MH701 Final Exam Solved 2022_A+ Guide.
Antipsychotic drugs remain first-line in treatment of ______________, even in the elderly.
Answer ✅- acute psychosis
Are acetylcholinesterase inhibitors and cholinesterase inhibitors the same thing Answer
✅- Yes.
Benzodiazepines also increase the risk of _________________________in older adults
Answer ✅- Cognitive decline and MVA
Benzodiazepines and sedative hypnotics (including the "Z" drugs) more than double the risk of
______________________________in older adults
Answer ✅- Falls and hip fracture
Can donepezil (Aricept) and memantine (Namenda) be used to treat moderate to severe Alzheimer's
disease?
Answer ✅- Yes
Caution should be used in prescribing memantine (Namenda) to individuals with severe
_________________impairment.
Answer ✅- Renal
Cholinesterase inhibitors and NMDA receptor antagonists produce a modest improvement in memory for
an average of ____________months before they stop working.
Answer ✅- 3-6 months
Give an example of a cholinesterase inhibitor
Answer ✅- Donepezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon)
How effective are ACH inhibitors and NMDA receptor antagonists in the treatment of dementia?
Answer ✅- May slow progression and improve memory and functional ability, but does not cure the
disease
How long does memantine (Namenda) take to work?
Answer ✅- It may take months until any stabilization in the degenerative course of it is seen
If a benzodiazepine must be used (e.g. emergent situation in a hospital setting), Which benzodiazepine is
the drug of choice?
Answer ✅- Lorazepam (Ativan)
--short acting (half-life does not increase with age)
--Fewer drug interactions
--No hepatic phase 1 metabolism (which declines with age)
--No active metabolites
,--Available in small doses (0.25-0.5 mg po)
--Well absorbed when given IM
If an antipsychotic was needed for a person with Lewy body dementia, which might be chose (due to
decrease risk of EPS effects)?
Answer ✅- Quetiapine (Seroquel)
If a patient is experiencing acute agitation and/or psychosis to the point of needing antipsychotic
medication, which medications are options?
Answer ✅- SGAs: Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa) or FGAs:
Haloperidol (Haldol)
Inhibition of butyrylcholinesterase (BuChE) helps present gliosis. What is gliosis?
Answer ✅- Scarring which occurs within the CNS, after neurons die. The proliferation/hypertrophy of
glial cells; usually in response to CNS damage.
In older adults, what is the first-line class of medications for depression?
Answer ✅- Selective serotonin reuptake inhibitors (SSRIs). These meds work by blocking serotonin
reuptake at the serotonergic neuron synapse.
In which stage of dementia are the cholinesterase inhibitors Galantamine (Reminyl, Razadyne) and
Rivastigmine (Exelon) useful?
Answer ✅- Mild to moderate disease
In which stage of dementia is donepezil (Aricept) useful?
Answer ✅- Mild to severe disease
In which stage of dementia is memantine (Namenda) used?
Answer ✅- Moderate to severe disease
List two second line medication treatments for agitation or aggression associated with dementia Answer
✅- Beta blockers
Valproate (Depakote)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Selegiline (MAOI)
Lithium
Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Buspirione (Buspar)
Trazodone
Mood stabilizers are (off label, FDA approved) in the treatment of dementia-related agitation and/or
aggression
,Answer ✅- Lithium and valproate may have some additional neuroprotective effects
Mood stabilizers (as a class) are considered ___________risk in older adults?
Answer ✅- High risk
Name a NMDA receptor antagonist
Answer ✅- Memantine (Namenda)
Name a source which lists drugs that carry high risks for older adults and criteria for potentially
inappropriate medication use in older adults
Answer ✅- BEERS criteria (STOPP/START criteria)
Anticholinergics (antihistamines, antispasmodics)
Tricyclic antidepressants
CV meds (alpha blockers, antithrombotics, antiarrythmics, central alpha agonists)
Antipsychotics
Benzodiazepines
Barbiturates
sulfonylureas
Sliding scale insulin
Muscle relaxers
Polypharmacy is MOST accurately defined as:
Answer ✅- the prescribing of multiple drugs to treat multiple conditions.
