Term
| MMSE and SLUMS tests are used for _ only |
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Definition
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Term
| if a screening test for alzheimers reveals deficits what should a pharmacist then do? |
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Definition
| review of medication regimen for drug induced dementia |
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Term
| 3 assessments used in clinical trials of Alzheiemr's med: |
|
Definition
globl dementia rating scale
Activite sof daily living
geriatric depression scale |
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Term
| reasarch tools like ADAS are muhc more _ than clinical toold and so are the primary outcome of trials |
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Definition
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Term
| the problem with reasearch tools like ADAS is that -2 |
|
Definition
hard to administed
not practical in pt care |
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Term
| change in ADAS can be eval what 2 ways |
|
Definition
magnitude of response
responder rate |
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Term
| what does magnitiude of response mean |
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Definition
| change in score before and after med and across points in time (avg of the group) |
|
|
Term
| what does responder rate mean |
|
Definition
| proportion of pt who achieve minimum threshold (expr as %) |
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Term
| Subjective measurements are mroe qualitative, but less sensitive |
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Definition
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Term
| which test is best when eval how well intervention influenced cohorts of pt progress to next dmentia stage |
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Definition
| Global Rating Scale (similar to the Responder Rate with ADAS) |
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Term
Mood and behviro scaled allow id of collateral _
ex of these scales-2 |
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Definition
psychiatric and behavioral
GDS, NPI |
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Term
| the surrogate markers for AD severity is-2 |
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Definition
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Term
what test is best for seeing care needs and resoruce utilization?
what can it aslo see? |
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Definition
Caregiver Burden
drug therapy effectivenss |
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Term
| the two cateogries for medications for AD by the FDA are |
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Definition
mild-moderate
moderate-severe |
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Term
what is the 7 stage scaling for AD?
what is its other name? |
|
Definition
Reisberg Scale
GLobal Deterioration scale |
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Term
what is this AD stage?
-last known period of nromal function |
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Definition
|
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Term
| whcih stage is often found retropsectively |
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Definition
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Term
what is this AD stage?
pt can compensate for deifcts so others dont notice |
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Definition
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|
Term
what is this AD stage?
depresison and anxiety are common co-morbidities |
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Definition
|
|
Term
| this is the stage where most dx of AD are made |
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Definition
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Term
| what is the stage where MMSE score is 21-24 |
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Definition
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|
Term
what is this AD stage?
pt will need assitance with household task/hygeine (self care acts) |
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Definition
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|
Term
what is sundowning?
whcih stage has this |
|
Definition
agitatin becomes more apparent at night
stage 4 |
|
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Term
| what is the MMSE of stage 4 |
|
Definition
|
|
Term
| what is the MMSE for stage 5 |
|
Definition
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|
Term
at what stage can the GDS not be used?
which one is better |
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Definition
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|
Term
| what is the MMSE for stage 5 |
|
Definition
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|
Term
| at whcih stage is cognition impairment so sever that have poor problem solving and awareness |
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Definition
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|
Term
| at whcih stage are pts depednent on most things and are only ambulatory in a wheelchair |
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Definition
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|
Term
| at whcih stage is the pt non veral or severe language impairment |
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Definition
|
|
Term
| what is the MMSE at stage 6 |
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Definition
|
|
Term
| stage 7= pt non functinal |
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Definition
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|
Term
| at stage 7 what is the most common cause of death |
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Definition
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|
Term
| at whihc stage cna pts not participate in MMSE? |
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Definition
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Term
| cholinesteras einhibitors are for what cateogry of AD? |
|
Definition
|
|
Term
| when do cholinesterase inhibitors star on the resiberg scale? when can you start them really tho? |
|
Definition
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|
Term
|
Definition
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|
Term
|
Definition
|
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Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are the 4 cholinesterase inhibitors |
|
Definition
tacrine
dnepezil
rivastigme
galantamine |
|
|
Term
|
Definition
|
|
Term
what is the worst ADE of tacrine?
