pearl of ponesimod?
Shorter half-life than other S1P agonists, leaves the body in about 1 week if treatment needs to be stopped for any reason
26
What is a consideration with siponimod?
Requires genetic screening prior to initiation
dose dependent on CYP2C9 genotype
CI in CYP2C19*3/*3 genotype
27
What is a BBW for teriflunomide?
hepatotoxicity, embryofetal toxicity
28
What type of MS is teriflunomide approved for?
relapsing forms of MS
29
What is the mechanism of action of teriflunomide?
Reduces activated lymphocytes in the CNS, decrease inflammation and demyelination
30
What is a consideration with teriflunomide?
Avoid pregnancy for 2 years after discontinuation
31
What are common ADRs with dimethyl fumarate, diroximel fumarate, and mono methyl fumarate?
flushing, abdominal pain, infection
32
What can be used as pretreatment for flushing with dimethyl fumarate?
ASA 325 30 minutes prior to dose, take with food
33
What is the mechanism of action of dimethyl fumarate?
Activator of the nuclear factor erythroid-derived-2-like-2 (Nrf2) pathway
involved in cellular response to oxidative stress
34
What type of MS is dimethyl fumarate approved for?
RRMS
35
What is a BBW for natalizumab?
progressive multifocal leukoencephalopathy
rare brain infection
36
What are risk factors for PML in patients taking natalizumab?
>24 months of treatment
prior use of immunosuppressives
history of JCV
37
What is a consideration with natalizumab?
REMS program
reserved for patients who have not responded to or cannot tolerate ABC therapy
38
What are serious ADRs of daclizumab?
hepatic injury including autoimmune hepatitis
REMS program
39
What is a BBW of alemtuzumab?
autoimmune effects, infusion reactions, malignancy, stroke
40
What is the mechanism of action of alemtuzumab?
Anti-CD-52, depletes circulating T and B cells
41
What are clinical pearls related to alemtuzumab?
high risk of infusion related reactions and malignancies
REMS program
42
What is the mechanism of action of ocrelizumab?
Anti-CD-20, humanized version of the rituximab monoclonal antibody
43
What type of MS is alemtuzumab approved for?
RRMS
44
What type of MS is ocrelizumab approved for?
RRMS
PPMS
45
What are clinical pearls related to ocrelizumab?
hep B screening required prior to initiation
increased risk of infections
case reports of PML
46
What is a BBW with Arzerra?
Hepatitis B virus infection, progressive multifocal leukoencephalopathy
47
What is the mechanism of action of ofatumumab?
Anti-CD-20, selectively depletes B cells
48
What type of MS is ofatumumab approved for?
RRMS
active SPMS
49
What are clinical pearls related to ofatumumab?
hep b screening required prior to initiation
increased risk of infections, including PML
50
What is multiple sclerosis?
an inflammatory disease of the CNS
51
Multiple sclerosis is more common in male/female
females
52
What are risk factors for multiple sclerosis?
female
greater distance from the equator
living in a high risk area prior to age 15
genetics
caucasian
53
What are the etiology theories of multiple sclerosis?
environmental
genetic
autoimmune
viral/microbial
54
What is the pathophysiology of multiple sclerosis?
demyelination and inflammatory response
55
Are demyleination and the inflammatory process happening at the same time?
yes
56
How are symptoms categorized in multiple sclerosis?
primary
secondary
tertiary
57
What are the most common primary symptoms of multiple sclerosis?
visual complaints/optic neuritis
gait problems
falls
paresthesias
58
What are two scales used to help in weighing the severity of multiple sclerosis?
EDSS
MSFC
59
What test is used to diagnose multiple sclerosis? What is seen?
MRI
Axonal damage is seen as a lesion
60
What are factors reported to aggravate symptoms or lead to an acute attack of MS?
infections
malnutrition
anemia
child birth
fever
organ dysfunction
sleep deprivation
exertion
stress
61
How is MS diagnosed?
MRI lesions
diagnosis of exclusion
cerebrospinal fluid evaluation
62
What is considered an attack/exacerbation of MS?
new symptoms lasting at least 24 hours and separated from other symptoms by at least 30 days
63
What is RRMS?
relapsing-remitting
clearly defined disease relapses
full recovery or residual effect
no disease progression between relapses
64
What is SPMS?
secondary progressive
Develops after an initial RRMS course
65
What is PPMS?
primary progressive
disease progression from onset, with almost continuous worsening
occasional plateau in clinical state
temporary minor improvements
66
What is PRMS?
progressive relapsing
progressive disease from onset
continuities progression between relapses
67
What are favorable indicators of prognosis in MS?
