Alzheimers Disease Chapter 49

Front 1

what does DSM IV stand for?

Back 1

diagnostic and statistical manual of mental disorders

Front 2

Name the exam used to diagnose dementia and what score shows that there is impairment

Back 2

Folstein Mini Mental State Exam
-MMSE score <24 shows impairment

Front 3

What class of drugs is considered the mainstay in treatment for Alzheimers/dementia

Back 3

acetylcholinesterase inhibitors

Front 4

Name the symptoms of Alzheimers disease

Back 4

memory loss
-difficulty communicating
-inability to learn or remember -new information
-difficulty with planning and organizing
-poor coordination and motor fxn
-personality changes
-inappropriate behavior
-paranoia
-agitation-
-hallucinations

Front 5

Give 2 mechanisms for the pathology behind alzheimers disease

Back 5

1. neuronal plaques and tangles in brain tissue that causes neuron signaling to be interrupted
2. alteration of neurotransmitters such as a decrease in acetylcholine

Front 6

Name drugs that can worsen dementia

Back 6

1. peripheral anticholinergics (such as those used for incontinence and IBS)
2. central anticholinergics (ex. benztropine)
3. antihistamines
4. antiemetics
5. anitpsychotics
6. barbiturates
7. Benzodiazepine
8. Skeletal muscle relaxants
9. other CNS depressants

Front 7

Name 2 other drug classes that are used to treat dementia and what are they used to treat

Back 7

1. antidepressants-used to treat anxiety and depression
2. anitpsychotics-used to treat anger and delusions

Front 8

name 2 "natural" products that have been used to treat dementia

Back 8

1. vitamin E
2. Ginkgo biloba

Front 9

name 2 "natural" products that have been used to treat dementia

Back 9

1. vitamin E
2. Ginkgo biloba

Front 10

Name the antidepressants commonly used for dementia

Back 10

citalorpam (celexa)
escitalopram (lexapro)
sertraline (zoloft)

Front 11

Why would one caution the use of antipsychotics in the elderly pt

Back 11

because they cause an increased risk of death and provide little benefit

Front 12

why do anitpsychotics cause an increased risk of death in the elderly

Back 12

mostly due to an increased risk of stroke

Front 13

When should one caution the use of vitamin E in dementia

Back 13

when doses become greater than 150 IU

Front 14

why would one use ginkgo biloba in alzheimers

Back 14

to treat memory

Front 15

What should be of concern if using ginkgo biloba

Back 15

increased bleeding risk

Front 16

Give the MOA of acetylcholinesterase inhibitors

Back 16

inhibit centrally acitve acetycholinersterase (the enzyme responsible for hydrolysis/breakdown of acetylcholine...which leads to an increase in ACh

Front 17

Do short acting or long acting acetylcholinesterase inhibitors cause dry mout

Back 17

short acting cause dry mouth so give long acting

Front 18

Name the acetylcholinesterase inhbitors brand and generic

Back 18

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
Tacrine (Cognex)

Front 19

What strength of donepezil is used for advanced disease even though it provides little benefit

Back 19

Aricept 23mg

Front 20

What drugs are used for mild to moderate and moderate to severe alzheimers

Back 20

1. mild to moderate-ACh-I
2. moderate to severe-ACh-I + memantine

Front 21

What time of day should donepezil be administred and why?

Back 21

at night because of possible nausea and vomitting

Front 22

Which alzheimers medication comes in a patch?

Back 22

Rivastigmine (Exelon)

Front 23

Which alzheimers medication comes in an ODT

Back 23

aricept =donepezil

Front 24

Give common SE of acetylcholinesterase inhibitors

Back 24

nausea
vomitting
loose stool/diarrhea
bradycardia
fainting

Front 25

Name the only acetylcholinesterase inhibitor that should be given with food

Back 25

Rivastigmine (Exelon)

Front 26

Which drugs should be recommended to decrease GI side effects of ACh-I

Back 26

Exelon patch or Aricept ODT

Front 27

Which ACh-I causes hepatotoxicity and when is it contraindicated

Back 27

Tacrine (Cognex)
-contraindicated if history of tacrine-induced jaundice or bilirubin >3 mg/dL

Front 28

Give the brand name of memantin

Back 28

Namenda

Front 29

Give the MOA of memantine

Back 29

blocks NMDA (N-methyl-D-aspartate), which inhibits glutamate from binding to NMDA receptors and decreases abnormal activity

Front 30

How has memantine been approved for use in the treatment of alzheimers

Back 30

approved alone or in combination with aricept (donepezil)

Front 31

What stage of alzheimers can memantine be used

Back 31

moderate to severe

Front 32

Give side effects of memantine (namenda)

Back 32

dizziness, diarrhea, headache
Rare: flu like symptoms, arhralgia, UTIs, urinary retention, small seizure risk

Front 33

How is memantin really adjusted

Back 33

do not exceed 5mg BID if CrCl <30mL/min

Front 34

Name 2 types of effects caused by drugs that would make you want to avoid certain classes of drugs in combination with acetylcholinesterase inhibitors

Back 34

1. lower blood pressure
2. call dizziness

Front 35

Why do you start with low doses of ACh-I's?

Back 35

do decrease the dizziness, diarrhea and nausea

Front 36

Which ACh-I has the least amount of nausea

Back 36

Rivastigmine (Exelon)

Front 37

What is the starting dose of donepezil

Back 37

5mg

Front 38

What time of the day is donepezil usually given

Back 38

at bedtime to avoid nausea

Front 39

What is the starting dose of rivastigmine

Back 39

1.5mg twice a day (BID)

Front 40

How should rivastigmine be given

Back 40

with food to decrease nausea

Front 41

What is the starting dose of Galantamine

Back 41

4mg BID with or w/o food

Front 42

After starting an acetylcholinesterase inhibitor, when can the dose begin to be increased

Back 42

at 4 weeks

Front 43

What parts of the body can the Exelon patch be applied to?

Back 43

upper and lower back
upper arm
chest

Front 44

How long should you wait before reapplying the Exelon patch to the same site

Back 44

14 days

Front 45

For all patches what areas of the skin should you not apply the patch to

Back 45

hairy, oily, irritated, broken, scarred or calloused skin

Front 46

How long can you wear one exelon patch

Back 46

24 hrs

Front 47

Which alzheimers medication can cause constipation

Back 47

memantine

Front 48

What is the starting does of memantine and how does this change?

Back 48

start with 5mg QD
-once dose is greater than 5mg take BID
ex. 5mg BID = 10mg/day

Front 49

What is the starting dose for the memantine extended release

Back 49

7mg QD

Front 50

How often is the memantine extended release taken

Back 50

once daily with food or liquid

Front 51

What can be done if the pt has trouble swallowing the memantine extended release capsule and what can not be done

Back 51

open capsule and sprinkle on applesauce but do
-do not crush or chew the capsule