WEEK 8 NR 546 QUESTIONS AND ANSWERS.

WEEK 8 NR 546 QUESTIONS AND
ANSWERS


Early (1-3 years) signs of AD - ANSWER: short term memory deficits
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disoriented to date bb bb



diminished recall of recent events bb bb bb bb



mild language and decision-making deficits
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mild problem copying figures (clock drawing)
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social withdrawal bb



mood change bb



personality changes bb



problems with managing finances bb bb bb




Middle (2-8 years) stage of AD - ANSWER: disoriented to date and place
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may get lost in familiar places
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impaired learning new skills bb bb bb



agitation, aggression, restlessness, or anxiety
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difficulty with ADLs such as cooking and grooming
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Late (6-12 years) stage of AD - ANSWER: disoriented to person, time, or place
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non-verbal
long term memory diminished
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unable to groom or dress bb bb bb bb



progress to need for total care at end stage
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incontinent
motor or verbal agitation
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Alzheimer's disease (AD) demographic - ANSWER: most prevalent in people over age
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65
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African American (13.8%), bb bb



Hispanics (12.2%),
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non-Hispanic whites (10.3%),
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American Indian and Alaska Natives (9.1%), bb bb bb bb bb bb



Asian and Pacific Islanders (8.4%)
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Genetics r/t AD - ANSWER: Genes appear to play a strong role, with late-onset AD
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showing heritability of 58-79% and early-onset AD showing over 90%
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Neuroanatomy r/t AD - ANSWER: amyloid plaques and neurofibrillary tangles. bb bb bb bb bb bb bb bb bb



atrophy of hippocampus and cerebral cortex.
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, Neural Networks r/t AD - ANSWER: damage to synapses, mitochondrial abnormalities,
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and inflammatory processes
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Neural Signaling r/t AD - ANSWER: decreased acetylcholinesterase activity and a
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permanent loss of cholinergic neurons
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Acetylcholine (ACh) is a neurotransmitter necessary for processing memory andbb bb bb bb bb bb bb bb bb



learning.
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Diagnosis of AD - ANSWER: comprehensive health history is key to gather clues
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Rule out other causes of dementia
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Early AD may include anxiety, irritability, and sleep disruption
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new-onset mental health symptoms in late 50s and 60s may be in the early stage of
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AD
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Cholinesterase Inhibitors (ChEIs)X - ANSWER: do not change the progression of AD bb bb bb bb bb bb bb bb bb bb bb



provide some alleviation of symptoms bb bb bb bb



eg. donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, Razadyne ER),
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donepezil (Aricept) bb



Mechanism of Action - ANSWER: inhibits centrally active acetylcholinesterase
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donepezil (Aricept) bb



Common Side Effects - ANSWER: gastrointestinal symptoms (nausea and diarrhea)
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headache
dizziness
muscle weakness bb




donepezil (Aricept) bb



Precaution - ANSWER: sick sinus syndrome
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seizure disorder bb




donepezil (Aricept) bb



Prescribing Pearls - ANSWER: Taper to avoid withdrawal effects. bb bb bb bb bb bb bb bb



Donepezil (Aricept) is approved to treat moderate to severe AD at 23 mg/day dose,
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but there is minimal improvement in cognitive functioning when compared to a 10
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mg/day dose. At the higher dose, donepezil has a higher incidence of adverse
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effects.
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When Donepezil (Aricept) is added to CYP2D6 or CYP3A4, there is a possibility of
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peripheral side effects, and inducers of CYP2D6 and CYP3A4 may increase the rate
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of elimination
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rivastigmine (Exelon) bb



Mechanism of Action - ANSWER: acts centrally for both acetylcholinesterase and
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butyrylcholinesterase, thereby potentially increasing its efficacy.
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