Materials for Alzheimer's Disease

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mcucullu
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160580
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Materials for Alzheimer's Disease
Updated:
2012-07-02 15:08:27
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disease state management II dsm alzheimer drugs doses treatments
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Materials for alzheimer's disease including doses, drugs, signs, symptoms, etc.
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  1. In what three key symptom domains is there a gradual decline in patients with Alzheimer's Disease?
    • 1) activities in daily living (ADL)
    • 2) behavior and personality
    • 3) cognition 
  2. List two types of onsets that are associated with Alzheimer's Disease.
    • 1) early onset
    • 2) normal onset 
  3. List the environmental factors that contribute to Alzheimer's Disease.
    • 1) age
    • 2) head injury
    • 3) depression
    • 4) hypertension
    • 5) coronary heart disease
    • 6) homocysteine
    • 7) obesity
    • 8) diabetes
  4. What are some factors that are associated with the pathophysiology of AD?
    • 1) acetylcholine
    • 2) glutamate
  5. What are some diagnosing criteria required for definite AD?
    • 1) histopathological evidence
    • 2) course and examination characteristic of AD
  6. What are some diagnosing criteria required for probable AD?
    • 1) defecits in > 2 areas of cognition
    • 2) onset 40-90
    • 3) other causes excluded
  7. What are some diagnosing criteria required for possible AD?
    • 1) deficit in only 1 area of cognition
    • 2) atypical course
    • 3) other dementia causes present
  8. What are some diagnosing criteria required for unlikely AD?
    • 1) sudden onset
    • 2) focal signs
    • 3) seizures or gait distrubance early in course
  9. What are some literature resources used to diagnose AD?
    • 1) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
    • 2) The agency for Healthcare Research and Quality (AHRQ) guidelines
    • 3) The American Academy of Neurology Guidelines
    • 4) The National Institute of Neurological Communicative Disorders and Stroke (NINCDS)
    • 5) The Alzheimer's Disease and Related Disorders Associated (ADRDA) Criteria 
  10. What are the assessment instruments for the mental state?
    • 1) Folstein MMSE
    •   a. 30 point scale = higher scores means better mental functioning
    • 2) Alzheimer Disease Assessment Scale - Cognitive (ADAS - cog)
    •   a. 70 point scale = lower scores means better mental functioning
    • 3) St Louis University Mental Status Examination (SLUMS)
    •   a. 30 point scale = higher score means better mental functioning
    • 4) Mini-Cog Assessment 
    •   a. clock-drawing test and 3 item recall test
  11. What are the assessment instruments for the functions of the patient?
    • 1) Alzheimer Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL)
    •   a.  54 point scale
    •   b.  the higher the better
    • 2) Functional Assessment Staging (FAST)
    •   a. 1-7 scale
    •   b. 1 = normal
    •   c. 7 = requires care
    • 3) Various scales to measure IADLs
  12. What are the AD top ten warning signs?
    • 1) recent memory loss affecting job
    • 2) difficulty performing familiar tasks
    • 3) problems with language
    • 4) disorientation to time or place
    • 5) poor or decreased judgement
    • 6) problems with abstract thinking
    • 7) misplacing things
    • 8) changes in mood or behavior
    • 9) changes in personality
    • 10) loss of initiative
  13. Define mild AD.
    An MMSE score of 26-18.  Difficulty remembering recent events, decline in everyday activites. Withdraws from difficult tasks and hobbies. May deny memory problems.
  14. Define moderate AD.
    An MMSE score 17-10. Patient requires helps with ADL. Disoriented with time (can't remember date). Can't remember recent memories.  May forget family members names. May become emotional. Agitation, paranoia, and delusion may be apparent.
  15. Define severe AD.
    An MMSE score of 9-0. Patient loses ability to speak, walk, and eat. May be incontinent.
  16. What drugs can be used in mild AD.
    • 1) Donepezil (Aricept)
    • 2) Galantamine (Razadyne)
    • 3) Rivastigmine (Exelon) 
  17. What drugs can be used in moderate AD.
    • 1) Donepezil (Aricept)
    • 2) Galantamine (Razadyne)
    • 3) Rivastigmine (Exelon)
    • 4) Memantine (Namenda) 
  18. What drugs can be used in severe AD.
    • 1) Donepezil (Aricept)
    • 2) Memantine (Namenda)
  19. What is the initial dose for donepezil (Aricept)?
    5 mg tab q.p.m.
  20. What is the maximum dose for donepezil (Aricept)?
    10 mg tab q.p.m.