<40 years
female
optic neuritis or sensory symptoms develop first
Low attack frequency in early disease
relapsing/remitting
68
Treatment of acute MS depends on __
severity of the attack
69
How should mild acute MS be treated?
may not require treatment, some may use PO steroids
70
What is considered a mild MS attack?
does not produce functional decline
71
What is considered a moderate MS attack?
functional ability is affected
72
How should a moderate acute MS exacerbation be treated?
high dose corticosteroids
73
What is considered a severe MS attack?
manifested by hemiplegia, paraplegia, or quadriplegia
74
How should a severe MS attack be treated?
plasma exchange every other day for 7 treatments
75
What corticosteroid is used in the treatment of acute MS attacks?
methylprednisolone IV 3-10 days
76
What is first line therapy in PPMS?
ocrelizumab
77
What is first line therapy in RRMS?
ABC therapy
78
What is first line therapy in SPMS?
ocrelizumab
79
What medications are used to manage gait difficulties and spasticity in MS?
baclofen and tizanidine and gabapentin
80
What are considerations with baclofen?
ADRs: somnolence and confusion
Should not be discontinued rapidly to avoid the possibility of seizures
81
What is the diagnosis of a patient complaint of urgency, frequency, and eventually incontinence of the bladder?
hyperreflexic bladder
82
What can be used to treat hyperreflexive bladder?
anticholinergic agents: oxybutynin, tolterodine
Antimuscarinic agents: trospium, solifenacin, darifenacin
83
What is the diagnosis for patients complaining of hesitancy, retention, and overflow incontinence of the bladder?
sphincter detrusor dyssynergia
84
What can be used to treat sphincter detrusor dyssynergia?
alpha adrenergic blockers -prazosin
85
What can be used in patients with high risk for developing UTIs?
vitamin C, antiseptics
86
What can be used for patients complaining of constipation?
increase dietary fiber and hydration, laxatives and enemas may be necessary
87
What can be used to manage trigeminal neuralgia in patients with MS?
carbamazepine
88
What can be used to manage neuropathic pain in patients with MS?
TCAs, pregabalin, gabapentin, duloxetine
89
What is the most common complaint of patients with MS?
fatigue
90
What can be used to manage fatigue in patients with MS?
amantadine
methylphenidate
modafinil or armodafinil
switch antidepressant to fluoxetine
91
What can be used to manage tremor in patients with MS?
propranolol, primidone, and isoniazid
92
What is required with S1P agonists at baseline?
ECG -risk of first-dose bradycardia
Eye exam - macular edema
93
What is the mechanism of action of acetaminophen, aspirin, naproxen, diclofenac, ketorolac, and ibuprofen?
centrally inhibits COX enzyme pathway, reducing pain and inflammatory signaling in the CNS
94
What is the mechanism of action of dihydroergotamine and ergotamine tartrate?
non-selective 5-HT antagonist, resulting in constriction of blood vessels in the brain and decreased neurogenic inflammation
95
What is a major problem with dihydroergotamine?
poor oral bioavailability
slow onset of action
ergotamine-induced headache and rebound headache associated with frequent use
96
Ergotamine tartrate is structurally similar to __ and structurally/biochemically related to __
neurotransmitters
ergoline
97
What is the mechanism of action of triptans?
selective agonist of 5-HT1B and 1D receptors, which inhibit vasoactive peptide release and decrease neurogenic inflammation via vasoconstriction
98
What are serious ADRs of triptans?
cardiovascular effects
99
What are limitations to sumatriptan?
low lipophilicity
low oral bioavailability
100
What are improvements seen with zolmitriptan?
highly lipophilic - crosses BBB
longer half-life
101
What are significant med chem points with naratriptan?
it is a sulfonamide
piperidine ring is incorporated
binds selectively and with high affinity
102
What are improvements seen with naratriptan?
low side effects
highest oral bioavailability
longer half life
103
What are significant med chem considerations with frovatriptan?
