Flashcards in Pharm - Stroke, Parkinsons, Dementia Deck (28):
What is the primary recommendation to avoid stroke?
Decrease BP to 140/90 or less (old numbers) or 130/80 or less (new numbers)
First-line agents (which class) for dyslipidemia? (Goal is stroke prevention)
Should ASA be used as antiplatelet therapy for everyone?
No - only those with a high risk of CV events or stroke.
What’s an Rx antiplatelet therapy other than aspirin?
In a lacunar stroke, what is blocking the flow?
An atherosclerotic plaque
In an embolic stroke, what is blocking the flow?
In an atherothrombotic stroke, what is blocking the flow?
Plaque and embolus together
MOA: fibrinolytic: converts plasminogen to plasmin, breaking up clots.
Risk of hemorrhagic transformation
Must administer within 3-4.5 hrs of onset
IV administration: bolus plus infusion
Must monitor BP regularly during infusion
Secondary stroke prevention - what does this mean and what is it?
After a stroke, HTN is still the most important goal: 140/90 or 130/90 for lacunar strokes.
diuretics and ACEis for HTN management.
Lipids and secondary stroke prevention: recommendations?
High intensity statins if stroke/TIA was related to atherosclerosis.
Diabetes and secondary stroke prevention: recommendations?
Screen for DM2 after a stroke... using HbA1C
Sleep apnea and secondary stroke prevention?
Provide a CPAP
Lifestyle changes after a stroke?
Quit smoking, decrease heavy alcohol consumption.
Antithrombotic Therapy options for noncardioembolic stroke or TIA
ASA 50-325mg monotherapy
ASA 25/Dipyridamole 200
Clopidogrel 75mg monotherapy
ASA+Clopidogrel for 21 days after stroke
Parkinson’s: What does SOAP stand for?
Other misc (fatigue, nausea, speech, pain, vision)
Autonomic symptoms (drooling, constipation, sexual dysfunction, dysphasia)
Psychological symptoms (anxiety, psychosis, depression, cognitive impairment)
Carbidopa/Levodopa for Parkinson’s motor symptoms: what happens over time? Tx?
Will become less effective over time
Can have wearing-off problems (take more frequently or add other drugs - MAO, COMT inhibitor, or apomorphine (dopamine agonist))
Can have peak dose dyskinesia (reduce levodopa dose, add amantadine)
Can have delayed or no “on” response (take on empty stomach or add apomorphine)
Can have ‘freezing” (use PT, increase dose, add apomorphine or MAO inhibitor)
-Lewy body dementia
Can all occur together, or separately, but...
Lewy body dementia: similar disease process to Parkinson’s.
Vascular dementia: d/t TBI, stroke, etc.
Alzheimer’s dementia: most common - default diagnosis when the type is unknown.
Loss of ability to execute learned, purposeful movements
Loss of ability to recognize objects)
Wandering, repetitive speech, motor hyperactivity, psychosis, depression, combativeness are all symptoms of...
Alzheimer’s pathology is characterized (physiologically) by
B-amyloid plaques and tangles
Dysregulated glutamate activity
Life expectancy after Alzheimer’s diagnosis?
Usually 4-8 years, but can live up to 20 years.
How does the treatment focus change for vascular dementia?
Goal is to reduce cardiovascular risks
How to evaluate where the patient is in their dementia? Does it matter what type?
Doesn’t matter what kind of dementia. This evaluates all cognitive function.
The lower the score, the worse the impairment. (Severe is 9 or less. Mild is 18-26).
What are cholinesterase inhibitors for? SEs? MOA? Names (DGR)?
To slow the progress of dementia.
MOA: increases ACH availability at the synapse
Donepezil, Galantamine, Rivastigmine
GI upset is common.
Diarrhea, cholinergic effects.
Stop treatment if: lack of improvement, poor adherence or tolerance.
What is Memantine? MOA? When would you start it? SEs?
NMDA receptor antagonist. Protects neurons from excessive glutamate. Only blocks glutamate when there are excessive amounts.
Start it in Moderate to Severe AD. Available as a liquid, too.
Constipation, Confusion, Dizziness, HA.
What should be addressed first when you see neurobehavioral symptoms in dementia patients?