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Naplex
Alzheimer's Disease
| Question | Answer |
|---|---|
| Q1. Mild Cognitive Impairment vs. Dementia | MCI • Measurable cognitive impairment • Preserved level of function Dementia: need assistance! • Significant cognitive impairment • Interferes w independence |
| Q2. Signs of Dementia | • Memory loss • Difficulty planning and organizing • Getting lost in familiar places |
| Q3. Signs of Dementia ctn | • Difficulty find words for common objects • Repeat words and information • Inability to learn / remember new info |
| Q4. Signs of Dementia ctn 2 | • Apathy and social disengagement •Delusions / agitation • Poor coordination and motor function |
| Q5. Dementia Types | • Vascular • Alzheimer's: 60-80% of cases, > 65 years • Lewy body • Frontotemporal |
| Q6. Alzheimer's Disease Pathophysiology | • Amyloid beta plaques • Tau tangles • Decreased acetylcholine, cause a decline: Memory, attention, and other cognitive processes |
| Q7. Screening and Diagnostic Tests | • Cognitive Testing: MMSE, MoCA • Brain Imaging: MRI, PET • Biomarkers |
| Q8. Rule out reversible causes of dementia | • Infection • Depression and/or delirium • B12 deficiency • Drugs affecting memory |
| Q9. Drugs that can Worsen Dementia | • Antipsychotics: Abilify, chlorpromazine • CNS depressants (CS) • Drugs with anticholinergic effects |
| Q10. CNS depressants (CS) that can Worsen Dementia | • Barbiturates (phenobarbital) • BZD (alprazolam, lorazepam) • Hypnotics (eszopiclone, zolpidem) • Opioids (hydrocodone, morphine) • Skeletal muscle relaxants (carisoprodol) |
| Q11. Drugs with anticholinergic effects | • Antiemetics (prochlorperazine) • Antihistamines (benadryl, doxylamine) • Central anticholinergics (benztropine) • Peripheral anticholinergics (oxybutynin, dicyclomine) • TCA (amitriptyline) |
| Q12. Lifestyle modifications | • Control BG, BP, cholesterol • Exercise • Eat a healthy diet • Use cognitive rehabilitation • Socialize |
| Q13. Natural Products | • Vitamin E • Ginkgo biloba |
| Q14. Drug Treatment | • No cure or reversal • Modest effect on slowing cognitive decline • Determined by severity (eg, MMSE score) |
| Q15. Drug Treatment ctn | • Acetylcholinesterase Inhibitors • NMDA Blocker • Amyloid Beta-Directed Antibodies |
| Q16. Acetylcholinesterase Inhibitors | • Donepezil • Rivastigmine • Galantamine For mild, moderate and server |
| Q17. NMDA Blocker | • Memantine • Moderate-severe disease |
| Q18. Amyloid Beta-Directed Antibodies | • MILD cognitive impairment or dementia • Aducanumab • Lecanemab • IV Q2-4W |
| Q19. Drugs for Mild-Moderate | Acetylcholinesterase inhibitor (eg, donepezil, rivastigmine) |
| Q20. Drugs for Moderate-Severe | Acetylcholinesterase inhibitor +/- memantine |
| Q21. Concomitant Psychiatric Disorders • Depression | • Antidepressants: SSRI (eg, sertraline) • Avoid TCA |
| Q22. Concomitant Psychiatric Disorders • Agitation and psychosis | • Antipsychotics [eg, brexpiprazole (Rexulti), olanzapine] • Brexpiprazole (Rexulti): FDA approved • BW: increased mortality • Increase rate of cognitive decline • Last line: pt harm to self or others |
| Q23. Acetylcholinesterase Inhibitors | • Bradycardia • Insomnia Gl: • N/V/Diarrhea • Weight loss • Contact dermatitis (Rivastigmine) • SJS (galantamine) |
| Q24. Donepezil (Aricept: tab, ODT, Adlarity: patch Q1W fridge) | • QT prolongation • QHS (AM if insomia) |
| Q25. DDI: Donepezil - beta-blockers, diltiazem, verapamil, digoxin | • Lower heart rate |
| Q26. Minimize Gl of Acetylcholinesterase Inhibitors | • Titrate slowly (every 4-6 weeks) • Retitrate if interrupted 3-7days • Caution with weight < 55 kg |
| Q27. Donepezil patch | • Adlarity • QW, Refrigerate • Upper or lower back (preferred) • Upper buttocks • Upper outer thigh |
| Q28. Rivastigmine: patch | • Exelon • QD, room tem • Upper or lower back • Upper arm • Chest |
| Q29. Memantine (NaMenDA) | • Moderate - Server • Preferably in combination • NMDA receptor blocker • Dizziness, confusion, HA |
| Q30. ER capsule of NaMenDA / Namzaric (+Donepezil) | • Not crush or chew • Open capsules and sprinkle on applesauce |
| Q31. To switch from NaMenDA to Namzari | • Stable on donepezil 10 mg • Namzari: memantine 7mg/donepezil 10mg QHS |
| Q32. Aricept (tab, ODT) dosing | • 5mg QHS, start • 10mg QHS, after 4-6 wks • Moderate to server: to 23mg QHS after 3mos of 10mg |
| Q33. Adlarity patch | • 5mg/24H QW, start • 10mg/24H QW, after 4-6 wks |
| Q34. Exelon cap dosing | • 1.5mg BID • Increase every 2wks to max 6mgBID • w FOOD |
| Q35. Exelon patch dosing | • 4.6mg/24H QD • increase every 4wks to 13.3mg/24H QD max • Hepatic impairment: max 4.6mg/24H QD |
| Q36. Galantamine: tab, cap, sol | • 4mg BID w FOOD • Increase every 4wks to 12mg BID • NO use in hapatic impairment |
| Q37. Benzgalantamine (Zulveyl) dosing Prodrug of galantamine | • 5mg BID • Increase every 4wks to 15mg BID • NO use in hapatic impairment |
| Q38. ER cap | • 8mg QD • Increase every 4wks to 24mgQD • NO use in hapatic impairment |
| Q39. Transition from Aricept to Adlarity | • Apply patch at the same time of the last dose Aricept |
| Q40. Namenda dosing | • IR 5mg QD, increase weekly to 10mg BID • ER 7mg QD, increase to 28mg QD • Switch from IR 10mg BID to ER 28mg QD: next day • CrCl<30: max IR 5mg BID, ER 14mgQD |
| Q41. NMDA caution | • Acetazolamide, Sodium bicarb |
| Q42. AChEi caution | • Pt at bleeding risk • Reduce effects if concurent use wanticholinergics |
Created by:
dao.vo11017