functional group at position 5 of indole structure is replaced by more metabolically stable functional groups
highest affinity
104
What are improvements seen with frovatriptan?
moderate affinity for 5-HT7
slow onset of action, but long half-life
105
What is the mechanism of action of lasmiditan?
high-affinity, highly-selective 5-HT1F receptor agonist, resulting in deactivation of the trigeminal system without vasoconstriction
106
What are the most serious ADRs with lasmiditan?
serotonin syndrome, CNS depression
107
What is the most serious ADR with CGRP antagonists?
hypersensitivity
108
What is the mechanism of action of CGRP antagonists (gepants and monoclonal antibodies)?
inhibits the CGRP, when CGRP is released in excess, it causes intense inflammation and causes migraine headaches
109
Which of the Gepants are abortive medications?
ubrogepant
rimegepant
zavegepant
110
Which of the gepants are preventative medications?
rimegepant
atogepant
111
What are the CGRP receptor antagonist monoclonal antibodies?
eptinezumab
erenumab
fremanezumab
galcanezumab
112
What is the mechanism of action of metoclopramide and prochlorperazine?
dopamine receptor antagonist, which suppresses signaling leading to nausea
113
What are serious ADRs related to metoclopramide and prochlorperazine?
extrapyramidal side effects
risk of QT prolongation
tarsades de pointes
114
What is a BBW with ketorolac?
should not be used longer than 5 days due to increased risk of GI bleeding, CV events, and renal impairment
115
What is the proposed mechanism of action of verapamil on cluster headaches?
exerts a vasodilatory effect on cerebral arterioles resulting in cluster headache relief
116
What are serious ADRs associated with verapamil?
heart block, increased risk for acute decompensated heart failure
117
What are serious ADRs of lithium?
hypotension, nephrotoxicity, seizures, hypercalcemia, hyperparathyroidism
118
What is the role of the 5-HT1B receptor in migraines?
induces constriction of cranial vessels/cerebral blood vessels
119
What is the role of the 5-HT1D receptor in migraines:
inhibits trigeminal vascular activity, inflammatory neuropeptide release, and nociception
120
What is included in the chemical structure of classic triptans?
side chain on the indole ring and a basic nitrogen in a similar distance from the indole structure
121
Which triptan is a secondary amine?
frovatriptan
122
Which triptans do not have active metabolites?
sumatriptan
almotriptan
naratriptan
123
Abnormal sensory modulation involving __ is critical in the induction of migraine
TGN
124
5-HT acts through receptors in the meninges to __
block the release of inflammatory chemical
125
5-HT acts through receptors in the brainstem to __
block the pain impulses and central brain perception via trigeminal nerve
126
What vasoactive neuropeptides are related with migraines?
CGRP
neurokinin A
substance P
127
What are medications that can precipitate a migraine headache?
tetracyclines, bactrim
theophylline, pseudoephedrine
NSAIDs
cimetidine, omeprazole
vasodilators, nitrates, dipyridamole
estrogen
128
What is the definition of an aura?
a complex of positive and negative focal neurologic symptoms that proceed or accompany an attack
evolves over 5 minutes or longer, lasts less than 60 minutes
129
What are examples of positive visual auras?
scintillations
photopsia
teichopsia
fortification
130
What are examples of negative visual auras?
scotoma
hemianopsia
131
What are examples of sensory and motor auras?
parasthesias
dysphasia
weakness
hemiparesis
132
What are symptoms of migraines?
recurring episodes of throbbing head pain, frequently unilateral, lasting from 4-72 hours if left untreated
133
What are diagnostic alarms of migraine headaches?
acute onset of first or worst headache ever
accelerating pattern of headache following subacute onset
onset of headache after age of 50
Headache associated with systemic illness
Headache with focal neurologic symptoms or papulledema
New onset headache in a patient with cancer or HIV
134
What are signs of a migraine headache?
stable patter, absence of daily headache
positive Fx
normal neurologic exam
food and menstruation may serve as triggers
improvement with sleep
aura can signal the migraine
135
What are diagnostic tests done for migraine headaches?
general medical and neurologic physical exam
palpitation and auscultation of the head and neck
consider neuroimaging if necessary
136
When can a migraine without aura be diagnosed?
at least 5 attacks
pulsating quality
one day duration
unilateral location
nausea, vomiting, photophobia, photophobia
disabiling intensity
137
When can migraine with aura be diagnosed?
