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28 Cards in this Set

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What are the risk factors for Alzheimer's Disease?
Hypertension
High LDL
Low HDL
Diabetes
Describe what the MMSE is, the different categories and what they represent.
Mini-Mental State Examination
Out of 30
18-26 is mild alzheimers
10-17 is moderate
0-9 is severe
Continuation
Mild - Trouble with more difficult tasks. May get lost driving and deny memory problems
Moderate - Trouble with daily activities. Agitation, paranoia and delusions are common
Severe - Loses ability to speak, walk, feed self. Incontinence occurs. Requires constant care.
What are your therapy options in mild-moderate disease?
Cholinesterase inhibitor therapy
Donepezil
Rivastigmine
Galantamine
Titrate up as tolerated to maintenance dose
What is recommended in moderate-severe disease?
Anti-glutaminergic therapy
Memantine
Managing blood pressure, cholesterol and blood sugar may reduce the risk of developing AD and may prevent the worsening of dementia in patients with AD.
Donepezil, Rivastigmine and Galantamine have not been assessed against each other in clinical triels, so no one agent is recommended over the other. Donepezil is indicated in both mild-moderate and moderate-severe AD.
When would you consider changing to a different cholinesterase inhibitor?
If MMSE score drops 2-4 points within one year. Otherwise, treatment should be continued with the initial medication throughout the course of the illness.
What are the common side effects with these drugs?
NVD
Urinary Incontinence
Dizziness, HA, Syncope
Bradycardia
Muscle weakness
Salivation
Sweating
Why do you not want to stop these medications abruptly?
This can cause worsening of cognition and behavior in some patients.
What is the starting and maintenance dose for Donepezil?
Starting dose is 5 mg daily at bedtime

Maintenance dose is 5-10 mg daily
Managing blood pressure, cholesterol and blood sugar may reduce the risk of developing AD and may prevent the worsening of dementia in patients with AD.
Donepezil, Rivastigmine and Galantamine have not been assessed against each other in clinical triels, so no one agent is recommended over the other. Donepezil is indicated in both mild-moderate and moderate-severe AD.
When would you consider changing to a different cholinesterase inhibitor?
If MMSE score drops 2-4 points within one year. Otherwise, treatment should be continued with the initial medication throughout the course of the illness.
What are the common side effects with these drugs?
NVD
Urinary Incontinence
Dizziness, HA, Syncope
Bradycardia
Muscle weakness
Salivation
Sweating
Why do you not want to stop these medications abruptly?
This can cause worsening of cognition and behavior in some patients.
What is the starting and maintenance dose for Donepezil?
Starting dose is 5 mg daily at bedtime

Maintenance dose is 5-10 mg daily
What is the starting and maintenance dose for Rivastigmine?
Starting dose is 1.5 mg twice a day

Maintenance dose is 3-6 mg twice a day
What is important to counsel on these drugs in regards to food?
Rivastigmine must be taken with food, whereas Donepezil can can be taken without regards to food.
What is the starting and maintenance dose for Memantine?
Starting dose is 5 mg daily and increased weekly by 5 mg to 10 mg twice daily.
What are the side effects associated with this medication?
Constipation
Confusion
Dizziness
Hallucinations
HA
Cough
Hypertension
The aformentioned drugs are used with the goal of improving cognition. What therapy options are available for the treatment of non-cognitive symptoms?
Cholinesterase Inhibitors and Memantine are first line therapy in early management of behavioral symptoms. Modest improvement may be seen
Anti-psychotics can also be used to treat disruptive behaviors and psychosis in AD patients.
Continuation
Anti-depressants such as SSRI's can be used. Tri-cyclics are avoided because of anti-cholinergic side effects.
Carabamazepine may improve psychosis
Oxazepam and other benzodiazepines can be used to treat anxiety, agitation and aggression, but show less efficacy than anti-psychotics.
In evaluating an Alzheimer's patients current medication regimen, what is important to consider?
You want to stop or taper any medications that can cause cognitive impairment such as anti-cholinergics.
You also want to simplify the patients medication regimen in terms of number of medications and the number of times per day that medication is taken.
According to lecture, which of the first line mild-moderate agents is not commonly used due to GI side effects?
Rivastigmine

Use Donepezil or Galantamine
What is the starting and maintenance dose of Galantamine?
Starting dose is 4 mg twice daily

Maintenance dose is 8-12 mg twice daily

Take with food
In what patients do would you caution giving a cholinesterase inhibitor?
Patients with COPD or PUD (increased secretions)
Why do you want to start cholinesterase inhibitors at a low dose?
It takes time for the medication to work. You must wait 4 weeks before increasing the dose of one of these drugs. If you start at too high a dose, you will experience increased side effects.
Counseling Point: This therapy isn't designed to improve the state of alzheimer's.
It is only used to halt the progression of disease.
What would you do for a patient who is experiencing nightmares with Donepezil?
Give the medication in the morning