Alzheimer's Disease: Pathophysiology and Brain Changes

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What percentage of clients with dementia may experience neuropsychiatric symptoms including behavioral disturbances?

Up to 90% (correct)

Up to 100%

Up to 70%

Up to 50%

Why is intervention sometimes necessary for clients with dementia and behavioral disturbances?

To enhance their quality of life

To improve their cognitive function

To reduce their medication dosage

For the safety of the client and others (correct)

What is the primary risk associated with using antipsychotic medication for behavioral disturbances in dementia?

Cognitive impairment

Cardiovascular side effects

Mortality and cardiovascular side effects (correct)

Weight gain

What is the first-line pharmacologic treatment for aggression and agitation in dementia?

SSRI/SNRI therapy Signup and view all the answers

Which stage of dementia is characterized by short-term memory deficits and difficulty recalling the date?

Early Signup and view all the answers

Alzheimer's Dz is most prevalent in people over?

65 Signup and view all the answers

What is a common symptom of dementia in the middle stage?

Agitation and aggression Signup and view all the answers

Alzheimer's Dz affects which ethic group the most at 13.8%?

African American Signup and view all the answers

What is believed to contribute to the formation of toxic amyloid plaques in the brain of clients with AD?

Abnormal processing of amyloid precursor protein Signup and view all the answers

What is the result of cell death in the brain due to AD?

Atrophy of brain tissue Signup and view all the answers

What is affected by the atrophy of brain tissue in AD?

Hippocampus and cerebral cortex Signup and view all the answers

What is the result of decreased acetylcholinesterase activity in AD?

Permanent loss of cholinergic neurons Signup and view all the answers

What is necessary for processing memory and learning in AD?

Acetylcholine Signup and view all the answers

What is associated with neurotransmitter failure and neuronal death in AD? Known as Neural networks.

All of the above Signup and view all the answers

What is the result of abnormal activation of N-methyl-d-aspartate receptors by glutamate in AD?

Neuronal damage Signup and view all the answers

What plays a strong role in late-onset Alzheimer's Dz?

Genes Signup and view all the answers

What is the suitable medication for a 65-year-old male with Alzheimer's disease, anxiety, smokes cigarettes, and COPD?

Donepezil Signup and view all the answers

Why is Rivastigmine not an appropriate medication for a pt. with COPD?

It can worsen his COPD Signup and view all the answers

Genetic coding abnormalities are associated with amyloid precursor protein. What chromosome are affected in early onset AD?

14 Signup and view all the answers

Why is Galantamine not an appropriate medication for a pt. with anxiety?

It cannot address his anxiety Signup and view all the answers

What is the consequence of discontinuing medication for Alzheimer's disease?

The medication may not work as well if restarted & return of cognitive symptoms may occur Signup and view all the answers

Which of the following medications requires tapering?

Donepezil Signup and view all the answers

What is the reason why a client might want to stop taking the medication for Alzheimer's disease?

Due to gastrointestinal side effects Signup and view all the answers

What medication should be eliminated from the treatment plan if a pt. is taking simvastatin and lisinopril due to its ability to increase plasma levels of the statin? This will increase the risk of muscle damage & Rhabdomyolysis.

fluoxetine (Prozac) Signup and view all the answers

Which medication is a good option for a pt. with bipolar disorder who may be forgetful or non-compliant?

IM aripiprazole Signup and view all the answers

Which medication is a good option for a patient who abuses illicit drugs and needs to manage withdrawal symptoms for 24 hrs and provides a steady control of cravings throughout the day?

Methadone Signup and view all the answers

Where is methadone typically administered?

In a federally regulated opioid treatment program Signup and view all the answers

What is a benefit of using methadone in medication-assisted treatment for opioid use disorder?

It extends client survival Signup and view all the answers

What is a characteristic of methadone clinics?

They require daily attendance for the first several months Signup and view all the answers

This term describes two hallmarks of AD (too many or not enough removal of amyloid & neurofibrillary tangles).

Neuroanatomy Signup and view all the answers

What is a risk associated with stopping methadone treatment?

High likelihood of relapsing Signup and view all the answers

Which medication might be prescribed to a patient trying to get pregnant?

Lurasidone (Latuda) Signup and view all the answers

Acetylcholine (ACh) is an NTM necessary for processing memory & learning, decreased cholinergic function is linked to memory dysfunction (esp. short-term). This is known as?

Neural signaling Signup and view all the answers

Which medication is the safest option for a patient who takes a daily aspirin, atorvastatin, and digoxin?

Escitalopram (Lexapro) Signup and view all the answers

Which medication can help alleviate anxiety and excessive sleepiness in a patient with depression?

