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Delirium and DementiasPsychiatric Nursing: Contemporary Practice

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When are Acetylcholinesterase inhibitors (AChEI) indicated for the treatment of AD?
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When the patient is diagnosed with mild to moderate AD.
What medications are Acetylcholinesterase inhibitors (AChEI) (4)?
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Galantamine/Razadyne, donepezil/Aricept, rivastigmine/Exelon, and tacrine/Cognex.
________ is a Acetylcholinesterase inhibitors (AChEI) that can be used to treat mild, moderate and severe AD (most can only treat mild and moderate)?
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Aricept/donepezil
What class of medications should be monitored closely if used with Acetylcholinesterase inhibitors (AChEI), and why?
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NSAIDS, they increase the risk of stomach ulcers
What class of medications should not be used with Acetylcholinesterase inhibitors (AChEI), and why?
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Anticholinergic medications
How do NMDA antagonists work in the treatment of AD?
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They prevent the response of N-methyl-D-aspartate to excesses of glutamate, preventing the development of increased intracellular calcium which destroys neurons.
What drug is an NMDA antagonist used in the treatment of AD?
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Namenda/memantine, used for mild, moderate and severe dementia to improve cognition and ADL abilities.
When and why are antipsychotic agents used to treat patients with AD?
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They are used to reduce psychosis, agitation, or aggressive behaviors in the moderate to severe stages of AD.
When atypical antipsychotic agents are used in elderly patients the dosage should be (higher/lower?) that the dose used for younger adults.
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Much lower
What is the typical class of antidepressants used to treat patients with AD for depression?
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SSRIs
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What are the risks of using benzodiazepines in patients with AD?
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In elderly patients they can cause paradoxical reactions.
What class of medications should be avoided for treating patients with AD?
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Anticholinergic agents
One of the earliest symptoms of AD is the inability to retain __________.
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New information
The most dramatic and consistent cognitive impairment in AD is in _________.
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Memory, eventually leading to impairment of even long term memory
What is agnosia?
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Difficulty finding a word in a sentence or naming an object
Early in AD ________ is a sign of language impairment. In the middle stages, ________ develops, eventually progressing to a person who is mute and unresponsive to directions or information.
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Agnosia is develops early and then fluent aphasia/diminished comprehension develops
When do visuospatial impairments develop in patients with AD and what is diagnostic of impairment in this area?
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These impairments develop in the early stages, impacting the ability to write and draw. An inaccurate clok drawing is diagnostic of this condition.
How is a patient with AD impacted by visuospatial impairments?
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They lose the ability to write, draw, perform sequencing tasks like cooking and dressing, and are unable to perform tasks to require calculations like balancing a checkbook.
How do patients compensate for memory losses associated with AD in the early and moderate stages?
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They compensate with hyperalertness, becoming very aware of many environmental stiumli that cannot be processed?this leads to an interpretation of danger and the development of suspiciousness.
When do executive functions like judgment, reasoning, and the ability to problem solve/make decisions occur in patients with AD?
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About the time a patient requires nursing home placement, in the moderate/later stages.
What is the difference between illusions and delusions in AD?
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Illusions are a false perception, like thinking your grandson is your son?triggered by actual external environmental stimuli. Delusions are a fixed, false belief, triggered by internal stimuli.
  
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