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45 Cards in this Set
- Front
- Back
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T/F Alzheimer's is a progressive disease, once you get it you'll have it forever and it will only get worse
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True :(
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T/F The goal of Alzheimer's disease is to cure the disease.
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False: no cure --> goal is to make ppl as fxl as possible for as long as possible
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T/F Alzheimer's occurs more often in males.
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False: affects both sexes equally, but women tend to live longer
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Lose (cognitive//behavioral/fxl) ability in the early stages & lose (cognitive//behavioral/fxl) ability in the late stages.
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Lose COGNITIVE ability in the early stages & lose BEHAVIORAL/FXL ability in the late stages.
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Examples of cognitive fx loss include:
a. memory b. driving c. getting lost (orientation) d. a & b e. a & c |
Examples of cognitive fx loss include:
e. a (memory) & c (getting lost (orientation)) driving is an instrumental activity of daily living (IADL) considered fxl decline |
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Which do you lose the ability to do first? (shopping / feeding yourself), which is a (ADL / IADL)
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You lose the ability to shop (IADL) before feeding yourself (ADL)
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what is the most common/primary presentation of early AD?
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memory loss
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which neurons are lost in AD?
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cholinergic neurons
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what is the major problem in the pathophysiology of AD?
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inflammation
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Which of the following does not happen in AD pathophysiology:
1. neurofibrillary tangles untangle 2. Beta amyloid proteins accumulate into plaques 3. cholinergic neurons degenerate |
neurofibrillary tangles DON'T untangle
B amyloid PROs accumulate into plaques --> form neurofibrillary tangles --> cause inflamm rxn --> destroys cholinergic neurons --> cortical atrophy |
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what is the genetic RF associated w/ AD?
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epsilon 4 variation of apolipoPRO E
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T/F AD is a clinical Dx
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true: must rule out other diseases first ie. other dementias, neurosyphilis, HIV, hypothyroidism, meds, depression, vit B12 def
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Matching the non-AD dementias:
1. DON'T give anti psychs to these PTs 2. often coexists w/ AD 3. minimal memory loss 4. abrupt onset bc big stroke 5. develop dementia Sx after experiencing tremors & bradykinesia Sx for yrs 6. commonly assoc'd w/ hallucinations 7. cognitive fx freqly fluctuates 8. develop dementia 1st then tremors later 9. executive dysfx a. Vascular dementia b. Parkinson's w/ dementia c. Lewy body disease d. Frontotemporal dementia |
c > b 1. DON'T give anti psychs to these PTs
a 2. often coexists w/ AD d 3. minimal memory loss a 4. abrupt onset bc big stroke b 5. develop dementia Sx after experiencing tremors & bradykinesia Sx for yrs c 6. commonly assoc'd w/ hallucinations c 7. cognitive fx freqly fluctuates c 8. develop dementia 1st then tremors later d 9. executive dysfx a. Vascular dementia b. Parkinson's w/ dementia c. Lewy body disease d. Frontotemporal dementia |
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which of the following is not likely a culprit of causing dementia like Sx? what are the other drugs that can cause dementia like Sx?
a. antihistamines b. muscle relaxants c. Abx d. TCAs e. urinary incontinence f. all of the above |
c. Abx are not likely to cause dementia like Sx
drugs w/ anticholinergic effects (antihistamines, muscle relaxants, TCAs, urinary incontinence, GI antispasmodics) BZDs, anticonvulsants, & opioids can induce cognitive changes |
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T/F It is possible to get a definitive Dx of AD via degree of cognitive impairment, fxl impairment (IADL, ADL), & behavioral impairment.
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false: definitive Dx only possible via autopsy (tangles in brain)
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what do AD PTs most commonly die from?
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infectious dzs (pneumonia & sepsis)
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T/F Non-pharmacological TX is MORE impt than pharmacological or is at least as impt as drug therapy
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true
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Match the non pharmacological TXs to the example:
1. list of family members 2. breaking down a process into smaller steps 3. disconnect the engine of the car to prevent it from being driven 4. "day care" 5. "instead of messing with those matches let's play chess" 6. talking to a PT about how they met their spouse a. caregiver support b. redirection c. envtl modification d. task simplification e. written reminders f. reminiscence therapy |
e 1. list of family members
d 2. breaking down a process into smaller steps c 3. disconnect the engine of the car to prevent it from being driven a 4. "day care" b 5. "instead of messing with those matches let's play chess" f 6. talking to a PT about how they met their spouse a. caregiver support b. redirection c. envtl modification d. task simplification e. written reminders f. reminiscence therapy |
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ChE Is are notorious for having GI SE except:
a. donepezil b. rivastigmine c. galantamine |
b. rivastigmine available in patch --> no GI SE
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an ideal ChE I inhibits
a. AChE b. BChE c. both equally |
an ideal ChE I inhibits a. AChE bc want more ACh. BCh causes GI SE
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Why is tacrine not used?
