Download - Aging Beautifully Part 3: Dementia
You have 9 seconds left…
Let’s Play!
Which color is
missing?
?
Guess who’s who?
Let’s Play!
Impressive!Scoreboard:• Dr. A• Dr. G• Dr. S• Dr. T
By the way, what is today’s date?
Memory is powerful.
but not until we lose it that we fully realize its significance
AgingBeautifully:Visions & Realities
Part III: Dementia
http://www.goodlifeguide.net/wp-content/uploads/2012/09/beach-seniors-X-license.jpg
By Christine HortillosaPharm.D. 2013 CandidateUniversity of Texas at Austin College of Pharmacy5. 9. 2013
DeliriumDementia
Acute
Two of the following:
• Misinterpretation, illusions, hallucinations• Incoherent speech• Disturbance in sleep-wake cycle• Change in psychomotor activity
Related to medical illness + medications
Reversible
Progressive
Marked by memory impairment
Not a normal part of aging
Irreversible
Most common form of dementia is…
Alzheimer’s disease
mild
moderate
severe
20-24
Short-term memory loss; word-finding problems
Loss of IADLs
10-19 Disorientation to time, place, inability to engage in activities
Needs assistance with ADLs
<10 Loss of speech and ambulation, incontinence of bowel and bladder
Dependency in basic ADLs; often requires around-the-clock care
*ADLS= activities of daily living (bathing, dressing); IADLS= instrumental activities of daily living (housekeeping); MMSE= Mini-Mental Status Examination
MMSE Examples of cognitive loss
Examples of functional loss
Stages
Drugs for Treatment of Alzheimer’s
Donepezil
Rivastigmine
Galantamine
Memantine
Donepezil
Starting Dose 5 mg/day; No dose change for renal impairment
Maintenance Dose 10mg/day May also increase to 23mg/day
Properties Cholinesterase inh; partly metabolized by CYP 2D6 and 3A4
Indication For all stages of Alzheimer’s
Adverse Effects Bradycardia, syncope, weight loss, N/V/D, Insomnia
DDI Anticholinergics, Antipsychotics, Beta-blockers, Alcohol
Administration At bedtime without regard to food
Starting Dose 1.5mg BID; No dosage change for renal impairment
Maintenance Dose 3-6mg BID
Properties Cholinesterase inh
Indication For mild to moderate Alzheimer’s and mild-to moderate dementia with Parkinson’s
Adverse Effects Has most intense cholinergic (N/V/D) ADE, bradycardia, syncope, dizziness, EPS
DDI Anticholinergics, Antipsychotics, Beta-blockers, Alcohol
Administration With meals; for patch (avoid application to same spot for 14 days)
Rivastigmine
Starting Dose 4 mg BID; Use not reco’d for CrCl <9ml/min
Maintenance Dose 8-12mg BID or 8-24mg ER Qday
Properties Cholinesterase inh and nicotine receptor modulator; partly metabolized by CYP 2D6 and 3A4
Indication For mild-to-moderate Alzheimer’s
Adverse Effects Bradycardia, syncope, weight loss, N/V/D
DDI Anticholinergics, Antipsychotics, Beta-blockers, Alcohol
Administration With meals; if therapy is interrupted for 3+ days, restart at lower dose and increase to current dose
Galantamine
Memantine
Starting Dose 5 mg/day (max dose of 20mg for CrCl 30-49 and max dose 5mg for CrCl 5-29)
Maintenance Dose 10mg BID
Properties Blocks glutamate transmission
Indication For moderate to severe Alzheimers; may be used in combination with donepezil
Adverse Effects Hypertension, confusion
DDI Sodium bicarbonate, Trimethoprim
Administration Without regard to food
Star t wi th chol inesterase inhib i torsCaution: statistically significant difference ≠ clinical meaningful improvement
http://inc1979.com/wp-content/uploads/2012/03/tumblr_ljtm2uPiD11qf0uwco1_1280.jpg
How long should the therapy be?• Evaluation at 3-6 months for prevention of decline
or improvement• Conflicting evidence in unresponsive patients• Taper upon discontinuation
http://2.bp.blogspot.com/-elpJbUEX820/Trvvb6PtfII/AAAAAAAAB1A/-fPVe_yW-4U/s1600/long+winding+road+p92b_saint_gothard_pass_switzerland.jpg
http://www.toledoblade.com/image/2012/01/22/800x_b1_cCM_z_cT/pharmacist-bryan-01-23-2012.jpg
Pharmacists are critical in effective alzheimer’s disease management.
With your help,I can preserve my memories a little
bit longer.
http://1dentalhealthblog.files.wordpress.com/2010/07/elderly-woman.jpg
Discussion.