Alzheimers (NAPLEX)

Pathophys of alzheimers

Neuropathic changes (amyloid beta plaques) causing the death of cholinergic neurons, causing decreased acetylcholine

Signs of dementia (5)

Delusions and agitation

Difficulty planning

Getting lost

Memory loss

Repeating words

Alzheimers screening tool

MMSE (mini-mental state exam)

What vitamin deficiency can cause memory impairment? (2)

B12

Vitamin D

Medications that can worsen dementia * (studygal lots)

Antipsychotics

Anticholinergics (antihistamines, benztropine, oxybutynin, dicyclomine, TCA)

CNS depressants (barbiturates, benzos, opioids, hypnotics, skeletal muscle relaxants)

Natural products for dementia (2)

Vitamin E

Gingko biloba

Mainstay TX for alzheimers

Mild-mod: Acetylcholinesterase inhibitors (donepezil)

Mod-severe: Above + memantine

Acetycholinesterase inhibitor examples (3)

Donepezil (Aricept ODT, Adlarity patch weekly), donepezil/memantine (Namzaric)

Rivastigmine (Exelon)

Galantamine

NMDA blocker example (2)

Memantine (Namenda)

Memantine/donepezil (Namzaric)

Memantine MOA

NMDA receptor blocker

When should you take donepezil tablets?

QHS to decrease nausea, but if insomnia occurs can take in AM

Donepezil patch is dosed _____

weekly

Rivastigmine patch is dosed ____

daily

Acetycholinesterase inhibitors adverse effects (5)

Bradycardia

Diarrhea

Insomnia

N/V

QT prolongation (donepezil)

What patch is stored in the fridge?

Donepezil (Adlarity)

Memantine adverse effects (3)

Dizziness

Confusion

Headache

T/F: Rivastigmine patch should be removed before an MRI?

True

Patient’s must be on ____mg of donepezil prior to starting Namzaric?

10mg