Pharm Geriatrics Alzheimers
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| 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.”
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| 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
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| 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.
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| Medications with anticholinergic properties | oxybutynin, diphenhydramine, tolterodine, amitriptyline, doxepin, bezotropine
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| Agnosia | loss of the ability to recognize common objects
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| Apraxia | impaired ability to carry out motor function despite having the physical ability to perform movement
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| Alzheimer's is not due to | CNS condition, Systemic condition, substance-induced condition, delirium, Axis I disorders
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| 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)
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| 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
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| Cholinesterase Inhibitors | Tacrine, Donepezil, Rivastigmine, Galantamine
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| N-methyl-D-Aspartate Antagonist | Memantine (Namenda)
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| Main AE of Tacrine | Elevated LFTs 29%
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| Biggest AE of Rivastigmine | Nausea 47%
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| Indications for Donepezil | dementia mild to moderate and severe.
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| Benefits of Donepezil | once a day dosing, can take without regard to food.
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| half-life of donepezil | 70 hours!
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| AEs of donepezil | nausea, vomiting, diarrhea (GI). Potential for scary dreams
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| Rivastigmine Indications | Alzheimer's dementia mild to moderate; Parkinson's dementia mild to moderate
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| Half life of Rviastigmine | 1 hour. 2 doses per day. Must take with food.
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| Dementia medication with the greatest GI AEs | Rivastigmine (nausea 47%, vomiting 31%, Diarrhea 19%, Headache 17%)
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| Galantamine indications | Alzheimer's dementia (mild to moderate). 2x/day (IR), 1x/day (ER). Recommended to have wiht food. Nausea 24%, Vomiting 13%
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| Abnormal dreams associated with | Donepezil
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| Side effect that all cholinesterase inhibitors have in common | N/V diarrhea
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| N-methyl-D Aspartate Antagonist MOA | Works like a calcium channel blocker. Magnesium and glutamate also affected.
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| In alzheimer's, the level of glutamate is | higher
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| Memantine half life | 60-100 hours. First week once a day. Then 2 doses/day. With or without food.
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| Memantine needs to be titrated for | renal impairment. 5mg/day
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| Benefit of Memantine | very few GI AE's and few overall AE's
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| Memantine role in Alzheimer's | moderate to severe dz. Not exactly firstline, it is more expensive and therefore further down the line of treatment
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| Monitor patient's | behavior, mood, bowel function, ADLs, Adherence, Cognitive function-->MMSE
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| Abilities tested by MMSE | Orientation (time, place), Recall ability, Short memory, Arithmetic ability.
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| How many points are possible in the MMSE? | 30. 23-25 indicates cognitive impairment
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| Data for using Vit. E | no benefits in patients with mild cognitive impairment
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| Data for using Statins | need additional studies
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| Antipsychotic AEs | Cerebrovascular events, increased risk of death when used to treat dementia
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