Pharmacology Geriatrics.db

Front 1

What are pharmacodynamic changes that occur in the elderly?

Back 1

• Absorption: increased fat; decreased GI absorption/motility
• Distribution: decreased lean body mass
• Metabolism: decreased phase I metabolism
• Elmination: decreased CrCl

Front 2

What are drugs that are commonly underused in the eldery?

Back 2

• aspirin
• ACE inhibitors
• antidepressants
• iron
• pain meds
• thrombolytics
• warfarin

Front 3

What are some primary risk factors for Alzheimer's Disease?

Back 3

• age
• family history

Front 4

What is a negative risk factor for Alzheimer's disease?

Back 4

educational status

Front 5

What is the definition of dementia?

Back 5

• general mental deterioration due to organic or psychological factors
• chacterized by disorientation, impaired memory, judgement, & intellect

Front 6

What are examples of cognitive deficits in dementia?

Back 6

• aphasia
• apraxia (inability to perform voluntary & skillful movements)
• agnosia (inability to recognize common objects, persons, or sounds)
• disturbances in executive function

Front 7

What is the definition of delirium?

Back 7

• 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

Front 8

What are different types of dementia?

Back 8

• Alzheimer's dementia
• dementia w/ lewy bodies (ex. parkinsons)
• frontotemporal dementia
• vascular dementia

Front 9

Dementia is often due to cerebral atrophy. What are 3 consistent hallmarks involved in the pathophysiology of dementia?

Back 9

• B-amyloid rich senile plaques
• neurofibrillary tangles
• neuronal degeneration

Front 10

Name and describe 3 neurotransmitters involved in the pathophysiology of dementia

Back 10

• 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

Front 11

What are signs and symptoms of dementia?

Back 11

• changes in personality
• decline in ADLs
• increase in resource utilization (asking others for help)

Front 12

Give examples of medications that can cause dementia

Back 12

• antibiotics (ex. quinolones)
• antihypertensive (ex. propanolol)
• antimanic
• antiparkinson
• antihistamine
• H2 antagonist
• muscle relaxants
• narcotics
• NSAIDS

Front 13

What are labs and radiologic tests that should be ordered for patients with dementia?

Back 13

• BUN/SCr
• CBC
• Chem 7 (electrolytes & glucose)
• CT scan
• Folate
• LFTs
• PET scan
• Vit B-12

Front 14

What are goals for treating patients with dementia?

Back 14

• foster safe & secure environment
• improve quality of life
• improve or slow progression
• maintain independance

Front 15

List different drugs used to treat Alzheimers

Back 15

• Donepezil (Aricept)
• Galantamine (Razadyne)
• Memantine (Namenda)
• Rivastigmine (Exelon)
• Tacrine (Cognex)

Front 16

What is the MOA of Tacrine (Cognex)?

Back 16

• centrally acting cholinesterase inhibitor
• elevates ACH in cerebral coretx by slowing the degradation of ACH

Front 17

What are adverse effects of Tacrine (Cognex)?

Back 17

• increase in LFTs

* metabolized extensively by the liver; must monitor LFTs

Front 18

What are drugs that interact with Tacrine (Cognex)?

Back 18

Theophylline

Front 19

What is the dosing for Tacrine (Cognex)?

Back 19

• 10 mg PO TID
• Max: 40 mg PO QID

Front 20

What is the MOA of Donepezil (Aricept)?

Back 20

• centrally acting cholinesterase inhibitor
• elevates ACH in cerebral cortex by slowing the degradation of ACH

Front 21

What are drugs that interact with Donepezil (Aricept)?

Back 21

• Dilantin
• Phenobarbital
• Rifampin

Front 22

What is the dosing and indications for Donepezil (Aricept)?

Back 22

• Dose: 5 mg PO QD; Max: 10 mg PO QD
• Indications: mild to moderate dementia

Front 23

What is the MOA, dose and indications for Rivastimine (Exelon)?

Back 23

• 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

Front 24

How is Rivastigmine (Exelon) eliminated from the body?

Back 24

by the kidneys

Front 25

What is the MOA of Galantamine (Razadyne)?

Back 25

• 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

Front 26

What are drugs that interact with Galantamine (Razadyne)?

Back 26

• antifungals
• SSRIs

Front 27

What is the dosing for Galantamine (Razadyne)?

Back 27

• 4 mg PO BID
• dose adjusted for renal insufficiency » 2 mg PO BID

Front 28

What are indications for using Galantamine (Razadyne) and how is the drug eliminated from the body?

Back 28

• indicated for mild to moderate dementia
• eliminated by the kidney and liver

* need to monitor LFTs and kidney function

Front 29

What is the MOA of Memantine (Namenda)?

Back 29

NMDA receptor antagonist

Front 30

What are adverse effects of Memantine (Namenda)?

Back 30

• dizziness
• drowsiness

Front 31

What is the dosage for Memantine (Namenda)?

Back 31

• 5 mg PO QD
• max: 30 mg PO QD

Front 32

What are indications for using Memantine (Namenda)?

Back 32

moderate to severe dementia

Front 33

What are other drugs that can be used for treatment of dementia?

Back 33

• Vitamin E
• antioxidants
• coenzyme Q-10