Question | Answer |
**ADRD = Alzheimer Dementias/Related Dementias** | |
ADRD care ? | * usu family/med staff at homes.... be empathetic to givers, bc there is a lot of turnover bc of burnout from stress from taking care of pts.... get care giver burden- can have neg outcomes for giver and pt |
For caregivers , what do we screen ? | * Caregivers Burden Inventory... CBI... *ask about their depression and if they have thoughts of harming themselves/ADRD pt |
Some developmental issues with ADRD pts and caregivers ? | * suffering social life, emotionally drained, retired and now have to fully assist spouse |
Physical Sx ? | * no sleep, bad health, emotionally drained |
Social Sx ? | * resentful of relatives who don't help out, stop hanging out w/ friends, family relationships suffer |
What to do to help w/ Caregiver Stress ? | * praise their efforts and just communicate with them |
Top thing to do when managing ADRD pts ? | * Educate them |
Meds for Alzheimers ? | * Cholinesterase inhibitors
---Aricept (donepezil)
-Aricept ER
-Exelon (rivastigmine): pills or patches
-Razadyne (galantamine)
..........**NMDA inhibitors---
-Namenda (memantine)
-Namenda ER |
Why is Aricept (generic for Donepezil) popular ? | * bc only dosed once a day |
Dosing Considerations ? | * CrCl in every drug except Donepezil |
Alternative non Pharmacologic ? | * Vit E - shown to preserve ADLs, no to stop dementia decline...... *Axona (medical food) - keeps pt in a ketotic state |
Mgt of medical issue w/ ADRD | * can have low compliance, but need managed.... * Watch for ADRD drugs to exacerbate other medical issues (150/90 bp is ok) |
What to do if caretaker said the ADRD pt is acting weird all of a sudden/ out of the norm ? | * get a UA - bc issues are harder to find in demented pts bc they can't remember whats going on |
Geriatric Dementia and Depression ? | * screen for both, bc they can overlap and lead in to one another |
If ADRD with Depression tmt ? | * SSRIs, lose dose and bump up..... NO TCAs...* trazadone or mirtazipine if sleep issues |
Disturbance of consciousness with reduced ability to focus, sustain, or shift attention and Disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day ? | * Delirium |
Delirium Consequences ? | * falls/fractures/illnesses, etc... Anesthesia can send a geriatric pt into a delirious state |
Causes of Delirium ? | *D - drugs, E - electrolytes, L - lack of drugs/withdrawal, I - infct, R - reduced sensory input, I - intercranial issues (bd/stroke), U - urinary infct/retention/fecal impaction, M - MI issues |
Delirium mgt ? | * non-pharm 1st !.... * quetiapine is DOC |
Treatment of Lewy Body ? | * Avoid antipsychotics and AVOID Razadyne (galantimine) - cause death !!! ---- * use approved ACh esterase inhibitor drugs or add memantine |
Behavioral and Psychological Symptoms of Dementia (BPSD) ? | * wandering, anger, avoid changing house stuff bc causes confusion, psychosis issues, depression, sleep issues, |
BPSD mgt ? | * educate caregivers/pt, safe environments, avoid tasks they can not do, ask ?s bc pt can't remember drug adverse RXns etc.... * |
BPSD drugs ? | *antipsychotics if psychosis, SSRIs if depressed, Anxious/Angry think Benzos, for apathy use stimulants |
Sudden onset of Laughing or Crying ? | * Pseudobulbar Affect (PBA)----Occur out of proportion or incongruent to the underlying emotional state....... *FDA Tmt drug = Nuedextra |
Medication Safety and ADRD ? | * only add meds if you have to and watch for adverse effects since pt can't remember them |
Transitions of Care and ADRD ? | * getting the person with ADRD back home is the very best thing you can do.... * make care comfortable bc Alz is a terminal disease |
Feeding tubes in end of life care ? | * NOT shown at all to help...do not use |
EOLC of Symptoms ? | * More sensitive to narcotics – reg time control dose is best, but often respond to RTC acetaminophen
-----* Narcotics if necessary, but use RTC regimens, remembering that patients will not be able to ask |
Possible preventive measures of ADRD ? | * healthy lifestyle, Mediterranean Diet - high olive oils, keep mind active, Avoid Modern Anti persperants “ Aluminum Chlorhydrate” – can cause dementias |