CHAPTER 4: CNS: Dementia Flashcards

1
Q

What is the non-pharmacological treatment for mild to moderate dementia with cognitive symptoms?

A

Structured group stimulation programmes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Can a GP initiate and supervise dementia pharmacological treatment?

A

No - specialist initiation and supervision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which drugs are recommended to manage the cognitive symptoms of mild to moderate dementia due to Alzheimer’s disease?

A
  1. Donepezil
  2. Rivastigmine
  3. Galantamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Donepizil, Rivastigmine and Galantamine all belong to which drug class?

A

Acetylcholinesterase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the drug of choice to manage the cognitive symptoms severe Alzheimer’s disease?

A

Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

As well as in severe Alzheimer’s disease, when else is memantine suitable?

A

As an alternative to for patients with moderate Alzheimer’s disease when acetylcholinesterase inhibitors are contra-indicated or not tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the drug of choice to manage the cognitive symptoms of vascular dementia?

A

Pharmacological treatment is not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment recommendation for patients with non-cognitive symptoms such as anxiety or delusions?

A

Non-pharmacological interventions such as multisensory stimulation or aromatherapy should be tried for less severe symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Should patients with mild to moderate non-cognitive symptoms (anxiety, delusion etc) be prescribed antipsychotics?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Should patients with severe non-cognitive symptoms (anxiety, delusion etc) be prescribed antipsychotics?

A

Yes, after careful consideration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In 2009, what did the MHRA report a clear increased risk of in elderly patients with dementia taking antipsychotic drugs?

A

Stroke (and death)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Before being prescribed an antipsychotic for severe non-cognitive symptoms of dementia, which risk factors for cerebrovascular disease should be considered? (4)

A
  1. History of stroke or TIA
  2. Diabetes
  3. Hypertension
  4. AF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Patients with DLB taking antipsychotics for non-cognitive symptoms should be assessed for severe untoward reactions such as?

A

Neuroleptic sensitivity reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Can acetylcholinesterase inhibitors and memantine also be used to treat non-cognitive symptoms of Alzheimer’s Disease and DLB?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Can acetylcholinesterase inhibitors be used in vascular dementia?

A

No, not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

As well as for severe non-cognitive symptoms (anxiety, delusions etc), when else can antipsychotics be used in dementia?

A

To manage behavioural symptoms of violence, aggression and extreme agitation

17
Q

Benzodiazepines can be used to manage behavioural symptoms of violence, aggression and extreme agitation. Through which routes can the be administered?

A
  1. Oral
  2. Intramuscular
  3. IV (special circumstances
18
Q

For the intramuscular administration of benzodiazepines to manage behavioural symptoms of violence, aggression and extreme agitation, which are the ones recommended? (3)

A
  1. Lorazepam
  2. Haloperidol
  3. Olanzapine
19
Q

Are diazepam and chlorpromazine recommended for behavioural symptoms of violence, aggression and extreme agitation?

A

NO

20
Q

Acetylcholinesterase inhibitors can cause unwanted dose-related cholinergic effects, give some symptoms of this (5)

A
  1. Excessive sweating
  2. Involuntary defaecation and urination
  3. Increased production of saliva
  4. Bradycardia
  5. Hypotension
21
Q

Which serious skin reaction has galantamine been associated with?

A

Steven-Johnson Syndrome

22
Q

What should patients be counselled to do if they experience any skin reactions while taking galantamine?

A

Stop taking and seek medical advice

23
Q

What is a side effect of rivastigmine less associated with transdermal administration?

A

GI effects

24
Q

What should happen if a patient taking rivastigmine experiences GI effects?

A

Drug should be witheld then re-titrated (if necessary) on resolution