MH701 FINAL EXAM QUESTIONS & ANSWERS
1 in 6 hospital admissions are due to _______________which is directly linked to
polypharmacy - Answer -an adverse drug reaction
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.
At what stage of Alzheimer's disease does mild cognitive impairment develop? -
Answer -Stage 2
Mild cognitive impairment (MCI)
--cognitive deficits, typically mild
--interferes with daily life
--major risk factor for frank dementia
Normal Aging
--subtle decline in episodic memory
--no effect on daily life
--Age is the single greatest risk for cognitive decline
Before managing agitation in dementia with medications, what other things should be
considered? - Answer -Consider and treat pain, nicotine withdrawal, medication side
effects, understimulation, overstimulation, or other illnesses/infection
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 -Ues
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
Delirium or Dementia? Attention and awareness more preserved - Answer -Dementia
,Delirium or Dementia? Duration: months to years - Answer -Dementia
Delirium or Dementia? Impaired recent and immediate memory - Answer -Delirium
Early Alzheimer dementia (AD) is often confused with what other disorder? - Answer -
Depression. The first symptoms of AD are usually mood changes
Give an example of a cholinesterase inhibitor - Answer -Donepezil (Aricept),
Galantamine (Razadyne), Rivastigmine (Exelon)
How can Schizophrenia with psychosis be differentiated from dementia? - Answer -
People with psychosis are often still oriented to person, place and time
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 do cholinesterase inhibitors ta?ke to work? - Answer -Up to 6 weeks before
any improvement in memory or behavior is evident (and months before stabilization of
cognition is seen).
How long does memantine (Namenda) take to work? - Answer -It may take months
until any stabilization in the degenerative course of it is seen
How should SSRIs typically be started in older adults? - Answer -Start at one half the
minimum effective dose and may double after one week if needed
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
List 2 ways to improve medication adherence: - Answer -1. Patient education
2. Family education
3. Brown bag test
4. Blister packs/Medication planner
5. Medication calendar
6. Single pharmacy
7. Smartphone reminder apps
8. Consider cost (can the patient afford the med)
9. Simplify med list (de-prescribe as possible)
10. Ask about adverse drug effects
11. Consider memory issues and cognitive ability to remember to take medications
12. Timing (once a day is easier to comply with than qid)
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
An immunization to beta amyloid is in the research phase and showing promise as a
preventative treatment for Alzheimer's disease - Answer -True
True or False:
Atypical antipsychotic medications are useful in the prevention of behavioral symptoms
in dementia such as agitation - Answer -FALSE: Atypical antipsychotics have shown
little efficacy for long-term use in dementia and may increase CV events, confusion, and
mortality
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
1 in 6 hospital admissions are due to _______________which is directly linked to
polypharmacy - Answer -an adverse drug reaction
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.
At what stage of Alzheimer's disease does mild cognitive impairment develop? -
Answer -Stage 2
Mild cognitive impairment (MCI)
--cognitive deficits, typically mild
--interferes with daily life
--major risk factor for frank dementia
Normal Aging
--subtle decline in episodic memory
--no effect on daily life
--Age is the single greatest risk for cognitive decline
Before managing agitation in dementia with medications, what other things should be
considered? - Answer -Consider and treat pain, nicotine withdrawal, medication side
effects, understimulation, overstimulation, or other illnesses/infection
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 -Ues
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
Delirium or Dementia? Attention and awareness more preserved - Answer -Dementia
,Delirium or Dementia? Duration: months to years - Answer -Dementia
Delirium or Dementia? Impaired recent and immediate memory - Answer -Delirium
Early Alzheimer dementia (AD) is often confused with what other disorder? - Answer -
Depression. The first symptoms of AD are usually mood changes
Give an example of a cholinesterase inhibitor - Answer -Donepezil (Aricept),
Galantamine (Razadyne), Rivastigmine (Exelon)
How can Schizophrenia with psychosis be differentiated from dementia? - Answer -
People with psychosis are often still oriented to person, place and time
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 do cholinesterase inhibitors ta?ke to work? - Answer -Up to 6 weeks before
any improvement in memory or behavior is evident (and months before stabilization of
cognition is seen).
How long does memantine (Namenda) take to work? - Answer -It may take months
until any stabilization in the degenerative course of it is seen
How should SSRIs typically be started in older adults? - Answer -Start at one half the
minimum effective dose and may double after one week if needed
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
List 2 ways to improve medication adherence: - Answer -1. Patient education
2. Family education
3. Brown bag test
4. Blister packs/Medication planner
5. Medication calendar
6. Single pharmacy
7. Smartphone reminder apps
8. Consider cost (can the patient afford the med)
9. Simplify med list (de-prescribe as possible)
10. Ask about adverse drug effects
11. Consider memory issues and cognitive ability to remember to take medications
12. Timing (once a day is easier to comply with than qid)
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
An immunization to beta amyloid is in the research phase and showing promise as a
preventative treatment for Alzheimer's disease - Answer -True
True or False:
Atypical antipsychotic medications are useful in the prevention of behavioral symptoms
in dementia such as agitation - Answer -FALSE: Atypical antipsychotics have shown
little efficacy for long-term use in dementia and may increase CV events, confusion, and
mortality
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