At least 2 attacks
fulfill aura criteria
pulsating quality
one day duration
unilateral location
nausea, vomiting, photophobia, photophobia
disabiling intensity
138
How should medication overuse headache be managed/prevented?
limit use to <10 days per month
139
When should preventative migraine therapies be considered?
recurring migraines that produce significant disability
frequent attacks occurring more than BIW
symptomatic therapies are ineffective
pt preference to limit number of attacks
140
What are nonpharm therapies for migraines?
application of ice to the head
periods of rest in the dark
wellness program
relaxation therapy
identify/avoid triggers
141
What is the first-line choice for mild-moderate migraine headaches?
analgesics
NSAIDs/acetaminophen
combination products
142
When should metoclopramide be avoided?
renal disease
143
T/F: if one triptan fails, patient can be switched to another
true
144
What are the contraindications for triptans?
hx of ischemic heart disease
uncontrolled hypertension
cerebrovascular disease
pregnancy
145
In which populations should the first dose of triptans be taken under medical supervision?
postmenopausal women, men>40, uncontrolled CV risk factors
146
What are considerations with triptans?
avoid within 24 hours of ergotamine derivatives
avoid within 2 weeks of MAOIs
monitor for serotonin syndrome with SSRI/SNRI use
147
What are contraindications of ergot alkaloids and derivatives?
renal or hepatic failure
coronary, cerebral, or peripheral vascular disease
uncontrolled hypertension
sepsis
pregnancy/nursing
148
When can CGRP receptor antagonists be used?
when triptan is contraindicated, ineffective, or not tolerated
149
When should antiemetics be given for N/V with migraines?
single dose 15-20 minutes before oral abortive migraine medication
150
When are corticosteroids used for migraine headaches?
status migrainosus
dexamethasone IV
151
When is valproate contraindicated?
pancreatitis, chronic liver disease
152
What anti epileptic drugs can be helpful in migraine prevention?
valproate
topiramate
153
What antidepressant can be helpful in migraine prevention?
amitriptyline
venlafaxine
154
What antihypertensives can be helpful in prevention of migraines?
metoprolol
propranolol
timolol
CCbs, ACEI, ARBs limited efficacy
155
What triptan can be used as prevention for menstrual migraines?
frovatriptan
156
When is botox an option for migraine prevention?
patients with at least 15 headache days per month with an inadequate response to at least two of the following:
topiramate, valproate, beta-blocker, TCA, SNRI
157
Botox should be avoided in which patients?
pregnancy and breastfeeding
158
What are risk factors for poor outcome with tension-type headaches?
coexisting migraine, depression, anxiety, poor stress management
159
What is the pathophysiology of tension-type headaches?
Originates from myofascial and peripheral sensitization of nociceptors
activation of supra spinal pain perception structures
160
What is the clinical presentation of tension-type headaches?
mild-moderate intensity, dull, non-pulsatile tightness or pressure, bilateral, hatband pattern, mild photophobia or phonophobia
161
What are nonpharm treatments for tension-type headaches?
stress management, relaxation training, biofeedback
162
What is abortive therapy for tension-type headaches?
simple analgesics +/- caffeine
163
What can be used for prevention of tension-type headaches?
TCAs
164
What are cluster headaches categorized as?
attacks of excruciating, unilateral head pain that occurs in series lasting for weeks-months, remission periods last months to years
165
What is the pathophysiology of cluster headaches?
hypothalamus activates trigeminal-automonic reflexes, ipsilateral pain and cranial autonomic features
166
What is the hallmark clinical presentation of cluster headaches?
circadian rhythm of painful attacks
occur daily x1 week to several months, followed by long pain-free periods
average period of remission is 2 years
167
What are autonomic symptoms associated with cluster headaches?
lacrimation, nasal stuffiness, rhinorrhea, miosis
168
What is first line abortive therapy for cluster headaches?
oxygen
169
What triptan is most effective for cluster headaches?
