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Alzeheimers-IOS 8 -4
Alzeheimers Med's
| Question | Answer |
|---|---|
| Alzheimers disease Facts | #1 neurodegenerative disorder, course 5-9 years, overlaps dementia |
| Dementia MOA | Insidious decline over time, can still have conversation, but lack short term initially |
| Cortical-Frontal dementia | More dis-inhibition or inappropriate behavior. Cognitive deficites in calculation and word finding. |
| Subcortical-midbrain Dementia | Can be Parkinsons, Huntingtins, or Normal pressure hydrocephalus (REVERSIBLE) |
| Delirium | Acute situation patient is not conversation and can be reversed |
| Risks for Alzeheimers | Age, FHx, Chromosomes (21,14,1) |
| Pathology Alzeheimers | Senile B-amyloid plaques, Apo E4, decrease in choline acetyltransferase |
| Senile B-amyloid plaque | Aggregation of B-pleated sheets potential nerve damage |
| Apo E4 | Lack function of the nutrient transporter tau-higher risk |
| Choline acetyltransferase | Memory impairment (also seen with anticholinergics) |
| Mental State evaluation based on | Orientation, Calculation, Recall total of 30 possible |
| Alzeheimers MSE score of > 24 | Normal |
| MSE score <24 | Likely cognitive impairment |
| MSE 17-23 | Mild impairment |
| MSE 10-16 | Moderate impairment |
| MSE < 10 | severe |
| Alzeheimers rule out | Vitamin deficiency, TSH, drugs (BZD, anticholinergics,methyldopa, reserpine, narcotics) |
| Diagnosis of alzeheimers | Based on exculsion, insidious- 6-8 months, decline in greater than 1 area of cognition (have conversation) |
| Alzeheimers 1st line | Choline esterase inhibitors |
| Choline esterase inhibitors | Donepezil (Aircept), Rivastigmine, Galantamine |
| Treat severe Alzeheimers | Choline esterase inhibitor and NMDA receptor antagonist |
| NMDA receptor antagonist | Memantine |
| Donepezil use | Immediately therapeutic, AVOID ALL CHOLINERGICS, TCA |
| Cholinesterase inhibitors caution | COPD, asthma, PUD,sick-sinus syndrome |
| Rivastigamine use | Therapeutic in a month, buteryl choline esterase inhibitor, metabolized VIA BLOOD |
| Ginko Biloba effects | Mixed results some sugest cognitive enhancing effects eimular to AcHEi |
| Menantine use | Only drug approved to treat severe dementia, requires renal adjustment, has not produced psychosis in humans |
| Vitamine E and Selegiline | Delayed endpoints of death,instutionalization, loss of ADL, but there has been reports that high dose VIT E causes increased mortality |
| Alzeheimers and antipsychotics | Postive with risperidone and olanzipine- increased risk of stroke |
| Antidepression in Alzeheimers | Use SSRI, Not TCA |
| Estrogen in Alzeheimers | Ok for aggressive/sexually aggressive behavior |
Created by:
liza001
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