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PHA333 > Wk 30 - Dementia in Practice > Flashcards

Wk 30 - Dementia in Practice Flashcards

1
Q

Outline the different types of dementia

A
  • Alzheimers
  • Lewy body
  • Vascular
  • Mixed
  • Parkinsons
  • Frontotemporal
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2
Q

What are the drugs related to cognitive impairment?

A
  • Anticholinergics
  • Benzodiazepine
  • Opioids
  • Anti-psychotics
  • Alcohols
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3
Q

Give examples of physical health problems that causes cognitive impairment

A
  • Infection (confusion)
  • Hyperthyroidism (impaired conc/memory)
  • Sensory impairment eg. sight/hearing loss, hypoglycaemia
  • Depression (lack of conc + poor ST memory)
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4
Q

What happens when dementia is diagnosed?

A
  • Legally required to inform DVLA
  • Early dementia, where sufficient skills are retained + progression slow, license may be issued subject to annual review - formal driving assessment necessary
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5
Q

What are the different groups of pharmacological managements?

A
  • AChE inhibitors: donepezil, galantamine, rivastigmine

- NMDA receptor antagonist memantine

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6
Q

When are AChE inhibitors usually used for?

A

Mild-mod disease

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7
Q

When is memantine usually used for?

A

Mod-severe disease

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8
Q

Which medication are used for lewy body?

A

Donepezil or rivastigmine

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9
Q

Which medications are used for parkinson’s?

A

All the above

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10
Q

What is the drug treatment for vascular dementia?

A

No licensed drug - mainstay to red risk of ischaemic attacks + stroke

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11
Q

Which drug group is dose-dependent activity?

A

AChE inhibitors

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12
Q

What are the cautions for AChE inhibtors?

A
  • GI ulcer risk
  • Asthma/COPD
  • Supraventricular cardiac conduction conditions eg. SA/VA block
  • Urinary retention
  • Low body weight
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13
Q

What are the side effects of AChE inhibitors?

A
  • Nausea, anorexia, vom
  • Diarrhoea, GI upset, ulceration
  • Alertness + agitation, hallucinations
  • Bradycardia
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14
Q

What are the interactions of AChE inhibitors?

A
  • Antimuscarinic drugs
  • Concurrent antipsychotic can inc risk of neuroleptic malignant syndrome
  • CYP3A4 inducer/inhibitors
  • Drugs w/ adverse CV effects eg. bradycardia
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15
Q

Donepezil

A
  • Take orally at bedtime (cause dizziness, switch OM if interfering sleeping)
  • 5mg for at least a month before assessment then titrate to 10mg
  • Well tolerated
  • Asses HR bc bradycardia + avoid co-prescription of drugs that red HR
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16
Q

Galantamine

A
  • W/after food
  • 8mg daily, inc every 4 wks to max 24mg if needed/tolerated (BD if IR)
  • C/Im in severe liver impairment (dose red in mod hepatic)
  • Rarely serious skin reaction (discontinue)
  • Can dec appetite - monitor
17
Q

Rivastigmine

A
  • For alzheimers + parkinsons
  • W/after food
  • Oral: 1.5mg BD + titrate in 2 wk intervals to max 6mg BD
  • Patch: 4.6mg daily, inc 13.3mg daily (rotate to avoid rash)
  • Monitor body weight (red appetite/anorexia)
18
Q

When should you discontinue the drug medication?

A
  • Poor compliance
  • Poor tolerance
  • Co-morbidity
  • No evidence of benefit
19
Q

Memantine

A
  • Monotherapy
  • Combination w/ AChE
  • 5mg daily, titrate to 20mg daily
  • Hallucinations, dizziness, constipation, headache, tiredness common
  • Dose mod in renal impairment
20
Q

What is BPSD?

A
  • Symptoms: delusions, hallucinations, agitation, aggression
  • 90% display in late stage
  • Antipsychotics discouraged bc inc risk cerebrovascular events (cognitive decline, inc mortality)
  • Risperidone for ST use
21
Q

What is used as a first line to BPSD?

A

Non-pharmacological approach:

  • Identify behaviour triggers
  • Comforting routines
  • Altered reality sense + communicating on this level
  • Information from carers/relatives
  • Forget me not card
  • Engage patient in activities meaningful to them
  • Include and involve patient in conversations at every opportunity
  • Sleep hygiene
  • Time orientation
22
Q

Outline the pharmacological approach to BPSD

A
  • Stop inappropriate meds, treat infection, constipation
  • Unrecognised pain: paracetamol
  • Underlying depression: sertraline, mirtazapine less likely to prolong QT interval that citalopram
  • Antipsychotic + benzodiazepines last resort bc worsen cognitive function, stroke risk + mortality risk

PHA333 (35 decks)

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