Sertraline (Zoloft) Signup and view all the answers

Which MDD medication is effective for a 75-year-old patient with urinary retention and chronic pain related to fibromyalgia?

Duloxetine (Cymbalta) Signup and view all the answers

What is a characteristic of SNRIs?

They can increase anxiety in some patients Signup and view all the answers

Which medication should be considered for a patient who has concerns about the sexual side effects of antidepressants?

Bupropion (Welbutrin) Signup and view all the answers

Which medication is suitable for a patient with anorexia related to MDD?

Mirtazapine (Rameron) Signup and view all the answers

Statin is a CYP450 3A4 _ & Prozac is a CYP450 ____.

Substrate, inducer Signup and view all the answers

Which medication inhibits both dopamine and norepinephrine?

Bupropion (Wellbutrin) Signup and view all the answers

What is a correct intervention for a patient who took haloperidol and suddenly experiences a fever, muscle rigidity, and altered mental status?

Advise the patient to go to the emergency room and begin the patient on Dantrolene Signup and view all the answers

What should the PMHNP consider when prescribing valproic acid with Lamotrigine (Lamictal) for a patient with bipolar type II disorder?

Reduce the dosage of valproic acid by half Signup and view all the answers

Which laboratory values need to be monitored for a patient on lithium?

All of the above Signup and view all the answers

What is a characteristic of a pt. who has lost his ability to speak and requires around-the-clock care for ADLs?

Late-stage dementia Signup and view all the answers

How does nicotine affect the clearance of medication?

Increases the clearance Signup and view all the answers

What is a characteristic of a pt. who is unable to recall who they are, the date or time, or where they are?

Late-stage dementia Signup and view all the answers

What is a characteristic of a pt. who is withdrawn, closed off, and moody?

Early-stage dementia Signup and view all the answers

Which stimulant medication should be avoided in a patient with a past medical history of MDD treated with Selegiline, a MAOI?

amphetamine (Adzenys) Signup and view all the answers

A patient taking IR dextroamphetamine (Adderall) states they feel great after taking their morning dose but notice their ADHD symptoms come back in the evening. Which intervention is correct?

Prescribe a nighttime dose of IR dextroamphetamine (Adderall) Signup and view all the answers

Which stimulant medication is the safest option to prescribe to a patient with a past medical history of obesity, alcohol abuse, and substance abuse?

lisdexamfetamine (Vyvanse) Signup and view all the answers

A patient who takes Acamprosate (Campral) for alcohol abuse informs the PMHNP that she recently found out she was pregnant. The patient is compliant with the medication, and she has not had a drink in over 6 months. Which response by the PMHP is correct?

Acamprosate is unsafe for pregnancy, we will switch you to naltrexone instead Signup and view all the answers

Methadone is a full u-receptor agonist with a ____half life?

Long Signup and view all the answers

All of the following are correct about memantine EXCEPT?

Take 1st thing in the morning Signup and view all the answers

Which medication inhibits the presynaptic reuptake of both DA & NE, leading to increased levels of both NTM in the synaptic cleft?

Buprenorphine Signup and view all the answers

Why does the patient taking IR dextroamphetamine (Adderall) experience a return of ADHD symptoms in the evening?

The IR dose of the medication wears off quickly Signup and view all the answers

What is the first-line treatment for restless leg syndrome?

Ropinirole Signup and view all the answers

A patient with alcohol abuse disorder is actively drinking and using opiates but wishes to participate in MAT to change their lifestyle. Which of the following medications is appropriate to prescribe this patient?

Naltrexone (Vivitrol) Signup and view all the answers

Which of the following statements is true about galantamine?

It should be avoided in patients who frequently use NSAIDS Signup and view all the answers

Increased irritability and insomnia can be treated with what class medication which will allow the client to fall asleep.

Low dose non-stimulant Signup and view all the answers

What is the primary concern when using stimulants in clients with no prior history?

Causing psychotic or manic symptoms Signup and view all the answers

A 27-year-old patient presents to the clinic with symptoms of ADHD and requests to be started on clonidine. Which medicaiton is most appropriate?

Atomoxetine Signup and view all the answers

What is the most appropriate medication for a dementia patient with dementia and tobacco use?

Donepezil Signup and view all the answers

What does Suboxone (buprenorphine/naloxone) increase the risk of in pregnant women?

Increases the risk for neonatal abstinence syndrome Signup and view all the answers

Which medication is contraindicated for a patient with a HgB A1C of 8 who has bipolar disorder?

