NURS 5432 Geriatric Patient and GI
Disorders in Primary Care
What does the Montreal cognition test for? - CORRECT ANSWER-Attention and
concentration, executive functions, memory, language, visuoconstructional skills,
conceptual thinking, calculations, and orientation.
What is Delirium? - CORRECT ANSWER-A sudden onset of clouded sensorium that
can occur at any age associated with a physical stressor.
What are the causes for Delirium? - CORRECT ANSWER-Toxins, alcohol/drug abuse,
trauma, Impactions in the elderly, poor nutrition, electrolyte imbalances, anesthesia and
septicemia.
What is the management of Delirium? - CORRECT ANSWER-Treat the underlying
cause
What is Dementia? - CORRECT ANSWER-A chronic progressive cognitive impairment
What is the mini mental evaluation? - CORRECT ANSWER-A tool that can be used to
thoroughly assess mental status.
What areas does the mini mental exam assess? - CORRECT ANSWER-It test five
areas of cognitive function: orientation, registration, attention and calculation, recall, and
language.
What is the Montreal cognition? - CORRECT ANSWER-A rapid screening assessment
used for mild cognitive dysfunction.
What are the causes of Dementia? - CORRECT ANSWER-Atherosclerosis,
neurotransmitter deficits, cortical atrophy, ventricular dilation, loss of brain cells,
possible viral causes, Alzheimer's disease, Lewy body dementia
What are the first line treatment drugs used to treat Alzheimer's? - CORRECT
ANSWER-Best in mild to moderate disease; may be effective in Lewy body dementia.
Donepezil (Aricept): Start at 5 mg/day PO; may increase to 10 mg/day after 1 month,
may increase to 23 mg/day after 3 months if needed. Orally disintegrating tablets;
generic available. Caution with digoxin or β-blockers (Donepezil may prolong PR
interval.)
, Rivastigmine (Exelon): Start at 1.5 mg PO BID and increase by 1.5 mg BID every 2
weeks; maintenance 6 to 12 mg/day total Capsule, solution, or patch (reduced side
effects)
Galantamine (Razadyne): Start at 4 mg BID for 4 weeks and then increase by 4 mg BID
every month with goal of 16 to 24 mg/day dose.
Tablets, solution, extended-release (ER) capsule, and transdermal formulations
Vitamin E—2,000 IU/day supplementation was found to slow decline in one study.
Memantine, a N-methyl-d-aspartate (NMDA) receptor antagonist for moderate to severe
AD
Monotherapy or in combination with acetylcholinesterase inhibitors, Memantine
immediate release: 5 mg/day; titrate up to 10 mg BID, adding 5 mg/day every week
PRN.
Memantine extended release: 7 mg/day up to 28 mg/day, adding 7 mg/day every week
PRN
What type of inhibitors are used to treat Alzheimer's - CORRECT ANSWER-
Acetylcholinesterase Inhibitors (ChEIs)
What are the side effects of Alzheimer's drugs? - CORRECT ANSWER-All have
potential for GI and other side effects, such as bradycardia/syncope.
Neuropsychiatric symptoms: assessment and treatment for delirium, environmental
modification, sleep hygiene, exercise, cognitive interventions, hearing/vision aids, and if
necessary for moderate to severe symptoms, consider second-line care
What are the second line drugs used to treat Alzheimer's? - CORRECT ANSWER-For
moderate to severe depression: selective serotonin reuptake inhibitors (SSRIs)
preferred
Insomnia: Medications have little efficacy for sleep in AD.
Avoid diphenhydramine and antihistamines in elderly due to negative side effects.
If using low-dose risperidone, trazodone, or sleep aid (e.g., zolpidem), use caution and
lowest dose possible in elderly.