  21. What is the initial dose for galantamine (Razadyne)?
    • 4 mg tab BID cf or
    • 4 mg oral solution BID  cf or 
    • 8 mg cap QD cf (ER)
  22. What is the maximum dose for galantamine (Razadyne)?
    • 12 mg tab BID cf or
    • 12 mg oral solution BID cf or
    • 24 mg cap QD cf (ER)
  23. What is the initial dose for rivastigmine (Exelon)?
    • 1.5 mg cap BID cf or
    • 1.5 mg oral solution BID cf or
    • 4.6 mg patch QD cf
  24. What is the maximum dose for rivastigmine (Exelon)?
    • 6 mg cap BID cf or
    • 6 mg oral solution BID cf or
    • 9.5 mg patch QD cf 
  25. What is the initial dose of memantine (Namenda)?
    • 5 mg tab QD or
    • 5 mg oral solution QD
  26. What is the maximum dose of memantine (Namenda)?
    • 10 mg tab BID or
    • 10 mg oral solution BID
  27. What are the adverse effects of donepezil (Aricept)?
    • 1) N/V/D
    • 2) muscle cramps
    • 3) urinary incontinence
    • 4) syncope
    • 5) bradycardia
    • 6) fatigue
  28. What are some DI of donepezil (Aricept)?
    • 1) CYP3A4 and 2D6 
    • 2) anticholinergic medications
  29. What are some neurotransmitters that are increased with use of galantamine (Razadyne)?
    • 1) glutamate
    • 2) serotonin
  30. What are some side effects associated with galantamine (Razadyne)?
    • 1) N/V/D
    • 2) muscle cramps
    • 3) urinary incontinence
    • 4) syncope
    • 5) bradycardia
    • 6) fatigue
  31. What is the DI for galantamine (Razadyne)?
    CYP3A4 and 2D6
  32. What are the adverse effects associated with rivastigmine (Exelon)?
    • 1) N/V
    • 2) anorexia
    • 3) muscle cramps
    • 4) bradycardia
    • 5) syncope
    • 6) fatigue
    • 7) urinary incontinence 
  33. What are the adverse effects associated with memantine (Namenda)?
    • 1) HA
    • 2) dizziness
    • 3) sedation
    • 4) agitation
    • 5) constipation
    • 6) hypetension
    • 7) coughing
    • 8) confusion 
  34. What are some tools to help measure behavioral symptoms?
    • 1) Neuropsychiatric Inventory (NPI)
    •   a. 144-point scale
    •   b. higher score = severe behavioral problems
    • 2) Behavioral Pathology in Alzheimer's Disease
    •   a. 75 point scale
    •   b. higher score = more behavioral problems
    • 3) Cohen-Mansfield Agitation Inventory 
    •   a. 203 point scale
    •   b. higher score = more behavioral problems 
  35. What are some drugs used in the treatment of behavioral symptoms?
    • 1) cholinesterase inhibitors
    • 2) atipical antipsychotics
    • 3) valproic acid/carbamezapine
    • 4) antidepressants
    • 5) memantine
  36. What are the atypical antipsychotics used in treatment of behavioral symptoms?
    • 1) risperidone (RisperDAL)
    • 2) olanzapine (ZyPREXA)
  37. What is the initial dose of risperidone (RisperDAL)?
    0.25 mg/day
  38. What is the maximum dose of risperidone (RisperDAL)?
    2 mg/day
  39. How is the risperidone (RisperDAL) dose titrated up?
    It is titrated up in increment of 0.25-0.5 mg/day until 1 mg/day is reached.
  40. What is the dose for olanzapine (Zyprexa)?
    5-10 mg/day
  41. What are the side effects associated with the typical antipsychotics?
    • 1) somnolence
    • 2) EPS
    • 3) abnormal gait
    • 4) worsening cognition
    • 5) cerebrovascular events
    • 6) increased risk of death
    • 7) hypotension
  42. What are the antidepressants used in treating behavioral symptoms?
    • 1) citalopram (CeleXA)
    • 2) sertraline (Zoloft)
  43. What two anticonvulsants are used in the treatment of behavioral symptoms?
    • 1) carbamazepine (Carbatrol, Epitol, Equetro, TEGretol)
    • 2) valproic acid (Depacon, Depakene, Stavzor)
  44. What are the two nonbenzodiazepines used in treating behavioral symptoms?
    • 1) zolpidem (Ambien)
    • 2) buspirone (Bustab, Buspirex, BuSpar)

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