Aging Beautifully Part 3: DementiaPresentation Transcript
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Memory ispowerful.but not untilwe lose it thatwe fully realizeits significance
AgingBeautifully:Visions & RealitiesPart III: Dementiahttp://www.goodlifeguide.net/wp-content/uploads/2012/09/beach-seniors-X-license.jpgBy Christine HortillosaPharm.D. 2013 CandidateUniversity of Texas at Austin College of Pharmacy5. 9. 2013
DeliriumDementiaAcuteTwo of the following:•Misinterpretation, illusions, hallucinations•Incoherent speech•Disturbance in sleep-wake cycle•Change in psychomotor activityRelated to medical illness + medicationsReversibleProgressiveMarked by memory impairmentNot a normal part of agingIrreversible
Most common formof dementia is…Alzheimer’sdisease
mildmoderatesevere20-24Short-term memory loss;word-finding problemsLoss of IADLs10-19Disorientation to time, place,inability to engage in activitiesNeeds assistance with ADLs<10Loss of speech andambulation, incontinence of boweland bladderDependency in basic ADLs; often requiresaround-the-clock care*ADLS= activities of daily living (bathing, dressing); IADLS=instrumental activities of daily living (housekeeping); MMSE=Mini-Mental Status ExaminationMMSE Examples of cognitive lossExamples of functional lossStages
Drugs for Treatmentof Alzheimer’sDonepezilRivastigmineGalantamineMemantine
DonepezilStarting Dose 5 mg/day; No dose change for renalimpairmentMaintenance Dose 10mg/dayMay also increase to 23mg/dayProperties Cholinesterase inh; partly metabolizedby CYP 2D6 and 3A4Indication For all stages of Alzheimer’sAdverse Effects Bradycardia, syncope, weight loss,N/V/D, InsomniaDDI Anticholinergics, Antipsychotics, Beta-blockers, AlcoholAdministration At bedtime without regard to food
Starting Dose 1.5mg BID; No dosage change forrenal impairmentMaintenance Dose 3-6mg BIDProperties Cholinesterase inhIndication For mild to moderate Alzheimer’s andmild-to moderate dementia withParkinson’sAdverse Effects Has most intense cholinergic (N/V/D)ADE, bradycardia, syncope, dizziness,EPSDDI Anticholinergics, Antipsychotics, Beta-blockers, AlcoholAdministration With meals; for patch (avoid applicationto same spot for 14 days)Rivastigmine
Starting Dose 4 mg BID; Use not reco’d for CrCl<9ml/minMaintenance Dose 8-12mg BID or 8-24mg ER QdayProperties Cholinesterase inh and nicotinereceptor modulator; partly metabolizedby CYP 2D6 and 3A4Indication For mild-to-moderate Alzheimer’sAdverse Effects Bradycardia, syncope, weight loss,N/V/DDDI Anticholinergics, Antipsychotics, Beta-blockers, AlcoholAdministration With meals; if therapy is interrupted for3+ days, restart at lower dose andincrease to current doseGalantamine
MemantineStarting Dose 5 mg/day (max dose of 20mg for CrCl30-49 and max dose 5mg for CrCl 5-29)Maintenance Dose 10mg BIDProperties Blocks glutamate transmissionIndication For moderate to severe Alzheimers;may be used in combination withdonepezilAdverse Effects Hypertension, confusionDDI Sodium bicarbonate, TrimethoprimAdministration Without regard to food
How long shouldthe therapy be?• Evaluation at 3-6 months for prevention ofdecline or improvement• Conflicting evidence in unresponsive patients• Taper upon discontinuationhttp://2.bp.blogspot.com/-elpJbUEX820/Trvvb6PtfII/AAAAAAAAB1A/-fPVe_yW-4U/s1600/long+winding+road+p92b_saint_gothard_pass_switzerland.jpg