Exam 3 Review

cyclobenzaprine brand

Amrix, Fexmid

cyclobenzaprine class

muscle relaxant

cyclobenzaprine use

muscle spasm, fibromyalgia

cyclobenzaprine moa

Potentiates norepinephrine and binds to serotonin receptors, reducing spasticity (centrally acting muscle relaxant)

cyclobenzaprine dose

5-10 mg PO TID or 15 mg ER qD

cyclobenzaprine contraindications

elderly pts, MI pts, hepatic pts, arrhythmias, heart block, CHF, avoid abrupt withdrawal

cyclobenzaprine bbw

none

tramadol brand

ConZip, Qdolo

tramadol class

opioid agonist

tramadol use

moderate to moderate-severe pain

tramadol moa

binds to mu receptors and weakly inhibits norepinephrine and serotonin reuptake producing analgesia (central opioid agonist

tamadol dose

50-100 mg PO q4-6h

tramadol contraindications

MAOI use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

tramadol bbw

high addiction/misuse risk, opioid analgesic REMS, life threatening respiratory depression can occur, concomitant use with benzodiazepines

nortriptyline brand

Pamelor

nortriptyline class

tricyclic antidepressant

nortriptyline use

depression

nortriptyline moa

inhibits norepinephrine and serotonin reuptake

nortriptyline dose

50-150 mg PO qHS

nortriptyline contraindications

Brugada syndrome, acute MI, avoid abrupt withdrawal

nortriptyline bbw

may cause suicidal thoughts in children and young adults, not approved for pediatric use

amitriptyline brand

amitriptyline

amitriptyline class

tricyclic antidepressant

amitriptyline use

depression, neuropathic pain, migraine, fibromyalgia

amitriptyline moa

inihibits norepinephrine and serotonin reuptake

amitriptyline dose

50-150 mg PO qHS

amitriptyline contraindications

MI recovery, avoid abrupt withdrawal

amitriptyline bbw

may cause suicidal thoughts in children and young adults

pregabalin brand

Lyrica

pregabalin class

anticonvulsant

pregabalin use

neuropathic pain, partial seizures, fibromyalgia

pregabalin moa

binds to alpha 2 delta subunit of calcium channels, reducing neurotransmitter

pregabalin dose

IR: 50-100 mg PO TID, ER: 165-330 mg PO qD

pregabalin contraindications

renal disease

pregabalin bbw

none

hydrocodone & acetaminophen brand

Lortab, Norco

hydrocodone & acetaminophen class

opioid combination, narcotic and non-narcotic

hydrocodone & acetaminophen use

moderate to severe pain

hydrocodone & acetaminophen moa

binds to various opioid receptors and centrally acting non opioid analgesic

hydrocodone & acetaminophen dose

2.5-10 mg hydrocodone PO q4-6h PRN

hydrocodone & acetaminophen contraindications

respiratory depression, asthma, GI obstruction

hydrocodone & acetaminophen bbw

avoid doses of APAP >4000 mg qD

oxycodone brand

Oxycontin, Roxicodone, Xtampza ER

oxycodone class

opioid agonist

oxycodone use

moderate to severe pain

oxycodone moa

binds to various opioid receptors, producing analgesia and sedation

oxycodone dose

individualized dosing

oxycodone contraindicatons

MAOI use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

oxycodone bbw

high addiction/misuse risk, opioid analgesic REMS, life threatening respiratory depression can occur, concomitant use with benzodiazepines

morphine sulfate brand

Kadian, Morphabond ER, MS Contin

morphine sulfate class

opioid agonist

morphine sulfate use

moderate to severe pain

morphine sulfate moa

binds to various opioid receptors, producing analgesia and sedation

morphine sulfate dose

varies

morphine sulfate contraindications

MAOI use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

morphine sulfate bbw

high abuse potential, may lead to dependency and respiratory depression may occur even at accepted dosing, adverse CV events and death reported on misuse

gabapentin brand

Neurontin, Horizant

gabapentin class

anticonvulsant

gabapentin use

partial seizures, neuralgia

gabapentin moa

blocks voltage dependent calcium channels, modulating excitatory neurotransmitter release