SubQ sumatriptan
170
If patient is not responding to triptan and has cluster headache, what else can be used?
ergotamine derivative
intranasal lidocaine
171
What is first-line prophylactic therapy for cluster headaches?
verapamil
172
What are other options for prophylactic therapy in cluster headaches?
lithium
galcanezumab
corticosteroids
173
When should lithium be used cautiously?
significant renal or CV disease, dehydration, pregnancy, concomitant diuretic or NSAID use
174
What drugs are anticholinergics used for Parkinson's?
benztropine
trihexyphenidyl
175
What are serious ADRs associated with anticholinergics?
anhidrosis, drug-induced psychosis, heat stroke, increased body temperature, tachycardia, visual hallucinations
176
What are dopamine agonists used in Parkinson's disease?
apomorphine
bromocriptine
pramipexole
ropinirole
rotigotine
177
What are serious ADRs associated with apomorphine?
QTc prolongation, hallucinations, psychosis, hemolytic anemia
178
What conformation is preferred for apomorphine?
trans
179
Which receptors does apomorphine activate?
D1 and D2
180
What are serious ADRs of bromocriptine and pramipexole?
blackouts, heart failure, impulsive behavior, melanoma, pulmonary fibrosis
181
What receptors is bromocriptine an agonist of?
partial D1
full D2
182
What receptors is pramipexole an agonist of?
full selective agonist at D2 and D3
183
What are serious ADRs of ropinirole?
sinus node dysfunction, neuroleptic malignancy syndrome, impulse control/impulsive behaviors
184
What receptors is ropinirole an agonist of?
full agonist for D2 and D3
185
What are serious ADRs of rotigotine?
blackouts, heart failure, impulsive behavior, melanoma
186
What receptors is rotigotine an agonist of?
full agonist for D2 and D3
187
Which medications are COMT inhibitors?
entacapone
tolcapone
188
What are serious ADRs of entacapone?
neuropsychiatric symptoms
189
Of the COMT inhibitors which inhibits peripheral and which inhibits peripheral and central?
entacapone: peripheral
tolcapone: peripheral and central
190
Entacapone is a member of the class of __
nitrocatechols
191
What are serious ADRs of tolcapone?
neuropsychiatric symptoms, liver toxicity
192
What medications are MAO-B inhibitors?
selegiline
rasagiline
safinamide
193
What are serious ADRs associated with selegiline and rasagiline?
serotonin syndrome, neuropsychiatric symptoms
194
T/F: selegiline and rasagiline are selective reversible MAO-B inhibitors
false
irreversible
195
What is a serious ADR associated with safinamide?
serotonin syndrome
196
What is the mechanism of action of amantadine?
enhances dopamine release from presynaptic terminals and inhibits NMDA receptors
197
What are serious ADRs associated with amantadine?
withdrawal syndrome, impulse control disorders, lived reticularis
198
Amantadine also has __ effects
antiviral
199
What is the mechanism of action of levodopa?
direct precursor to dopamine in its metabolic pathway
200
What is the mechanism of action of carbidopa?
helps to prevent its peripheral metabolism in order to increase dopamine concentrations in the brain
201
What are serious ADRs associated with carbidopa/levodopa?
orthostatic hypotension, neuroleptic malignant syndrome, hallucinations, sleep attacks, compulsive behaviors
202
What is the mechanism of action of istradefuline?
increases movement via inhibition of the adenosine A2A receptor
203
What are serious ADRs associated with astradefuline?
hallucinations, behavioral disturbances
204
T/F: there is a correlation between reduced dopamine levels and PD severity
true
205
The neuropathology of Parkinson's is related to what two things?
deficiency of dopamine in striatum in the forebrain
appearance of lewy bodies
206
What are possible causes of Parkinson's?
neurotoxins, mitochondrial dysfunction, oxidative metabolism, genetics, drugs
207
The side chain of dopamine is __ and has __ rotation about phenyl-beta-carbon single bond
flexible
unrestricted
208
Which dopamine agonists are ergot derivatives?
bromocriptine and pergolide
209
Which dopamine agonists are non-ergot derivatives?
pramipexole and ropinirole
210
What are hallmark motor features of Parkinson's?
Tremor at rest
Rigidity
Akinesia
Postural instability
211
Parkinsons is a disorder of the __ system
extrapyramidal
212
Parkinson's is more common in male/female
males
213
What is the hallmark sign of Parkinson's?
degeneration of dopaminergic neurons projecting from the substantial nigra pars compact (Sac) to the striatum
214
What environmental factors increases risk of Parkinson's disease?
chronic exposure to pesticides
215
The basal ganglia regulates voluntary movement and includes:
Substantia nigra
striatum
216
What are other symptoms of Parkinson's?
motor symptoms
autonomic and sensory symptoms
mental status changes
sleep disturbances
217
What is the diagnosis process of Parkinson's?