Rivastigmine (Exelon) must be titrated up slowly (even if it has only been stopped for a couple of days).
What occurs if a patient is rapidly titrated to a high dose?
Answer ✅- Serious side effects are more likely to occur, including violent nausea and vomiting (with risk
of esophageal rupture).
A rivastigmine (Exelon) patch should be placed in what location?
Answer ✅- Upper back, chest or upper arm
Absorption is 20-30% less if placed on the thigh or abdomen
What antipsychotics may be used in the treatment of acute delirium with psychosis and agitation?
Answer ✅- Haloperidol (Haldol) po or IM
Risperidone (Risperdal
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
What are CV risks of SNRIs in older adults?
Answer ✅- Hypertension
Orthostatic hypotension
Syncope
Arrhythmia
, Acute ischemia
Death in overdose
What are concerning side effects of trazodone and mirtazapine in older adults?
Answer ✅- Sedation
Orthostatic hypotension
Falls
What are the most common side effects of acetylcholinesterase inhibitors?
Answer ✅- Gastrointestinal: increased gastic acid secretion (increased risk of ulcers), nausea, vomiting,
and weight loss
What are the most common side effects of memantine (Namenda)?
Answer ✅- Usually well tolerated
Dizziness, Headache, Constipation
What are the risks of atypical antipsychotics in older adults?
Answer ✅- Cerebrovascular events (stroke)
Venous thromboembolism
Metabolism syndrome
Pancreatitis
What are the risks of typical antipsychotics in the elderly?
Answer ✅- Extrapyramidal symptoms
Pseudoparkinsonism
Akasthsia
What are the side effects of SSRIs, which are increased in older adults?
Answer ✅- Increased risk of bleeding
Hyponatremia
SIADH
Osteoporosis
What are the "Z drugs"?
Answer ✅- 3rd generation Hypnotics
--Zolpidem (Ambien)
--Zaleplon (Sonata)
--EsZopiclone (Lunesta)
selective agonist at GABA A alpha 1 site
shortens sleep latency and prolongs total sleep time
onset within 30 minutes
half life of 2-4 hours, greater in hepatic insufficiency and elderly
Antipsychotic drugs remain first-line in treatment of ______________, even in the elderly.
Answer ✅- acute psychosis
Are acetylcholinesterase inhibitors and cholinesterase inhibitors the same thing Answer
✅- Yes.
Benzodiazepines also increase the risk of _________________________in older adults
Answer ✅- Cognitive decline and MVA
Benzodiazepines and sedative hypnotics (including the "Z" drugs) more than double the risk of
______________________________in older adults
Answer ✅- Falls and hip fracture
Can donepezil (Aricept) and memantine (Namenda) be used to treat moderate to severe Alzheimer's
disease?
Answer ✅- Yes
Caution should be used in prescribing memantine (Namenda) to individuals with severe
_________________impairment.
Answer ✅- Renal
Cholinesterase inhibitors and NMDA receptor antagonists produce a modest improvement in memory for
an average of ____________months before they stop working.
Answer ✅- 3-6 months
Give an example of a cholinesterase inhibitor
Answer ✅- Donepezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon)
How effective are ACH inhibitors and NMDA receptor antagonists in the treatment of dementia?
Answer ✅- May slow progression and improve memory and functional ability, but does not cure the
disease
How long does memantine (Namenda) take to work?
Answer ✅- It may take months until any stabilization in the degenerative course of it is seen
If a benzodiazepine must be used (e.g. emergent situation in a hospital setting), Which benzodiazepine is
the drug of choice?
Answer ✅- Lorazepam (Ativan)
--short acting (half-life does not increase with age)
--Fewer drug interactions
--No hepatic phase 1 metabolism (which declines with age)
--No active metabolites
,--Available in small doses (0.25-0.5 mg po)
--Well absorbed when given IM
If an antipsychotic was needed for a person with Lewy body dementia, which might be chose (due to
decrease risk of EPS effects)?
Answer ✅- Quetiapine (Seroquel)
If a patient is experiencing acute agitation and/or psychosis to the point of needing antipsychotic
medication, which medications are options?