Moderate agitation, anxiety/restlessness: first-line care; may consider low-dose
risperidone or SSRIs (citalopram)
Risperidone at low dose for severe psychosis and safety concern; treatment not usually
required
Precautions
Disorders in Primary Care
What does the Montreal cognition test for? - CORRECT ANSWER-Attention and
concentration, executive functions, memory, language, visuoconstructional skills,
conceptual thinking, calculations, and orientation.
What is Delirium? - CORRECT ANSWER-A sudden onset of clouded sensorium that
can occur at any age associated with a physical stressor.
What are the causes for Delirium? - CORRECT ANSWER-Toxins, alcohol/drug abuse,
trauma, Impactions in the elderly, poor nutrition, electrolyte imbalances, anesthesia and
septicemia.
What is the management of Delirium? - CORRECT ANSWER-Treat the underlying
cause
What is Dementia? - CORRECT ANSWER-A chronic progressive cognitive impairment
What is the mini mental evaluation? - CORRECT ANSWER-A tool that can be used to
thoroughly assess mental status.
What areas does the mini mental exam assess? - CORRECT ANSWER-It test five
areas of cognitive function: orientation, registration, attention and calculation, recall, and
language.
What is the Montreal cognition? - CORRECT ANSWER-A rapid screening assessment
used for mild cognitive dysfunction.
What are the causes of Dementia? - CORRECT ANSWER-Atherosclerosis,
neurotransmitter deficits, cortical atrophy, ventricular dilation, loss of brain cells,
possible viral causes, Alzheimer's disease, Lewy body dementia
What are the first line treatment drugs used to treat Alzheimer's? - CORRECT
ANSWER-Best in mild to moderate disease; may be effective in Lewy body dementia.
Donepezil (Aricept): Start at 5 mg/day PO; may increase to 10 mg/day after 1 month,
may increase to 23 mg/day after 3 months if needed. Orally disintegrating tablets;
generic available. Caution with digoxin or β-blockers (Donepezil may prolong PR
interval.)
, Rivastigmine (Exelon): Start at 1.5 mg PO BID and increase by 1.5 mg BID every 2
weeks; maintenance 6 to 12 mg/day total Capsule, solution, or patch (reduced side
effects)
Galantamine (Razadyne): Start at 4 mg BID for 4 weeks and then increase by 4 mg BID
every month with goal of 16 to 24 mg/day dose.
Tablets, solution, extended-release (ER) capsule, and transdermal formulations
Vitamin E—2,000 IU/day supplementation was found to slow decline in one study.
Memantine, a N-methyl-d-aspartate (NMDA) receptor antagonist for moderate to severe
AD
Monotherapy or in combination with acetylcholinesterase inhibitors, Memantine
immediate release: 5 mg/day; titrate up to 10 mg BID, adding 5 mg/day every week
PRN.
Memantine extended release: 7 mg/day up to 28 mg/day, adding 7 mg/day every week
PRN
What type of inhibitors are used to treat Alzheimer's - CORRECT ANSWER-
Acetylcholinesterase Inhibitors (ChEIs)
What are the side effects of Alzheimer's drugs? - CORRECT ANSWER-All have
potential for GI and other side effects, such as bradycardia/syncope.
Neuropsychiatric symptoms: assessment and treatment for delirium, environmental
modification, sleep hygiene, exercise, cognitive interventions, hearing/vision aids, and if
necessary for moderate to severe symptoms, consider second-line care
What are the second line drugs used to treat Alzheimer's? - CORRECT ANSWER-For
moderate to severe depression: selective serotonin reuptake inhibitors (SSRIs)
preferred
Insomnia: Medications have little efficacy for sleep in AD.
Avoid diphenhydramine and antihistamines in elderly due to negative side effects.
If using low-dose risperidone, trazodone, or sleep aid (e.g., zolpidem), use caution and
lowest dose possible in elderly.
Moderate agitation, anxiety/restlessness: first-line care; may consider low-dose
risperidone or SSRIs (citalopram)
Risperidone at low dose for severe psychosis and safety concern; treatment not usually
required
Precautions
