1. Dementia and Parkinson’s ADHD
Tutoring 11/1/17
Dementia and Parkinson’s
ADHD

2. PSA Always defer to your notes if something is confusing
Ask for help early!
I didn’t have these slides/professors, so I’m making my best guess 

3. Dementia and Parkinson’s

4. What are the 3 types of dementia?
A. Alzheimer's
B. Parkinson’s
C. Lewy Body
D. Vascular

5. How does a brain look different in Alzheimer’s than a normal brain?
A. Increased neuron signaling
B. Increased number of neurons
C. Plaques
D. Tangles
C,D

6. What are the symptoms of Alzheimer’s Disease (AD)?
A. Memory loss
B. Wandering
C. Paranoia, agitation, hallucinations
D. Poor coordination
E. Difficulty planning/organizing
F. All of the above

7. What other tests should you do in an AD patient?
A. Screen for infection
B. B12 levels
C. Vitamin E level
D. Vitamin A level
B,C

8. What drug could worsen dementia?
A. Lisinopril
B. Adderall
C. Benztropine
D. Citalopram C

9. Which medication is an NMDA antagonist?
A. Memantine
B. Donepezil
C. Rivastigmine
D. Galamantine A

10. Which medication had high protein binding?
A. Memantine
B. Donepezil
C. Rivastigmine
D. Galamantine B

11. Which medication is renally eliminated?
A. Memantine
B. Donepezil
C. Rivastigmine
D. Galamantine C

12. Which medication comes in a patch?
A. Memantine
B. Donepezil
C. Rivastigmine
D. Galamantine C

13. Which drug can cause insomnia?
A. Memantine
B. Donepezil
C. Rivastigmine
D. Galamantine B

14. A. Propranolol--donepezil B. Xarelto—donepezil C. Aspirin—donepezil
PM is discharged from the hospital on these medications: propranolol, xarelto (rivaroxaban), aspirin, and lisinopril in addition to home medications of metformin and donepezil. What DDI are you concerned about?
A. Propranolol--donepezil
B. Xarelto—donepezil
C. Aspirin—donepezil
D. Lisinopril—donepezil
A- lowers heart rate

15. Which neurotransmitter is lacking in Parkinson’s disease?
A. Norepi
B. Serotonin
C. Acetylcholine
D. Dopamine D

16. Which drug inhibits dopamine breakdown?
A. Levodopa
B. Carbidopa
C. Pramiprexole
D. Selegiline B

17. Which drug for Parkinson’s has the longest half life?
A. Carbidopa/levodopa
B. Ropinirole
C. Benztropine C

18. Which drug is associated with dyskinesias?
A. Carbidopa/levodopa
B. Ropinirole
C. Benztropine A

19. Which drug comes as an oral solution?
A. Carbidopa/levodopa
B. Ropinirole
C. Benztropine A

20. Which drug comes as an injection?
A. Carbidopa/levodopa
B. Ropinirole
C. Benztropine C

21. Which drug would you be concerned about interacting with warfarin?
A. Carbidopa/levodopa
B. Ropinirole
C. Benztropine B

22. ADHD

23. ADHD is often related to other diseases?
True
False T

24. What are the 3 major features of ADHD?
A. Inattention
B. Impulsivity
C. Depression
D. Anxiety
E. Hyperactivity
A,B,E

25. ADHD is more common in adults
True
False F

26. What is NOT a risk factor/cause for ADHD?
A. Lead exposure
B. Alcohol in pregnancy
C. Low birth weight
D. Lack of sleep D

27. In children up to age 16, how many symptoms of inattention or hyperactivity/impulsivity have to be present for diagnosis?
A. >/= 4
B. >/= 5
C. >/= 6
D. >/= 7 C

28. What about for 17 years or older?
C. >/= 6
D. >/= 7 B

29. In addition to inattention and hyperactivity/impulsivity criteria, what else has to be met to be diagnosed?
A. Several inattentive or hyperactive-impulsive symptoms were present before age 12
B. Several symptoms are present in two or more settings
C. There is clear evidence that the symptoms interfere with, or reduce quality of, social, school, or work functioning
D. Symptoms are not better explained by another mental disorder
E. All of the above

30. What is the first line therapy for ADHD in a 3-5 year old?
A. Behavioral therapy
B. Adderall
C. Group therapy
D. No therapy A

31. What receptors do stimulants work on?
A. Norepi
B. Serotonin
C. Acetylcholine
D. Dopamine
B,D

32. What schedule drugs are amphetamines and methylphenidate?
A. I
B. II
C. III
D. IV B

33. What is not a side effect of stimulants?
A. Insomnia
B. Decreased appetite
C. Headache
D. Jitters
E. Rash E

34. B. D/C medication and start behavior therapy
RJ is a 15 y.o. white male and had been on adderall 10 mg qday for 7 days. His mother reports he is not getting any better focus at home or in class. You suggest:
A. D/C medication
B. D/C medication and start behavior therapy
C. D/C adderall and start bupropion
D. Increase adderall dose to 20 mg qday D
B is an option but you won’t get immediate symptom relief with therapy
C might be an option but probably not first line if he’s only been on adderall for a week

35. A. tomorrow B. 2-3 days C. 1 week D. 2 weeks
DT was started on atomoxetine today as adjunctive therapy to her adderall. She wants to know how long it will take to see an effect since the adderall only took a couple days. You say:
A. tomorrow
B. 2-3 days
C. 1 week
D. 2 weeks D

36. What unusual side effects could DT experience on atomoxetine?
A. Orthostasis
B. Insomnia
C. Sedation
D. Headache A
Also liver dysfx so be careful in liver disease

37. How many times daily would you dose Kapvay?1 2 3 1

38. A. Continue adderall qday B. D/C adderall and switch to Vyvanse
SS has been on adderall XR 20 mg qday for over a year and her doctor has no plans to stop medication. She presents today because she has noticed less symptomatic control within the last couple weeks with no other changes in her daily life. What should you consider today?
A. Continue adderall qday
B. D/C adderall and switch to Vyvanse
C. Increase adderall to 40 mg qday
D. Plan in drug holidays to her dosing plan D
B and C are options however they will all lose effectiveness if patient is taking them every single day

39. Questions/Comments/Concerns???
Dylan Knox

40. Question- Sinemet t1/2 Ropinirole- elim t1/2- 6 hours
Benztropine- no elim t1/2 listed??? Time to peak is 7 hours.
Levo/carb- levodopa elim t1/2 in presence of carbidopa is 1.5 hours. “May be prolonged with controlled and extended release formulations to do continuous absorption” per Lexicomp....
Not that helpful??? I would defer to the chart on your slide that says that levo/carb is “very short”