Term
What symptom does mild dementia entail ?
What symptoms does moderate, severe dementia entail ?
Lewy bodies dementia can cause what? What can it be misdiagnosed as ? Why is this a problem? |
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Definition
Mild dementia - Depression
Moderate/Severe dementia - aggression,
Be careful diagnosing Lewy bodies dementia and delirium because lewy bodies dementia can cause altered conciousness. If antipsychotics are prescribed they can precipitate dementia. |
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Term
Cholinesterase inhibitors
Name them (3), and what they're used for
Side effects (Common and individual)
Interactions
Which drug is available as a transdermal patch that causes less SE's?
Which is indicated for all severities of alzheimers? |
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Definition
Cholinesterase inhibitors
Donepezil, Rivastigmine, Galantamine
Donepezil - moderate/severe alzheimers dementia
Rivastigmine - Lewy bodies dementia & Parkinsons dementia
Galantamine - Vascular or Alzheimers dementia
Side effects: HA, nausea, diarrhea, urinary frequency, RARE: Heart block, lower the seizure threshold.
Donepezil specifically - above and sleep disturbances, worsen COPD, GI disturbances.
Galantamine - Bradycardia, weight loss, UTI
Rivastigmine - Anorexia
Interactions
2D6, 3A4 substrates
Rivastigmine - available as transdermal patch
Donepezil approved for all severities of alzheimers |
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Term
Memantine
How is it used? When is it used alone?
When is dose adjusted?
Tolerability and side effects
Interaction |
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Definition
Memantine
Used with donepezil for moderate/severe alzheimers. Can be used monotherapy when donepezil causes ulceration
Dose adjust for renal failure
Well tolerated - confusion, dizziness
Avoid use with carbonic anhydrase inhibitors |
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Term
Dementia with depression
What class to use? Which drugs specifically?
What to watch out for with SSRI's in the elderly?
When should TCAs be used? Which TCAs |
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Definition
Dementia with depression
SSRIs - Citalopram & sertraline
Watch out for SIADH & hyponatremia, especially when using thiazides
Use TCAs when sensitivity to SSRIs or lack of response. Specifically desipramine & nortriptyline |
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Term
BPS with dementia
First line?
When to switch to quetiapine
antipsychotic induced akathsia is a problem, why? |
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Definition
BPS with dementia
SGAs - low dose risperidone or olanzapine are preferable, first line.
Switch to quetiapine if EPS is an issue
Antipsychotic induced akathisia can cause us to increase dose which can cause muscle rigidity. |
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