\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{Bailey\_Rickett}
\pdfinfo{
  /Title (pharmacology-of-alzheimer-s-disease.pdf)
  /Creator (Cheatography)
  /Author (Bailey\_Rickett)
  /Subject (Pharmacology of Alzheimer's Disease Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{8CDE91}
\definecolor{LightBackground}{HTML}{F0FAF1}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pharmacology of Alzheimer's Disease Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Bailey\_Rickett} via \textcolor{DarkBackground}{\uline{cheatography.com/184326/cs/38661/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Bailey\_Rickett \\
  \uline{cheatography.com/bailey-rickett} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 12th May, 2023.\\
   Updated 12th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Dementia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Dementia occurs in a cluster of diseases (mental decline)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{It is a prominent part of Alzheimer's disease.} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Symptoms: forgetfullness, memory loss, reduced reasoning, trouble paying attention, impaired judgement and problem solving, visual perception issues that aren't related to normal age-related changes, changes in personality and behavior, any other changes that interfere with a person's normal daily functions.} \tn 
% Row Count 10 (+ 7)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Dementia gets progressively worse.} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pathphysiology of Alzheimer's Disease}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1683861095_IMG_2231.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Medications to Treat Dementia Behaviors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Antidepressants} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Antipsychotics} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Benzodiazepines} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Buspirone} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\seqsplit{Dextromethorphan/Quinidine}} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Image Explained}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{There is an enlarged left ventricle, a thinner cortex, an atrophied hippocampus, and atrophy all over.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{The hippocampus is responsible for spacial and recent memory. This is where Alzheimer's starts.} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Cholinesterase Inhibitors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: Prevents the breakdown of ACh, leading to increased ACh and increase in cholinergic activity in the CNS.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: better for mild cognitive impairment, you must have cholinergic neurons left. {\bf{NO disease modifying effects seen}}} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: {\bf{mainly GI related}} (N/V/D/Anorexia, advise taking with food to help), could cause bradycardia (risk of syncope, increased fall risk)} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: Pregnancy, liver disease, peptic ulcer} \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: should be tapered off, otherwise can cause discontinuation syndrome: difficulty concentrating, altered consciousness, delirium, hallucinations, insomnia, agitation, anxiety, labile mood} \tn 
% Row Count 16 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Rule of Thirds: 1/3 of patients will improve on these, 1/3 of patients will stabilize (slow progression temporarily), 1/3 of patients will experience no improvement.} \tn 
% Row Count 20 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Donepezil (Aricept)}}: Oral tablet (Aricept), ODT (Aricept RDT), patch (Adlarity), ER caps combo with memantime for more severe cases (Namzaric). Well tolerated and is NOT hepatotoxic T1/2 \textasciitilde{}70 hours. Also approved for severe cognitive impairment. Has less GI effects compared to other agents (Rivastigmine)} \tn 
% Row Count 27 (+ 7)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Galantamine}} (Razadyne): Tablet (Razadyne), ER capsule (Razadyne ER), oral soultion} \tn 
% Row Count 29 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Rivastigmine (Exelon)}}: Capsule (Exelon) patch} \tn 
% Row Count 30 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Lewy Body vs Alzheimer's}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1683864945_IMG_2232.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Benzodiazepines}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Used only for severe anxiety.} \tn 
% Row Count 1 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Buspirone}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: antagonist of 5HT1A receptor} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: used for anxiety and mild/moderate agitation} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Anxiolytic drug.} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Well tolerated.} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Limited data in dementia patients.} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Has addictive potential.} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Five Pathological Types of Dementia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Alzheimer's disease- the most common cause of dementia} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Vascular dementia- this type of dementia is caused by damage to the vessels that supply blood to you brain. Is caused by atherosclerosis in the carotid arteries, and other arteries serving the brain.} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lewy body dementia- on its own or in Parkinson's dementia} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Frontotemporal dementia- atrophy of neurons that die off in the frontotemporal region.} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Mixed dementia.} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pathophysiology of Alzheimer's Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{It is a progressive memory impairment, dementia, and cognitive dysfunction.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{It occurs in up to 20\% of patients over 85 (5th leading cause of death 65+)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{It is a progressive loss of neurons, especially cholinergic neurons.} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{There is also an inflammatory process.} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{There is increased amyloid beta peptide deposits in the cerebral cortex (they are insoluble so they stick together) this leads to plaque formation, lesion, and neuronal fibrillary tangles (Tau proteins)} \tn 
