what are the cognitive symptoms of dementia?
- memory loss
- lack of concentration
- disorientated
- speech difficulty
what are the non-cognitive symptoms?
- agitation, aggression, distress, psychosis
- depression & anxiety
3 drugs to manage mild-moderate alzheimer’s
- donepezil
- galantamine
- rivastigmine
cautions in donepezil
- cardiac conduction
- neuroleptic malignant syndrome
- EPS
- asthma & COPD
cautions in galantamine
- avoid GI & urinary flow obstruction
- severe skin reactions
cautions in rivastigmine
- stop if dehydrated from vomiting/diarrhea
- less side effects with transdermal
- monitor body weight
1 drug to manage moderate-severe alzheimer’s
- memantine
cautions in memantine
- epilepsy
- history of convulsions
drugs to review with bad cognitive function
- antidepressants (amitriptyline & paroxetine)
- anti-histamines (chlorphenamine & promethazine)
- antipsychotics (olanzapine & quetiapine)
- urinary spasmodics (solifenacin & tolterodine)
why review drugs cause bad cognitive function
- antimuscarinic burden
- bradycardia, bronchospasm, muscle weakness, diarrhoea
management non-cognitive symptoms
- agitation, aggression, distress, psychosis (only if risk of harm & delusions)
- depression & anxiety (CBT, anti-depressants for pre-existing conditions)
what is the risk of antipsychotic use in dementia?
- increased stroke
- lowest effective dose & shortest time
- review at least every 6 weeks
symptoms of epilepsy
- uncontrollable jerking & shaking
- losing awareness
- tingling feeling in extremities
- collapsing
- becoming stiff
treatment focal seizures without second generalisation
- lamotrigine/levetiracetam
- OR carbamazepine
treatment generalised seizures
- sodium valproate
immediate measures for epilepsy status?
- position to avoid injury
- support respiration
- maintain BP
- correct hypoglycaemia
- pyridoxine if deficiency
measures for epilepsy status if alcohol abuse
- parenteral thiamine
treatment if seizure longer than 5 minutes
- urgently Lorazepam IV
final measures treatment epilepsy status
- diazepam rectal solutions
- midazolam oromucosal in buccal cavity
epilepsy monotherapy and combination
- mono with 1st line then 2nd line
- combo with 2 or more drugs but increase risk AE and interactions
category 1 drugs epilepsy
- carbamazepine
- phenobarbital
- phenytoin
- use same brand
category 2 drugs epilepsy
- clobazam
- clonazepam
- lamotrigine
- sodium valproate
- brand based on patient & clinical judgement
category 3 drugs epilepsy
- gabapentin
- levetiracetam
- vigabatrin
- no specific brand
carbamazepine levels & monitoring
- 4-12mg/L (20-50 micromol/L) after 1-2 weeks
- HLA-B*1502 in Han Chinese/Thai (risk SJS)
- plasma concentration, renal & hepatic