Olanzapine Signup and view all the answers

What is the advantage of Suboxone for a client who may not be able to leave work for medication dosing?

It does not need to be taken under direct observation Signup and view all the answers

Why is Suboxone a less desirable street drug?

Naloxone prevents any rewarding effects from buprenorphine Signup and view all the answers

What is the increased risk associated with buprenorphine use during pregnancy?

Neonatal withdrawal syndrome Signup and view all the answers

John is a prescription drug abuser who wishes to partake in MAT, however, he has a history of abusing and selling street drugs. Which medication option would be most appropriate for him?

Suboxone (buprenorphine) Signup and view all the answers

Why is naloxone added to buprenorphine in Suboxone?

To prevent any rewarding effects from buprenorphine Signup and view all the answers

A patient undergoing MAT for alcohol abuse presents with palpations, headache, vomiting, and flushing. The patient states she had a glass of wine last night at dinner. Which medication is this patient most likely taking?

Disulfiram (antabuse) Signup and view all the answers

Which of the following statements is true? A)Patents who take medications for AD can reverse the presence of amyloid plaques in the brain. B) Clozapine is a first-line medication for the treatment of agitation and behavioral symptoms in patients with dementia . C) Patients who take medication for AD will have an increased life expectancy. D) Galantamine is safe to be used during pregnancy.

C Signup and view all the answers

What is a key teaching point for a patient prescribed memantine and donepezil?

Ensuring the living environment is free of clutter and well-lit Signup and view all the answers

A patient presents with dementia associated with Parkinson’s disease. Which medication would be the best to prescribe to this patient?

Rivastigmine (transdermal) Signup and view all the answers

A patient with GAD presents with new onset insomnia and states she has an uncomfortable urge to move her legs at night. Which of the following medications is the first line treatment for restless leg syndrome?

Ropinirole Signup and view all the answers

Which medication is not safe to use during pregnancy?

Galantamine Signup and view all the answers

What medication relieves spasms, cramping, & tightness of muscles in conditions such as MS?

Dantrolene Signup and view all the answers

What med is approved in pregnancy for heroin-addicted women?

Methadone Signup and view all the answers

How soon will treatment efficacy be seen with stimulants?

1 week Signup and view all the answers

A patient presents to the PMHNP with the following symptoms of dementia: disorientation to date, trouble learning new skills, and newly onset difficulties with cooking and grooming. Which stage of dementia is the patient in?

Late stage Signup and view all the answers

Alzheimer's Disease: Pathophysiology and Brain Changes

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Questions and Answers

What percentage of clients with dementia may experience neuropsychiatric symptoms including behavioral disturbances?

Why is intervention sometimes necessary for clients with dementia and behavioral disturbances?

What is the primary risk associated with using antipsychotic medication for behavioral disturbances in dementia?

What is the first-line pharmacologic treatment for aggression and agitation in dementia?

Which stage of dementia is characterized by short-term memory deficits and difficulty recalling the date?

Alzheimer's Dz is most prevalent in people over?

What is a common symptom of dementia in the middle stage?

Alzheimer's Dz affects which ethic group the most at 13.8%?

What is believed to contribute to the formation of toxic amyloid plaques in the brain of clients with AD?

What is the result of cell death in the brain due to AD?

What is affected by the atrophy of brain tissue in AD?

What is the result of decreased acetylcholinesterase activity in AD?

What is necessary for processing memory and learning in AD?

What is associated with neurotransmitter failure and neuronal death in AD? Known as Neural networks.

What is the result of abnormal activation of N-methyl-d-aspartate receptors by glutamate in AD?

What plays a strong role in late-onset Alzheimer's Dz?

What is the suitable medication for a 65-year-old male with Alzheimer's disease, anxiety, smokes cigarettes, and COPD?

Why is Rivastigmine not an appropriate medication for a pt. with COPD?

Genetic coding abnormalities are associated with amyloid precursor protein. What chromosome are affected in early onset AD?

Why is Galantamine not an appropriate medication for a pt. with anxiety?

What is the consequence of discontinuing medication for Alzheimer's disease?

Which of the following medications requires tapering?

What is the reason why a client might want to stop taking the medication for Alzheimer's disease?

What medication should be eliminated from the treatment plan if a pt. is taking simvastatin and lisinopril due to its ability to increase plasma levels of the statin? This will increase the risk of muscle damage & Rhabdomyolysis.

Which medication is a good option for a pt. with bipolar disorder who may be forgetful or non-compliant?

Which medication is a good option for a patient who abuses illicit drugs and needs to manage withdrawal symptoms for 24 hrs and provides a steady control of cravings throughout the day?

Where is methadone typically administered?