% Row Count 12 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{The alpha and beta tubulin dimers are wrapped around in a spiral to hold the microtubule together. Normally the tau protein holds microtubules together. But the {\bf{hyperphosphorylation}} of tau causes a disassociation of the microtubules, forming a "clump" that tangles.} \tn 
% Row Count 18 (+ 6)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Mitochondrial dysfunction.} \tn 
% Row Count 19 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Increased glutamate}} activity may also play a role (NMDA receptor)} \tn 
% Row Count 21 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{The bottom line is there is an {\bf{increase}} in amyloid beta and a {\bf{decrease}} in amyloid beta breakdown.} \tn 
% Row Count 24 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{This typically starts out in the hippocampus, it spreads out from there.} \tn 
% Row Count 26 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Found in 20\% of patients over 85.} \tn 
% Row Count 27 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Alzheimer's Pharmacology}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Cholinomimetic drugs are a main focus of Alzheimer's therapy because there is evidence of loss of cholinergic neurons in this disease.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Decreasing glutamate is another focus of therapy due to excess glutamate excitation being present in this disease.} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{NMDA Receptor Blockers}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Drug: Memantine {\bf{(Namenda)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA: by blocking NMDA receptor, decreases the activity of glutamate} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Place in Therapy: used in patients with more moderate cognitive impairment} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Formulation: comes in a titration pak until goal dose achieved} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: overall well tolerated, more common ADRs are dizziness, confusion, HA, constipation.} \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: Gastric ulcers, lung disease, heart disease, kidney disease.} \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: Patients should taper off of memantine, Abrupt discontinuation could lead to withdrawal effects like insomnia, aggression, delusions, and disinhibition. Treatment should be stopped after 6 months if no improvement is seen.} \tn 
% Row Count 16 (+ 5)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Other notes: has a long half life 60-80 hours, 100\% absorbed orally. {\bf{Memantine in combination therapy with a cholinesterase inhibitor is recommended in moderate to severe disease (efficacy not shown in mild disease) }}Memantine comes in combo with Donepezil (Namzaric)**} \tn 
% Row Count 22 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Antidepressants}}  \tn
% Row 0
\SetRowColor{LightBackground}
Agitation: & {\bf{Citalopram (has the most data)}}, escitalopram, sertraline, mirtazapine, trazodone \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
Depressions: & citalopram, sertraline \tn 
% Row Count 5 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Psychosis: & citalopram \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
Insomnia/Sleep problems: & trazodone \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Anxiety: & trazodone *antidepressants haven't been studied for anxiety in dementia \tn 
% Row Count 11 (+ 3)
% Row 5
\SetRowColor{white}
Neuropathy: & Duloxetine, desvenlafaxine \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Notes: & \seqsplit{citalopram/escitalopram:} QT prolongation, limit dosing \tn 
% Row Count 16 (+ 3)
% Row 7
\SetRowColor{white}
 & trazodone: sedation and orthostatic hypotension risk \tn 
% Row Count 19 (+ 3)
% Row 8
\SetRowColor{LightBackground}
 & Avoid TCA due to anticholinergic effects (already low on ACh) \tn 
% Row Count 22 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{\seqsplit{Dextromethorphan/Quinidine}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: blocks the NMDA receptor, reduces agitation, reduced excitotoxicity in cholinergic nerves, inhibits the breakdown of dextro} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: Used for agitation in Alzheimer's disease, FDA approved for pseudobulbar effects (uncontrolled laughing/crying due to neurological condition)} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: oral every expensive} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Characteristics of Alzheimer's Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Memory Decline} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{They start having: learning problems, trouble with problem solving, poor judgement making, trouble communicating, depression and mood swings} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Sundowners syndrome- in the later afternoon/early evening they experience additional confusion, irritablity, agitation, prancing, and wandering.} \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Finally there is a loss of self care.} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Parkinson's Disease with Lewy Body}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lewy body dementia are dementia with Lewy bodies and Parkinson's disease dementia.