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Tx of Alzheimer's
Pharmocotherapy II
| Question | Answer |
|---|---|
| Global cognitive impairment that interferes w/ functioning | dementia |
| What is alzheimer’s dementia | progressive dementia that affects memory, higher learning, reasoning, behavior and emotion |
| How is alzheimer’s characterized | neuro tangles and plaques ↓ serotonergic and noradrenergic pathways |
| Mc patho for AD | amyloid cascade of B-amyloid plaques: EOAD |
| What correlates w/ dementia severity | Density of neurofibrillary tangles |
| What NMT’s are associated w/ AD | abnormalities in serotonin, norepi, dopamine, glutamate |
| What other factors may relate to AD incidence | CV RF’s like HTN, ↑LDL, ↓HDL, DM |
| What are the stages of Alzheimer’s and MMSE’s score | mild: 26-18, Mod: 17-10, Severe: 9-0 |
| Begins to withdraw from difficult tasks and to give up hobbies: may deny memory problems | Mild Dementia |
| Loses ability to speak, walk,, feed self, incontinent, 24hr care | Severe dementia |
| Pt requires assistance /w ADL’s, often disoriented w/ time, may forget details of past life or current | Mod Dementia |
| What are 4 ways for prevention of alzheimer’s | heart-head connection, physical activity & healthy eating, social connections and intellectual activity, head trauma |
| Tx goals for AD | symptomatically tx cog sxs, maintain pt fxn, tx psychiatric and behavioral sequel |
| Non pharm tx for AD | pt ed and caregiver ed, |
| Pharmacologic therapy for cognitive sxs | cholinesterase inhibitors, memantine |
| Noncog sxs therapy | anxiolytics, antidepressants, antipsychotics, mood stabilizers |
| AE’s for Cholinesterase inhibitors | N/V/D anorexia, wt loss, bradycardia-no tolerance |
| Four cholinesteraseinhibitors | donepezil, galantamine, rivastigmine, tacrine |
| How can we decrease GI SE’s | slow titration up to therapeutic dose |
| What happens with withdrawal from cholinesterase inhibitors | rapid cognitive decline |
| What other pharm tx can cholinesterase inhibitors have | + effects on physch and behavioral sxs |
| SE’s of memantine | generally well tolerated, constipation, dizziness, HA somnolence |
| MOI of memantine | N-Methyl-D-aspartate receptor antagonist; ↓effects of glutamate |
| Tx for dementia mild-mod | Cholinesterase inhibitors |
| Tx for dementia mod-severe | add memantine |
| Targets for future AD therapies | B-amyloid, Tau protein, Inflammation, insulin resistance |
| What tx for dementia is associated w/ ↑mortalitiy | tx of behavioral d/o in elderly pt’s w/ dementia w/ atypical antipsychotics |
| What are some atypical antipsychotic | Olanzapine, Quetiapine, Risperidone, Ziprasidone |
| Which medications should we avoid in pts w/ dementia | anticholinergics and benzodiazepines |
Created by:
becker15
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