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GERIATRICS

Alzheimer's disease and treatment

1-Most common types of dementia

A-Alzheimer,s disease B-Lewey body dementia

C-Vascular causes of dementia

D-Pick,s disease E- Common reversible cause of mental status change such as (Alcohol abuse ,thyroid ....dysfunction,vitamineB12 deficiency, etc

Treatmentcomments Pharmacologic

propertiesDosage forms

Maintenance dose

Starting dose

Cholinesterase inhibitors

Bradycardia&syncope

with all CIS.

Acetyl cholinesterase

inhibitor

5-10mg even

for dis tab

10mg/d 5mg/d Donepezil(Aricept)

===oral disintegrating

tablet

Labeled for mild-

moderate Alzheimer

mild-moderatd dementia

with Parkinson's disease

Acetyl&butylchOlinestrase

inhibitor

1.5mg,3mg,4.5,

6mg 2mg/ml

oral soln

3-6mg 2time/d 18mg patch

delivers 9.5mg/d

1.5mg 2times/d9mgpatc

h delivers4.6mg/d

Rivastigmine(Exelon)

rivastigmine patch

Prefer to take with food

A selective competitive ,reversible inhibitor of acetylcholinestrase &nicotine

4,8,12mg tabs 8,16,24mgER capsules 4mg/ml of oral solution

8-12mg 2time/day or8-24mg ER once daily

4mg2 time/day

Glanatamine&Galantamine extended release

Glutamatergic therapy

Labeled for use in pt with moderate to sever Alzheimer's disease

N-methyl-D-aspartate receptor antagonist that block glutamate transmission

5-10mg tablet,2mg/ml oral solution

10mg 2time/day

5mg once/day

Mematine

BEHAVIORAL SYMPTOMS OF DEMENTIA

A-Cholinesterase inhibitors B-Atypical antipsychotic(APS)

C-Other medication -!Valproic acid

-!!Carbamazepine

-!!!Antidepressants

URINARY INCOTINENCECommon Types Of UI,Drug-Induced cause, and treatment

COMMENTS DRUG TREAMENT DESCRIPTION &DRUG INDUCE CAUSES

TYPE OF INCONTINENCE

Ant cholinergic agents are first line therapy

Antimuscarinic/anti cholinergic agent oxybutynin ,tolterodine,trospium

Detrusor muscle instability can be cause CNS damage from stroke

Urge or overactive bladder

TCAS are not preferred for use in elder pts

TCAS such as imipramine doxepin

Drug induce cause..cholinergic agents the bladder such

bethanechol

Description Stress

incontinence

It has low efficacy in treatment UI

Not FAD approved(including

nausea` dry mouth est).

α-adrenergic agonists(pesudoehedrine,phenylephrine conjugated estrogen vaginal creamDuloxetineSerotonin/norepinephrine reuptake inhibitor

Loss of urine with increased abdominal pressure(sneezing, coughing)

Drug induced causes (α-blockers such as prazosin dec urethral sphincter tone

CON DESCRIPTION OVERFLOW IU

Adverse effects depneding on selectivity to receptors they will act

Stimulate s the detrusor muscle

α-Adrenergic antagonists (Alfuzosin,Tamsulosin,terazosin +5-hydroxy reductase inhibitor or bladder antispamodics (finasteride ,tolterodine,oxybutyninCholinomimetic as Bethanechol

Caused by obstruction

Treatment according to cause

Focus on symptoms that dominate

Description UI more than cause either stress and overactive bladder

MixedIU

Benign Prostatic Hypertrophy

Epidemiology

Usually develops after age 40,by the age 60 half of them have BPH,by age 85 ,90% have BPH

Treatment α-Adrenergic blocker which act by reducing smooth muscle contraction in the urethra

Nonspecific α-adrenergic blockers such as terazosin lower b.p

CONT

Newer agent are selective α1a adrenergic blockers as(Tamsulosin,Alfuzosin) all theα-a-blocker lower b.p

2-α-Reductase inhibitor

========Prevent the conversion of testosterone

To(DHT) dihydrotesosteone which stimulate prostate growth (e.g.) Finasteride inhibits Type II5-αredutcase and lower prostate( DHT) by 80%-90%

Duratation of therapy six months

-Combination therapy

Finasteride +tamsulosin

-Surgery

ARTHRITIS

Osteoarthritis

Women are afflicted more often than men. Large weight-bearing joints ,such as hip and knee are commonly affected GOALS OF THEPAY

-To relieve pain -Maintain or improve joint function

-prevent loss of function

No pharmacologic treatment Patients need to understand chronic of (OA) -Weight loss-Physical therapy-

,finally surgery Exercise-Drug therapy

Acetaminophen 1G/4times/day (large dose can PT,with liver disease should take 2600mg/day))liver failure

In older people with OA,NSAIDS should seldom be used

In selected PT,cyclooxygenase-2(cox-2)- inhibitors and NSAIDS may be used ,for those using nonselective

NSAIDS ,a proton pump inhibitor should be used, also in those using celecoxib and aspirin(for cardiac disease)

Opioids for persistent OA

Adjuvant drug therapy Gabapentin ,in patients with neuropathic pain ,avoid TCAS

-Avoid the used of skeletal muscle relaxants because of high risk of anti cholinergic adverse effect

-Alternative dietary supplements

a-GLUCOSAMINE SULAFATE 500mg taken 3time/day,for chronic therapy to prevent joint degradation and relive pain

RHEUMATOID ARTHRITIS

Epidemiology

1-Asystemic disease characterized by inflammatory arthritis that affects the small joint of hands ,wrists ,and feet

2-It is an autoimmune disease

Treatment

The same as AO

HANAN.N Pharmacist