1: bradykinesia plus one other hallmark symptom
2: elude other disorders
3: presence of three supportive criteria
218
What is a digital health tool used for Parkinson's?
MyoExo
wearable system that detects movements in muscle
219
What surgery is used for Parkinson's?
Deep brain stimulation
220
What criteria must be met for patients to undergo deep brain stimulation surgery?
diagnosis of L-DOPA responsive Parkinson's disease
absence of cognitive impairment
221
Anticholinergics should be avoided in which populations?
advanced age
pre-existing cognitive deficits
dysphagia
222
What are motor complications of L-DOPA?
end of dose wearing off
delayed on or no on response
freezing
dyskinesias
223
How can end of dose wearing off be treated?
Increase carbidopa/levodopa
Add istradefylline, COMT inhibitor, MAO-B inhibitor, or dopamine agonist
224
How can delayed or no one response be treated?
Give carbidopa/levodopa on an empty stomach
use ODT
avoid sustained release
225
How can freezing be treated?
increased carbidopa/levodopa dose
Add dopamine agonist or MAO-B inhibitor
226
How can dyskinesias be treated?
lower carbidopa/levodopa dose
Use amantadine
227
What are drug-drug interactions with MAO-B inhibitors?
SSRIs, meperidine, and other opioid analgesics
228
What is a concern with selegiline?
may worsen preexisting dyskinesias or delusions
229
Dopamine agonists should be avoided with which patients?
cognitive problems or dementia
230
A patient <65 presents with bradykinesia and rigidity, what is the treatment?
dopamine agonist
231
A patient <65 presents primarily with tremor, what is the treatment?
anticholinergic
232
Alzheimer's is described as what?
a gradually progressive dementia that affects cognition, behavior, and functional status
233
What are factors associated with increased risk of Alzheimer's disease?
increasing age
female
decreased reserve capacity in the brain
head injury
down syndrome
depression
mild cognitive impairment
risk factors for vascular disease
234
What three gene mutations are associated with early onset Alzheimer's disease?
APP on chromosome 21
Presenilin 1 on chromosome 14
Presenilin 2 on chromosome 1
235
What is a genetic risk factor for late onset Alzheimer's disease?
APOE on chromosome 19
236
What consists of phosphorylated tau protein which is involved in micro tubular assembly?
tangles
237
What are extracellular protein deposits of fibrils and amorphous aggregates of beta-amyloid protein?
plaques
238
What is responsible for transmitting messages between certain nerve cells in the brain?
acetycholine
239
What is an excitatory neurotransmitter involved in memory and learning?
glutamate
240
What has properties that protect against memory loss associated with normal aging?
estrogen
241
What are symptoms of Alzheimer's?
memory loss, aphasia, apraxia, agnosia, disorientation, depression, psychotic symptoms, behavioral disturbances, inability to care for self
242
An MMSE score of 26-21 is considered?
mild Alzheimer's
243
An MMSE score of 20-10 is considered?
moderate Alzheimer's
244
An MMSE score of 9-0 is considered?
severe Alzheimer's
245
What is a digital health tool used for Alzheimer's?
Tranquil GPS Watch
has 2-way SOS calling, safe home alerts
246
Successful treatment is considered what in Alzheimer's?
decline of <2 points/year on the MMSE
247
What are cholinesterase inhibitors used in Alzheimer's?
donepezil
rivastigmine
galantamine
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What is the washout period from donepezil to other agents?
7-14 days
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What is the washout period from rivastigmine or galantamine to other agents?
1-2 days
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What test should be done prior to initiating monoclonal antibodies in Alzheimer's disease?
APOE*4
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What is the recommendation for treatment of Alzheimer's?
Mild-Moderate: cholinesterase inhibitor
Moderate-Severe: add memantine
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What is the recommended antidepressant to use in patients with Alzheimer's disease?
citalopram
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What are recommended antipsychotics to use in patients with Alzheimer's?
olanzapine, risperidone, arirpripazole, brexpiprazole
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