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28 Cards in this Set
- Front
- Back
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What are the risk factors for Alzheimer's Disease?
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Hypertension
High LDL Low HDL Diabetes |
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Describe what the MMSE is, the different categories and what they represent.
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Mini-Mental State Examination
Out of 30 18-26 is mild alzheimers 10-17 is moderate 0-9 is severe |
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Continuation
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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. |
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What are your therapy options in mild-moderate disease?
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Cholinesterase inhibitor therapy
Donepezil Rivastigmine Galantamine Titrate up as tolerated to maintenance dose |
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What is recommended in moderate-severe disease?
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Anti-glutaminergic therapy
Memantine |
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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.
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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.
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When would you consider changing to a different cholinesterase inhibitor?
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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.
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What are the common side effects with these drugs?
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NVD
Urinary Incontinence Dizziness, HA, Syncope Bradycardia Muscle weakness Salivation Sweating |
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Why do you not want to stop these medications abruptly?
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This can cause worsening of cognition and behavior in some patients.
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What is the starting and maintenance dose for Donepezil?
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Starting dose is 5 mg daily at bedtime
Maintenance dose is 5-10 mg daily |
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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.
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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.
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When would you consider changing to a different cholinesterase inhibitor?
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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.
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What are the common side effects with these drugs?
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NVD
Urinary Incontinence Dizziness, HA, Syncope Bradycardia Muscle weakness Salivation Sweating |
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Why do you not want to stop these medications abruptly?
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This can cause worsening of cognition and behavior in some patients.
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What is the starting and maintenance dose for Donepezil?
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Starting dose is 5 mg daily at bedtime
Maintenance dose is 5-10 mg daily |
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What is the starting and maintenance dose for Rivastigmine?
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Starting dose is 1.5 mg twice a day
Maintenance dose is 3-6 mg twice a day |
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What is important to counsel on these drugs in regards to food?
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Rivastigmine must be taken with food, whereas Donepezil can can be taken without regards to food.
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What is the starting and maintenance dose for Memantine?
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Starting dose is 5 mg daily and increased weekly by 5 mg to 10 mg twice daily.
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What are the side effects associated with this medication?
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Constipation
Confusion Dizziness Hallucinations HA Cough Hypertension |
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The aformentioned drugs are used with the goal of improving cognition. What therapy options are available for the treatment of non-cognitive symptoms?
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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. |
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Continuation
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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. |
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In evaluating an Alzheimer's patients current medication regimen, what is important to consider?
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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. |
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According to lecture, which of the first line mild-moderate agents is not commonly used due to GI side effects?
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Rivastigmine
Use Donepezil or Galantamine |
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What is the starting and maintenance dose of Galantamine?
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Starting dose is 4 mg twice daily
Maintenance dose is 8-12 mg twice daily Take with food |
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In what patients do would you caution giving a cholinesterase inhibitor?
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Patients with COPD or PUD (increased secretions)
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Why do you want to start cholinesterase inhibitors at a low dose?
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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.
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Counseling Point: This therapy isn't designed to improve the state of alzheimer's.
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It is only used to halt the progression of disease.
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What would you do for a patient who is experiencing nightmares with Donepezil?
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Give the medication in the morning
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