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33 Cards in this Set

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  • Back
What are pharmacodynamic changes that occur in the elderly?
• Absorption: increased fat; decreased GI absorption/motility
• Distribution: decreased lean body mass
• Metabolism: decreased phase I metabolism
• Elmination: decreased CrCl
What are drugs that are commonly underused in the eldery?
• aspirin
• ACE inhibitors
• antidepressants
• iron
• pain meds
• thrombolytics
• warfarin
What are some primary risk factors for Alzheimer's Disease?
• age
• family history
What is a negative risk factor for Alzheimer's disease?
educational status
What is the definition of dementia?
• general mental deterioration due to organic or psychological factors
• chacterized by disorientation, impaired memory, judgement, & intellect
What are examples of cognitive deficits in dementia?
• aphasia
• apraxia (inability to perform voluntary & skillful movements)
• agnosia (inability to recognize common objects, persons, or sounds)
• disturbances in executive function
What is the definition of delirium?
• acute change w/ a clouded state of consciousness and confusion

• marked by:
- difficulty in sustaining attention to stimuli
- disordered thinking
- defective perception
- disordered sleep cycle
- motor disturbances
What are different types of dementia?
• Alzheimer's dementia
• dementia w/ lewy bodies (ex. parkinsons)
• frontotemporal dementia
• vascular dementia
Dementia is often due to cerebral atrophy. What are 3 consistent hallmarks involved in the pathophysiology of dementia?
• B-amyloid rich senile plaques
• neurofibrillary tangles
• neuronal degeneration
Name and describe 3 neurotransmitters involved in the pathophysiology of dementia
• Acetylcholine: cholinergic pathways are damaged by formation of plaques

• Glutamate: overstimulation of the NMDA receptor by glutamate may result in neuronal damage

• Nicotine:
- controls release of ACH, glutamate, serotonin, and norepi
- inhibition of nicotinic receptors impairs cognition
- stimulation of nicotinic receptors may improve memory
What are signs and symptoms of dementia?
• changes in personality
• decline in ADLs
• increase in resource utilization (asking others for help)
Give examples of medications that can cause dementia
• antibiotics (ex. quinolones)
• antihypertensive (ex. propanolol)
• antimanic
• antiparkinson
• antihistamine
• H2 antagonist
• muscle relaxants
• narcotics
• NSAIDS
What are labs and radiologic tests that should be ordered for patients with dementia?
• BUN/SCr
• CBC
• Chem 7 (electrolytes & glucose)
• CT scan
• Folate
• LFTs
• PET scan
• Vit B-12
What are goals for treating patients with dementia?
• foster safe & secure environment
• improve quality of life
• improve or slow progression
• maintain independance
List different drugs used to treat Alzheimers
• Donepezil (Aricept)
• Galantamine (Razadyne)
• Memantine (Namenda)
• Rivastigmine (Exelon)
• Tacrine (Cognex)
What is the MOA of Tacrine (Cognex)?
• centrally acting cholinesterase inhibitor
• elevates ACH in cerebral coretx by slowing the degradation of ACH
What are adverse effects of Tacrine (Cognex)?
• increase in LFTs

* metabolized extensively by the liver; must monitor LFTs
What are drugs that interact with Tacrine (Cognex)?
Theophylline
What is the dosing for Tacrine (Cognex)?
• 10 mg PO TID
• Max: 40 mg PO QID
What is the MOA of Donepezil (Aricept)?
• centrally acting cholinesterase inhibitor
• elevates ACH in cerebral cortex by slowing the degradation of ACH
What are drugs that interact with Donepezil (Aricept)?
• Dilantin
• Phenobarbital
• Rifampin
What is the dosing and indications for Donepezil (Aricept)?
• Dose: 5 mg PO QD; Max: 10 mg PO QD
• Indications: mild to moderate dementia
What is the MOA, dose and indications for Rivastimine (Exelon)?
• MOA: centrally acting cholinesterase inhibitor; elevates ACH in cerebral cortex by slowing the degradation of ACH

• Dose: 1.5 mg PO BID or 3 mg PO QD

• Indications: mild to moderate dementia
How is Rivastigmine (Exelon) eliminated from the body?
by the kidneys
What is the MOA of Galantamine (Razadyne)?
• centrally acting cholinesterase inhibitor » elevates ACH in cerebral cortex by slowing the degradation of ACH
• stimulates nicotinic receptors to increase ACH at the synapse
• may also increase serotonin and glutamate
What are drugs that interact with Galantamine (Razadyne)?
• antifungals
• SSRIs
What is the dosing for Galantamine (Razadyne)?
• 4 mg PO BID
• dose adjusted for renal insufficiency » 2 mg PO BID
What are indications for using Galantamine (Razadyne) and how is the drug eliminated from the body?
• indicated for mild to moderate dementia
• eliminated by the kidney and liver

* need to monitor LFTs and kidney function
What is the MOA of Memantine (Namenda)?
NMDA receptor antagonist
What are adverse effects of Memantine (Namenda)?
• dizziness
• drowsiness
What is the dosage for Memantine (Namenda)?
• 5 mg PO QD
• max: 30 mg PO QD
What are indications for using Memantine (Namenda)?
moderate to severe dementia
What are other drugs that can be used for treatment of dementia?
• Vitamin E
• antioxidants
• coenzyme Q-10