NU553 Unit 3 Alzheimers Disease Advanced Pharmacology and Pharmacotherapeutics Exam 2

Alzheimers disease accounts for what percentage of all dementia cases?

60% to 80%

What is the primary cognitive complaint in early Alzheimers disease?

Short-term recent memory loss

At what age is Alzheimers disease classified as early onset?

Younger than 65 years

What is the most significant risk factor for Alzheimers disease?

Advanced age

Which Apolipoprotein E allele increases Alzheimers disease risk?

E4 allele

Which Apolipoprotein E allele is protective?

E2 allele

What genetic condition increases Alzheimers disease risk with about 50 percent affected by their 60s?

Trisomy 21 Down syndrome

What are the two hallmark brain lesions in Alzheimers disease?

Neurofibrillary tangles and beta amyloid plaques

What protein forms neurofibrillary tangles?

Tau protein

Beta amyloid plaques are composed of what protein?

Beta amyloid protein

What neurotransmitter is decreased in Alzheimers disease?

Acetylcholine

Excess stimulation of which neurotransmitter leads to toxicity in Alzheimers disease?

Glutamate

What is required for a definitive diagnosis of Alzheimers disease?

Neuropathologic confirmation usually by autopsy

Which quick screening tool includes a clock drawing test?

Mini-Cog

What longer cognitive tests are commonly used?

Mini Mental State Examination and Montreal Cognitive Assessment

Which medication can cause reversible dementia-like symptoms?

Diphenhydramine

Which drug class can cause reversible cognitive impairment in older adults?

Benzodiazepines

Deficiency in which vitamin can cause reversible dementia?

Vitamin B12

What is the primary goal of Alzheimers disease treatment?

Maintain function and quality of life

First-line drug class for mild to moderate Alzheimers disease?

Cholinesterase inhibitors

Name the three cholinesterase inhibitors.

Donepezil rivastigmine galantamine

What is recommended for moderate to severe Alzheimers disease?

Cholinesterase inhibitor plus memantine

What enzyme inhibition contributes to cholinesterase inhibitor side effects?

Butyrylcholinesterase

Which cholinesterase inhibitor also treats Parkinson disease dementia?

Rivastigmine

Which cholinesterase inhibitor modulates nicotinic receptors?

Galantamine

Which cholinesterase inhibitor is available as a patch?

Rivastigmine

What is the starting dose of donepezil?

5 milligrams daily

When can donepezil be increased to 10 milligrams?

After 4 to 6 weeks

What is the major adverse effect group of cholinesterase inhibitors?

Gastrointestinal nausea vomiting diarrhea

What serious cardiovascular risk occurs with cholinesterase inhibitors?

Bradycardia

If nightmares occur with donepezil what should you do?

Give in the morning

What weight increases gastrointestinal risk with cholinesterase inhibitors?

Less than 55 kilograms

What is the mechanism of memantine?

N methyl D aspartate receptor antagonist

What stage is memantine used for?

Moderate to severe Alzheimers disease

Maximum dose of memantine immediate release?

10 milligrams twice daily

When should memantine dose be reduced?

Creatinine clearance below 30 milliliters per minute

What is the black box warning for antipsychotics in dementia?

Increased risk of death

Which antipsychotics increase stroke risk in dementia?

Risperidone and olanzapine

How often should antipsychotics be reassessed?

Every 3 to 6 months

Preferred antidepressant class in Alzheimers disease?

Selective serotonin reuptake inhibitors

Give examples of preferred antidepressants.

Sertraline escitalopram

Why avoid benzodiazepines in older adults?

Sedation falls worsened cognition

What supplement may slow decline in moderate Alzheimers disease?

Vitamin E

What is the risk of vitamin E with anticoagulants?

Increased bleeding risk

What herbal supplement increases bleeding risk with aspirin or warfarin?

Ginkgo biloba

If one cholinesterase inhibitor fails what is next?

Switch to another cholinesterase inhibitor

Which cholinesterase inhibitor should be taken with food?

Rivastigmine

If decline occurs after stopping therapy what should you do?

Restart medication

What nonpharmacologic intervention improves safety?

Evaluate stove and machinery use

What lifestyle strategy helps Alzheimers patients?

Maintain predictable routine

Why assess driving ability in Alzheimers disease?

Increased accident risk

How long for antidepressants to work?

4 to 6 weeks

What medication interaction reduces donepezil effectiveness?

Anticholinergic drugs

What is the main enzyme targeted by cholinesterase inhibitors?

Acetylcholinesterase

What happens with glutamate excess?

Neurotoxicity

Do Alzheimers medications cure the disease?

No they only slow progression

What metabolic issue can cause dementia?

Hyponatremia

What condition with excess cerebrospinal fluid causes reversible dementia?

Normal pressure hydrocephalus

What are major late-stage risks in Alzheimers disease?

Falls wandering swallowing loss

Most common cause of dementia?

Alzheimers disease

What cancels the effect of cholinesterase inhibitors?

Anticholinergic drugs

When should therapy be reassessed?

Every 3 to 6 months

What is the biggest prescribing mistake in dementia?

Using anticholinergic medications

When should memantine be added?

Moderate to severe disease

Why is memantine used over other options?

Reduces glutamate toxicity which improves symptoms when cholinesterase inhibitors alone are insufficient

What would make cholinesterase inhibitors a poor choice?

Significant bradycardia because it increases risk of syncope and falls

Other options include benzodiazepines but why are they not first-line?

They worsen cognition and increase fall risk