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lewy bodies are made up of brain proteins that are misfolded and forms aggregates. The protein aggregates causes cell death.} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{This type of dementia is the 3rd most common type of dementia.} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Quetiapine and Clozapine are used off-label. Can also use Achase inhibitors.} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{It is important to determine Lewy body vs. Alzheimer's because the pharmacotherapy is different.} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lewy Body vs. Alzheimer's: lewy body has reduces DA uptake vs Alzheimer's. Lewy body has less temporal lobe atrophy it can be confirmed on MRI. Lewy body has less occipital lobe glucose metabolism per PET scan. (this may be the reason for increased visual hallucinations in Lewy body because of occipital lobe hypometabolism)} \tn 
% Row Count 18 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Alzheimer's Disease and Acetylcholine}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Acetylcholine (ACh) is released by neurons in the CNS.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{It is involved in memory, motivation, arousal, and attention.} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{ACh is broken down by acetylcholinesterase.} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{ In Alzheimer's disease, there is a decreased synthesis of ACh, which leads to impaired cholinergic function. }}} \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{It begins in the hippocampus and spreads out to all areas of the cerebrum.} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{1/3 of cases are inherited.} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monoclonal Antibody: Amyloid Beta}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1683907487_IMG_2233.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monoclonal Antibody: Amyloid Beta}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Aducanumab}} (Aduhelm)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA: a monoclonal antibody against amyloid beta plaque} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Place in therapy: FDA approved for MILD cognitive impairment, approved with the accelerated approval pathway (saw a plaque reduction but plaque reduction hasn't been associated with clinical improvements) cost is high, efficacy data is lacking, insurance doesn't like to cover it.} \tn 
% Row Count 9 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Formulation: given as a 1 hour infusion every 4 weeks} \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: edema, cerebral microhemorrhage -\textgreater{} patients must have MRI at start and continually to monitor any changes.} \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: \$56,000, serious side effects, benefits unknown. Has been shown to reduce plaques.} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Antipsychotics}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Psychosis: delusions, hallucinations, and paranoia} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Only used in patients with severe agitation or psychosis that are distressing to the patients or makes them act in a way that they are dangerous to themselves or others. This is a last resort.} \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{They are not to be used as a chemical restraint}}} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{There are not a lot of benefit seen in these drugs in the populations, LOTS of side effects. Most evidence with aripiprazole, olanzapine, risperidone. Haloperidol is reserved for emergency use.} \tn 
% Row Count 11 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Caution: CV events, metabolic effects of antipsychotics (weight gain, DM, dyslipidemia), {\bf{sedation}}, QT prolongation} \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Labeled waring for antipsychotic use in patients with dementia- increased risk of death and cerebrovascular events} \tn 
% Row Count 17 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Cognitive impairment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Cholinesterase inhibitors will help attention, executive function (emotions, memory, impulse control, tasks, organization) and visuospatial deficits (spatial judgement, visual analysis)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Donepezil or Rivastigmine recommended as first line options.} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Memantine NOT shown to work in this population.} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Psychosis/Behavioral Symptoms}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cholinesterase Inhibitors}} are shown to help with behavioral symptoms, there is limited evidence that they help with hallucinations and delusions. They can help with negative symptoms (things missing from personality-emotion, speech, motivation, and anhedonia)} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Last line}}: antipsychotics- unlikely effective and may worsen motor symptoms} \tn 
% Row Count 8 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Quetiapine or Clozapine may be tried at low doses, doesn't affect motor symptoms} \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Nuplazid (pimavanserin)}}: FDA approved for hallucinations/delusions associated with Parkinson's disease (positive diseases)} \tn 
% Row Count 13 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Positive symptoms are things that are there: hallucinations, delusions} \tn 
% Row Count 15 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{It blocks the 5HT2A and C receptors, NOT DA receptors so less effects on motor symptoms. High risk of side effects or death (almost 10\%). QT prolongation. Also helps with anxiety.} \tn 
% Row Count 19 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}