Answer ✅- SGAs: Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa) or FGAs:
Haloperidol (Haldol)
Inhibition of butyrylcholinesterase (BuChE) helps present gliosis. What is gliosis?
Answer ✅- Scarring which occurs within the CNS, after neurons die. The proliferation/hypertrophy of
glial cells; usually in response to CNS damage.
In older adults, what is the first-line class of medications for depression?
Answer ✅- Selective serotonin reuptake inhibitors (SSRIs). These meds work by blocking serotonin
reuptake at the serotonergic neuron synapse.
In which stage of dementia are the cholinesterase inhibitors Galantamine (Reminyl, Razadyne) and
Rivastigmine (Exelon) useful?
Answer ✅- Mild to moderate disease
In which stage of dementia is donepezil (Aricept) useful?
Answer ✅- Mild to severe disease
In which stage of dementia is memantine (Namenda) used?
Answer ✅- Moderate to severe disease
List two second line medication treatments for agitation or aggression associated with dementia Answer
✅- Beta blockers
Valproate (Depakote)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Selegiline (MAOI)
Lithium
Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Buspirione (Buspar)
Trazodone
Mood stabilizers are (off label, FDA approved) in the treatment of dementia-related agitation and/or
aggression
,Answer ✅- Lithium and valproate may have some additional neuroprotective effects
Mood stabilizers (as a class) are considered ___________risk in older adults?
Answer ✅- High risk
Name a NMDA receptor antagonist
Answer ✅- Memantine (Namenda)
Name a source which lists drugs that carry high risks for older adults and criteria for potentially
inappropriate medication use in older adults
Answer ✅- BEERS criteria (STOPP/START criteria)
Anticholinergics (antihistamines, antispasmodics)
Tricyclic antidepressants
CV meds (alpha blockers, antithrombotics, antiarrythmics, central alpha agonists)
Antipsychotics
Benzodiazepines
Barbiturates
sulfonylureas
Sliding scale insulin
Muscle relaxers
Polypharmacy is MOST accurately defined as:
Answer ✅- the prescribing of multiple drugs to treat multiple conditions.
Rivastigmine (Exelon) must be titrated up slowly (even if it has only been stopped for a couple of days).
What occurs if a patient is rapidly titrated to a high dose?
Answer ✅- Serious side effects are more likely to occur, including violent nausea and vomiting (with risk
of esophageal rupture).
A rivastigmine (Exelon) patch should be placed in what location?
Answer ✅- Upper back, chest or upper arm
Absorption is 20-30% less if placed on the thigh or abdomen
What antipsychotics may be used in the treatment of acute delirium with psychosis and agitation?
Answer ✅- Haloperidol (Haldol) po or IM
Risperidone (Risperdal
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
What are CV risks of SNRIs in older adults?
Answer ✅- Hypertension
Orthostatic hypotension
Syncope
Arrhythmia
, Acute ischemia
Death in overdose
What are concerning side effects of trazodone and mirtazapine in older adults?
Answer ✅- Sedation
Orthostatic hypotension
Falls
What are the most common side effects of acetylcholinesterase inhibitors?
Answer ✅- Gastrointestinal: increased gastic acid secretion (increased risk of ulcers), nausea, vomiting,
and weight loss
What are the most common side effects of memantine (Namenda)?
Answer ✅- Usually well tolerated
Dizziness, Headache, Constipation
What are the risks of atypical antipsychotics in older adults?
Answer ✅- Cerebrovascular events (stroke)
Venous thromboembolism
Metabolism syndrome
Pancreatitis
What are the risks of typical antipsychotics in the elderly?
Answer ✅- Extrapyramidal symptoms
Pseudoparkinsonism
Akasthsia
What are the side effects of SSRIs, which are increased in older adults?
Answer ✅- Increased risk of bleeding
Hyponatremia
SIADH
Osteoporosis
What are the "Z drugs"?
Answer ✅- 3rd generation Hypnotics
--Zolpidem (Ambien)
--Zaleplon (Sonata)
--EsZopiclone (Lunesta)
selective agonist at GABA A alpha 1 site
shortens sleep latency and prolongs total sleep time
onset within 30 minutes
half life of 2-4 hours, greater in hepatic insufficiency and elderly