gabapentin dose

300-1200 mg PO TID

gabapentin contraindications

none

gabapentin bbw

none

lamotrigine brand

Lamictal, Lamical XR

lamotrigine class

anti mania anticonvulsant

lamotrigine use

bipolar disorder, partial seizures

lamotrigine moa

inhibits voltage dependent sodium channels, decreasing presynaptic glutamate and aspartate release

lamotrigine dose

varies by disease state

lamotrigine contraindications

avoid abrupt withdrawal

lamotrigine bbw

serious rashes requiring hospitalization may develop

topiramate brand

Topamax, Trokendi, Qudexy

topiramate class

anticonvulsant

topiramate use

partial seizures, tonic/clonic seizures, migraine prophylaxis

topiramate moa

blocks voltage dependent sodium channels, augments GABA activity, antagonizes glutamate receptors, inhibits carbonic anhydrase

topiramate dose

IR: 200 mg PO BID, ER: 400 mg PO qD

topiramate contraindications

avoid abrupt withdrawal

topiramate bbw

none

DSM-5 Criteria for Dementia

Evidence of significant cognitive decline from 1+ of the domains of:

• learning and memory

• language

• executive function

• complex attention

• perceptual-motor

• social cognition

Signs of cognitive decline

interference with indepence of everyday activities (including paying bills or taking medications), cannot be other mental disorders or delirium

Diagnosing Alzheimer’s

memory impairment along with one of the following: apraxia, aphasia, agnosia, disturbance of executive function

Define Alzheimer’s disease

chronic irreversible neurodegenerative disorder with slow, progressive loss of cognitive function

Clinical presentation of Alzheimer’s

Cognitive and non-cognitive symptoms (BPSD)

Examples of reversible cognitive impairment

normal pressure hydrocephalus, medication conditions (depression, thyroid/B12 deficiency, metabolic imbalances)

Examples of irreversible cognitive impairment

Alzheimer’s, Vascular dementia, Lewy body dementia, Parkinson’s, Frontotemporal dementia, Creutzfeldt-Jakob disease

*Medication-Induced Cognitive Impairment

• anticholinergics

• antihypertensives

• hypoglycemics

• opioids

• sedatives/hypnotics

• steroids

• NSAIDs

• anticonvulsants (B12 & folic acid deficiency)

• methotrexate (folic acid deficiency)

• metformin (B12 deficiency)

Signs of B12 deficiency

confusion, fatigue (these are reversible if it’s caught soon enough

What is the mini mental status exam used for?

Assess cognitive impairment

What does the MMSE measure?

orientation, attention, recall, language

What does the MMSE NOT measure?

mood and disordered forms of thinking

True or False. The MMSE is used as a diagnostic tool

False. Only used for screening

What stages of AD are present with mild cognitive impairment (24-20)?

decrease in memory of recent events, decline in ability to manage finances, withdrawal from hobbies and challenging tasks, mood swings, personality changes

What stages of AD are present with a moderate MMSE (19-10)?

Need assistance in activities of daily living, disorientation, short and long term memory impairment, aphasia, ataxia, agnosia, BPSD (depression, suspicion, agitation, paranoia, delusions)

What stages of AD are present with a severe MMSE (9-0)?

loss of speech, loss of ambulation, loss of ability to self feed, incontinence, 24/7 care, bed or chair bound, may need long term care

Early Stage treatment goals

improve and preserve cognitive function, slow disease progression

Mid-Stage treatment goals

Preserve function of ADLs, maintain safety/dignity, support within the home, delay institutionalization

Advanced Stage treatment goals

treating psychiatric and behavioral issues, provide family and caregiver support

Palliative stages of treatment goals

symptom management

Acetylcholinesterase inhibitors used to treat Alzheimer’s

donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne)

NMDA antagonist used to treat Alzheimer’s

memantine (Namenda)

IgG1 used to treat Alzheimer’s

lecanemab (Leqembi)