thera dementia

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coal
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251576
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thera dementia
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2013-12-07 23:08:15
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thera dementia
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  1. how is dementia characterized
    • impaired memory and one of the following
    •   aphasia
    •   apraxia
    •   agnosia
    •   executive function
  2. cholinesterase inhibitors
    • donepezil - aricept
    • rivastigmine - exelon
    • galantamine - razadyne
    • tacrine - cognex
  3. NMDA receptor antagonist
    memantine - namenda
  4. which meds are used for mild - moderate AD
    • donepezil - aricept
    • rivastigmine - exelon
    • galantamine - razadyne
  5. which meds are used for moderate-severe AD
    • donepezil - aricept
    • memantine - namenda
  6. the most frequent adverse effects of cholinesterase inhibitor
    mild to moderate GI
  7. tacrine - cognex limiting adverse effect and a drug interaction cause
    • hepatotoxicity - occurs early
    • substrate of CYP 1A2
  8. which med is 1st line therapy and approved for severe AD dementia
    donepezil (Aricept)
  9. donepezil (Aricept) MOA
    specifically and reversibly inhibits acetylcholinesterase
  10. donepezil (Aricept) adverse effects
    • N/V
    • diarrhea
  11. rivastigmine (Exelon) MOA
    inhibits acetyl and butyryl cholinesterase
  12. which acetylcholinesterase inhibitor comes in a transdermal patch
    rivastigmine - exelon
  13. which AChEI is not metabolized by CYP450
    rivastigmine - exelon
  14. which med is indicated for PD dementia
    rivastigmine - exelon
  15. galantamine (razadyne) MOA
    • selective, competitive, reversible AChEI
    • nicotinic receptor agonist
  16. 5 scenarios when cognitive enhancing medications might be stopped
    • poor quality of life
    • AE's intolerable
    • improvement not seen with therapeutic doses
    • pt is bedridden and unable to perform ADL's
    • slowing disease progression is no longer a goal
  17. memantine - Namenda MOA
    blocks glutamatergic neurotransmission by antagonizing NMDA receptors
  18. A DI of memantine (Namenda)
    • clearance decreases by 80% when urinary pH >8
    • caution with carbonic anhydrase inhibitors
    • sodium bicarb
  19. 2 statins that show a lower prevalence of AD
    • pravastatin
    • lovastatin
  20. rember - methylene blue MOA
    dissolves tau tangles and prevents formation of new tangles
  21. new drug with a MOA of "plaque buster"
    PBT2 - attacke beta-amyloid 42
  22. new drug with a MOA of mitochondrial health and an antihistamine
    latrepirdine - dimebolin
  23. studied drug that treats the agitation in AD
    • AVP-23 (dextromethorphan & quinidine)
    • dex works on NMDA receptor
  24. what is BPSD in AD
    behavioral and psychological symptoms of dementia
  25. where do antipsychotics stand in the tx of BPSD
    may tx symptoms but not indicated for mgmt. of behavioral symptoms in AD and there is a risk of death
  26. 6 types of dementia
    • AD
    • vascular
    • lewy body
    • Parkinson's
    • frontotemporal - responds poorly to meds
    • reversible
  27. 7 drugs and toxins that can cause dementia symptoms
    • anticholinergics
    • antihypertensives
    • anxiolytic/sedatives
    • alcohol
    • hypoglycemics
    • heavy metals
    • CNS depressants
  28. 4 systemic illness' that can cause dementia symptoms
    • cardiovascular disease
    • B12 & folate deficiency
    • infection
    • metabolic disorders
  29. do cognitive impairments warrant a diagnosis of dementia
    no but there is a 10-15% chance per year of progressing to AD diagnosis
  30. where does AD rank in causes of death and some trivia
    • 5th
    • 3-20 year survival
    • 42% incidence at 85 years and older
  31. 6 risk factors for dementia
    • genetics
    • family history
    • age/gender
    • mild cognitive impairment
    • risk factors for vascular diseae
    • lifestyle and activity
  32. what are the genetic links for AD
    • early onset = chromosomes 1,14 or 21
    • late onset (sporadic) linked to APO E4
    •   40% have one copy
    •   90% with 2 copies will develop AD by age 80
    •     you can have Apo E4 and not develop AD
  33. what are the neurotransmitter abnormalities in dementia
    • decreased ACh synthesis
    • increased glutamate
  34. what neurologic transformation happens in AD
    hippocampal shrinking
  35. examples of complex ADL and what they are associated with
    • telephone use
    • shopping
    • cleaning
    • using TV/Radio
    • more associated with executive function
  36. how do you get a definitive diagnosis of dementia
    brain tissue exam
  37. some clinical diagnosis for dementia
    • interview pt, family, caregiver
    • full medical history
    • physical exam
    • neuropsychological screening
    • neuroimaging - PET scan, MRI
    • serologic and CSF evaluation
  38. tests used to identify cognitive dysfunction
    • MMSE
    • MoCA
  39. test used to evaluate severity of dysfunction in AD
    ADAS - Alzheimer's disease assessment scale
  40. 3 phases of AD
    • asymptomatic, preclinical phase
    • symptomatic, pre-dementia phase (MCI)
    • dementia phase
  41. features of very mild cognitive decline
    forgetfulness, subjective complaints only
  42. features of mild cognitive decline
    • objective decline(tests) mild anxiety and denial
    • work/social impairment
  43. features of moderated cognitive decline
    concentration, complex skill decline, withdrawal
  44. features of moderately severe cognitive decline
    early dementia, difficulty in interactions
  45. features of severe cognitive decline
    assistance with bathing, behavioral symptoms present
  46. features of very severe cognitive decline
    total dependence
  47. some nonpharm therapy for dementia
    • make things simple and make the pt safe
    • exercise
    • mental stimulation - and new challenges
  48. donepezil - Aricept dosing
    5-10 mg QD
  49. rivastigmine - Exelon dosing
    • 1.5 mg BID - starting
    • 3-6 mg BID
  50. galantamine - razadyne dosing
    • 4 mg BID starting
    • 12 mg BID
  51. tacrine - cognex dosing
    • 10 mg QID starting
    • 160 mg/day
  52. memantine - Namenda dosing
    • 5 mg day starting
    • 10 mg BID - increased weekly to get there
  53. max dose of vitamin E
    400 iU/day

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