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Pharm Ger/Alzheimers
Pharm Geriatrics Alzheimers
| Question | Answer |
|---|---|
| Dementia Definition | “a syndrome characterized by progressive decline in multiple areas of cognitive function, which eventually produces significant deficits in self-care and social and occupational performance.” |
| Delirium Definition | “a disturbance of consciousness that is accompanied by a change in cognition that cannot be accounted for by a preexisting or evolving dementia”. Develops over a short period of time, Tends to fluctuate |
| First question to ask yourself if you see a patient with declining cognition | Look at their medication list to see if it is medication induced. |
| Medications with anticholinergic properties | oxybutynin, diphenhydramine, tolterodine, amitriptyline, doxepin, bezotropine |
| Agnosia | loss of the ability to recognize common objects |
| Apraxia | impaired ability to carry out motor function despite having the physical ability to perform movement |
| Alzheimer's is not due to | CNS condition, Systemic condition, substance-induced condition, delirium, Axis I disorders |
| Hypothesized causes of Alzheimers | Heavy metals, vascular factors, viral infections, accumulation of beta-amyloid peptide (main hypothesis, this is neurotoxic and leads to cell death) |
| Patient's family education in alzheimers | No treatments exist to reverse or stop the disease. The goals are to preserve cognitive and functional ability, mimize behavioral disturbances and slow progression |
| Cholinesterase Inhibitors | Tacrine, Donepezil, Rivastigmine, Galantamine |
| N-methyl-D-Aspartate Antagonist | Memantine (Namenda) |
| Main AE of Tacrine | Elevated LFTs 29% |
| Biggest AE of Rivastigmine | Nausea 47% |
| Indications for Donepezil | dementia mild to moderate and severe. |
| Benefits of Donepezil | once a day dosing, can take without regard to food. |
| half-life of donepezil | 70 hours! |
| AEs of donepezil | nausea, vomiting, diarrhea (GI). Potential for scary dreams |
| Rivastigmine Indications | Alzheimer's dementia mild to moderate; Parkinson's dementia mild to moderate |
| Half life of Rviastigmine | 1 hour. 2 doses per day. Must take with food. |
| Dementia medication with the greatest GI AEs | Rivastigmine (nausea 47%, vomiting 31%, Diarrhea 19%, Headache 17%) |
| Galantamine indications | Alzheimer's dementia (mild to moderate). 2x/day (IR), 1x/day (ER). Recommended to have wiht food. Nausea 24%, Vomiting 13% |
| Abnormal dreams associated with | Donepezil |
| Side effect that all cholinesterase inhibitors have in common | N/V diarrhea |
| N-methyl-D Aspartate Antagonist MOA | Works like a calcium channel blocker. Magnesium and glutamate also affected. |
| In alzheimer's, the level of glutamate is | higher |
| Memantine half life | 60-100 hours. First week once a day. Then 2 doses/day. With or without food. |
| Memantine needs to be titrated for | renal impairment. 5mg/day |
| Benefit of Memantine | very few GI AE's and few overall AE's |
| Memantine role in Alzheimer's | moderate to severe dz. Not exactly firstline, it is more expensive and therefore further down the line of treatment |
| Monitor patient's | behavior, mood, bowel function, ADLs, Adherence, Cognitive function-->MMSE |
| Abilities tested by MMSE | Orientation (time, place), Recall ability, Short memory, Arithmetic ability. |
| How many points are possible in the MMSE? | 30. 23-25 indicates cognitive impairment |
| Data for using Vit. E | no benefits in patients with mild cognitive impairment |
| Data for using Statins | need additional studies |
| Antipsychotic AEs | Cerebrovascular events, increased risk of death when used to treat dementia |
Created by:
ltm12