why? |
|
Definition
hepatoxicity / increased LEFT
bc mroe haarmful than any others |
|
|
Term
| what is the monitoring for tacrine |
|
Definition
| LEFTs every other week for 16 weeks, then q 2 months, then every 3 months |
|
|
Term
| donepezil is approve for what AD stages? |
|
Definition
|
|
Term
| donepezil become more used than tacrine why? |
|
Definition
one daily dosing
no LFT monitoring
both 5 mg and 10 mg are effiacious (no need to titrate) |
|
|
Term
| reccomedned dosing for donepezil |
|
Definition
|
|
Term
ADes of donepezil-4
counseling pint on these is |
|
Definition
N/D
dizziness
incontience
initital increase in agitation
-most will disspaear in 4 wks |
|
|
Term
| whcih cholinesterase inhibitor is used for dementia assoicated with Parkinsons's |
|
Definition
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|
Term
| dosing for rivastigmine PO: |
|
Definition
| 1.5 BID-> 3 mg BId-> 4.5 BID-> 6 mgBID |
|
|
Term
| dosing for rivastigmine trnasdermal |
|
Definition
4.5
can go up to 9.6 mg (need 2 wks befoer up ddosing |
|
|
Term
| if pt stops rivastigmine and then restarts, what dose should they start t? |
|
Definition
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|
Term
|
Definition
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|
Term
| dosing for reg release galantamine |
|
Definition
| 4 mg BID-> 8 mg BID-> 12 BID (4 wks btwn each |
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|
Term
| dosing for extedned release galantamine |
|
Definition
| same total dose as regular relase, but all given at one time (titration is same too) |
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|
Term
| NMDA receptor anatognists |
|
Definition
|
|
Term
|
Definition
|
|
Term
| NMDA recpt antags are apporved for whcih AD |
|
Definition
| moderate-severe (block Glu) |
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|
Term
| memantine is titrate to what maint dose |
|
Definition
| 10 mg BID in a starter pack |
|
|
Term
| what is the maint for memantine if cr cl < 30 |
|
Definition
|
|
Term
| XR memantine is titrated to maint dose of- |
|
Definition
|
|
Term
| what is the maint dosinf for XR memantine for Cr Cl <30 |
|
Definition
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|
Term
| data on Vit C and E is inconclusive: but if pt wanta to feel goo can take daily mutli vit, or OTC 400 IU |
|
Definition
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|
Term
| ginkgo has conflicitng evidence and only had 1.4 increase on ADAS. but if pt wants to take they can just know is antiplatelet and can increase bleeding |
|
Definition
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|
Term
| B12 def causes neuro problems, does an excess prevent AD> |
|
Definition
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|
Term
| B12 injections are not proven yet, but cn have placebo effects and have low toxicity |
|
Definition
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|
Term
| long term NSAIUD use not provne in prospective tiral and have too muhc toxicity to recocmedn chronic use |
|
Definition
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|
Term
| new study negates estrogen rpotective effects against AD so only use for shortest time like 5yrs |
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Definition
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|
Term
| some statins can cause confusional symptoms in pts and arent reccomedned alone for AD risk reduction |
|
Definition
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|
Term
| if use statin in elderly use pravastatin |
|
Definition
|
|
Term
| primary offenders that exacerbate AD-7 |
|
Definition
atropine
anithistamines
antidepressents
muscle relaxants
bladder antispas
GI antispas
certain antiarrhythmias |
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|
Term
| drugs that if cognition impairs adherence, pharmacist needs to do what |
|
Definition
| touch base with pt regulalry and reinforce edu, assess adherence nad monitor response regulalrly |
|
|
Term
| some meds with hard directions for AD-3 |
|
Definition
otic preps
inhalers
injectable |
|
|
Term
| what are meds with fine duration that need to be addressed by pharm-2 |
|
Definition
|
|
Term
| *medicaitons with irregular dosing intervals need assitance from pharm |
|
Definition
|
|
Term
| pscyhaitric distubrance is defined as |
|
Definition
| atributed to underlying pschiatric rpoblem |
|
|
Term
| examples of psychiatric disturbances-4 |
|
Definition
depresison
anxiety
psychosis
mania |
|
|
Term
| behavioral distburances are defined as |
|
Definition
| behaviro that do not have discernable source |
|
|
Term
| examples of behavioral disturbances |
|
Definition
verbal, physical, restless, disinihibted (like disrobing or urinating in public
) |
|
|
Term
| neurodegenerative symtpoms include insomnia and poor appetite |
|
Definition
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|
Term
| drug therapy inervention for psychiatirc or behaviro distburances are focus for pharmacist why-2 |
|
Definition
they are commonly prescribed
fine line bte appropiate nad inappropiate selection |
|
|
Term
| *never punish AD ppl for bheaving badly, they wont remember what they did |
|
Definition
|
|
Term
| non drug intervention for AD-3 |
|
Definition
redirection
reassurane
come back at later time |
|
|
Term
| psychoactive medicaiton use is limited to treating bheavior that- |
|
Definition
| interfer with pts funct, safety, or caregivers ability ro provide care |
|
|
Term
| for psychoactive meds use what med duration |
|
Definition
| periodic graadula dose reduction and withdrawla attemps q 4-6 months to determine cont need |
|
|
Term
| what test is used to assess type, frequency, ad severity of behavrioal disturbance? |
|
Definition
| neuropsychiatric inventory |
|
|
Term
| *cholinesterase inhibitors can be used for chronic behaior problem tx- not acute |
|
Definition
|
|
Term
| what antidepressans whould be avoided in AD>-4 |
|
Definition
(TCAs)
amitrtiptyline
nortriptyline
desipramine
imipramine |
|
|
Term
| *use atnipsychotics with caution and check outcomes periodically |
|
Definition
|
|
Term
| what antipsychotics should be avoided if possible-5 |
|
Definition
| typicals: haloperiodl, thithexine, perphenazine, thirridazine, chlorpromazine |
|
|
Term
| anatianxiety/sedative/hypno only use PRN bc can induce falls, exacerbate confusion |
|
Definition
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|
Term
| what antianxiety/hyontics should be avoided-5 |
|
Definition
antihistamines
alprazolam
diazepam
triazolam
chlordiazepoxide |
|
|
Term
| psychostmulants like provigil and methylpheidate arent really needed to be prescirbed |
|
Definition
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