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1. QID --> poor compliance
2. inc liver enzs |
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donepezil reversibly inhibits:
a. AChE >> BChE b. AChE = BChE c. BChE >> AChE |
donepezil reversibly inhibits:
a. AChE >> BChE rivastigmine AChE = BChE |
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Which of the following is FDA approved to TX mod - severe AD?
a. rivastigmine b. memantine c. donepezil d. all the above e. all except a |
e. all except a
memantine & donepezil are approved to TX mod - severe AD |
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of the ChE Is, which has the longest t 1/2?
a. donepezil b. rivastigmine c. tacrine d. galantamine e. all of them are about equal |
a. donepezil has longest t 1/2 (~70 hrs)
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T/F If a PT has AD you should start them at the full dose right away so as to prevent any further cognitive loss
If false, why? |
false: start at low dose & titrate up q mo. full dose will cause severe GI probs
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rivastigmine is a
a. reversible inhibitor b. pseudoirreversible inhibitor c. irreversible inhibitor |
rivastigmine is a
b. pseudoirreversible inhibitor which means it sticks to the binding site for a while then comes off allowing BID dosing |
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galantamine is a
a. reversible inhibitor b. pseudoirreversible inhibitor c. irreversible inhibitor |
galantamine is a
a. reversible inhibitor AChE > BChE |
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T/F A PT that is started on a ChE I can expect substantial improvements in their cognitive fx.
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false: it may or may not help
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which of the following is available in a patch?
a. donepezil b. rivastigmine c. galantamine |
b. rivastigmine is available as a patch & so is best tolerated, but may have dec efficacy
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how much do ChE Is slow the progression of AD by?
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6 - 12 mo
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T/F ChE Is can stop the progression of further cholinergic neuronal atrophy (stop the progression of AD).
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false: can only slow the progression, won't stop it
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Which is the major monitoring tool of AD PTs?
a. MMSE b. caregiver input c. CIBIC-Plus |
b. caregiver input major monitoring tool
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T/F You must taper ChE Is if you want to D/C them.
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true: TAPER gradually
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T/F It would be absurd to start a PT on galantamine if there's a choice of Aricept or Exelon patch bc Aricept & Exelon are superior.
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false: diffs in MOA, drug interaxns not very clinically significant matters more about how the PT tolerates the SE, ease of titration/compliance
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T/F If you find that a hospitalized PT has AD you should immediately start them on a ChE I to slow the progression of AD.
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false: DON'T start PTs acutely ill in hosp on ChE I --> inc mortality risk
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memantine (Namenda) MOA
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NMDA Rc antag
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which has more GI SE?
memantine / ChE I |
ChE I have more GI SE
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which works better memantine / ChE I ?
a. memantine b. ChE I c. they work ab the same d. neither work |
c. they both work about the same
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Which is the best combo therapy?
a. ChE I + ginkgo biloba b. Vit E + Selegiline c. Memantine + estrogen d. high dose Vit E e. ChE I + memantine f. indocin (NSAID) |
e. ChE I + memantine best combo therapy
a. ChE I + ginkgo biloba --> GB doesn't prevent dementia & no evidence of efficacy b. Vit E + Selegiline --> not effective c. Memantine + estrogen --> estrogen no benefit & may be harmful d. high dose Vit E --> risk >> benefit bc inc mortality risk f. indocin (NSAID) --> bad for elderly bc hard on kidneys & GI tract, but NSAIDs show small benefit for inflamm prob |
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what are the noncognitive Sx of AD? (5)
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1. depression
2. aggression/agitation 3. psychotic Sx 4. anxiety 5. insomnia |
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which of the following would ChE I &/or memantine not be beneficial for? what would be beneficial?
a. vascular dementia b. Parkinson's w/ dementia c. LBD d. frontotemporal dementia e. all the above would benefit |
d. frontotemporal dementia -- SSRI
would not benefit from ChE I &/or memantine. SSRI better for frontotemporal dementia |
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Which would benefit from antiplatelet &/or anti coag therapy?
a. vascular dementia b. Parkinson's w/ dementia c. LBD d. frontotemporal dementia |
a. vascular dementia
would benefit from antiplatelet &/or anti coag therapy |
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which is the most sensitive to anti psychotics?
a. vascular dementia b. Parkinson's w/ dementia c. LBD d. frontotemporal dementia e. b & c |
e. b & c
Parkinson's w/ dementia & LBD are most sensitive to anti psychotics |
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T/F There are several things proven to prevent AD including HTN mgmt, eating lots of fruits & vegs, & getting plenty of Vit D.
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false: currently no scientific evidence of reducing AD risk but somethings that MAY help: choose parents wisely, avoid head trauma, HTN mgmt, cholesterol/statin mgmt, antioxidants/fruits & vegs, Vit D
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T/F AD is a growing concern bc the # of elderly are increasing and we currently have no cure for it
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true :(
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