What is a benefit of using methadone in medication-assisted treatment for opioid use disorder?

What is a characteristic of methadone clinics?

This term describes two hallmarks of AD (too many or not enough removal of amyloid & neurofibrillary tangles).

What is a risk associated with stopping methadone treatment?

Which medication might be prescribed to a patient trying to get pregnant?

Acetylcholine (ACh) is an NTM necessary for processing memory & learning, decreased cholinergic function is linked to memory dysfunction (esp. short-term). This is known as?

Which medication is the safest option for a patient who takes a daily aspirin, atorvastatin, and digoxin?

Which medication can help alleviate anxiety and excessive sleepiness in a patient with depression?

Which MDD medication is effective for a 75-year-old patient with urinary retention and chronic pain related to fibromyalgia?

What is a characteristic of SNRIs?

Which medication should be considered for a patient who has concerns about the sexual side effects of antidepressants?

Which medication is suitable for a patient with anorexia related to MDD?

Statin is a CYP450 3A4 _________ & Prozac is a CYP450 ____________.

Which medication inhibits both dopamine and norepinephrine?

What is a correct intervention for a patient who took haloperidol and suddenly experiences a fever, muscle rigidity, and altered mental status?

What should the PMHNP consider when prescribing valproic acid with Lamotrigine (Lamictal) for a patient with bipolar type II disorder?

Which laboratory values need to be monitored for a patient on lithium?

What is a characteristic of a pt. who has lost his ability to speak and requires around-the-clock care for ADLs?

How does nicotine affect the clearance of medication?

What is a characteristic of a pt. who is unable to recall who they are, the date or time, or where they are?

What is a characteristic of a pt. who is withdrawn, closed off, and moody?

Which stimulant medication should be avoided in a patient with a past medical history of MDD treated with Selegiline, a MAOI?

A patient taking IR dextroamphetamine (Adderall) states they feel great after taking their morning dose but notice their ADHD symptoms come back in the evening. Which intervention is correct?

Which stimulant medication is the safest option to prescribe to a patient with a past medical history of obesity, alcohol abuse, and substance abuse?

A patient who takes Acamprosate (Campral) for alcohol abuse informs the PMHNP that she recently found out she was pregnant. The patient is compliant with the medication, and she has not had a drink in over 6 months. Which response by the PMHP is correct?

Methadone is a full u-receptor agonist with a ____half life?

All of the following are correct about memantine EXCEPT?

Which medication inhibits the presynaptic reuptake of both DA & NE, leading to increased levels of both NTM in the synaptic cleft?

Why does the patient taking IR dextroamphetamine (Adderall) experience a return of ADHD symptoms in the evening?

What is the first-line treatment for restless leg syndrome?

A patient with alcohol abuse disorder is actively drinking and using opiates but wishes to participate in MAT to change their lifestyle. Which of the following medications is appropriate to prescribe this patient?

Which of the following statements is true about galantamine?

Increased irritability and insomnia can be treated with what class medication which will allow the client to fall asleep.

What is the primary concern when using stimulants in clients with no prior history?

A 27-year-old patient presents to the clinic with symptoms of ADHD and requests to be started on clonidine. Which medicaiton is most appropriate?

What is the most appropriate medication for a dementia patient with dementia and tobacco use?

What does Suboxone (buprenorphine/naloxone) increase the risk of in pregnant women?

Which medication is contraindicated for a patient with a HgB A1C of 8 who has bipolar disorder?

What is the advantage of Suboxone for a client who may not be able to leave work for medication dosing?

Why is Suboxone a less desirable street drug?

What is the increased risk associated with buprenorphine use during pregnancy?

John is a prescription drug abuser who wishes to partake in MAT, however, he has a history of abusing and selling street drugs. Which medication option would be most appropriate for him?

Why is naloxone added to buprenorphine in Suboxone?

A patient undergoing MAT for alcohol abuse presents with palpations, headache, vomiting, and flushing. The patient states she had a glass of wine last night at dinner. Which medication is this patient most likely taking?

What is a key teaching point for a patient prescribed memantine and donepezil?

A patient presents with dementia associated with Parkinson’s disease. Which medication would be the best to prescribe to this patient?

A patient with GAD presents with new onset insomnia and states she has an uncomfortable urge to move her legs at night. Which of the following medications is the first line treatment for restless leg syndrome?

Which medication is not safe to use during pregnancy?

What medication relieves spasms, cramping, & tightness of muscles in conditions such as MS?

What med is approved in pregnancy for heroin-addicted women?

Statin is a CYP450 3A4 _ & Prozac is a CYP450 ____.