Acetylcholinesterase Inhibitors Flashcards
For what type of dementia should acetylcholinesterase inhibitors and memantine not be used for?
Do not use acetylcholinesterase inhibitors or memantine for people with frontotemporal dementia.
Describe the short-term effects of acetylcholinesterase inhibitors in Alzheimer dementia.
In the short term, they modestly improve or stabilise cognition, alertness and function.
Describe the variance in efficacy between acetylcholinesterase inhibitors in Alzheimer dementia.
All acetylcholinesterase inhibitors appear to have similar efficacy for Alzheimer dementia.
What is the major consideration when initiating acetylcholinesterase inhibitors for Alzheimer dementia.
Their modest benefits must be weighed against their significant adverse effects
What are 9 significant adverse effects associated with acetylcholinesterase inhibitors.
- Prominent gastrointestinal adverse effects (particularly nausea, vomiting and anorexia)
- Weight loss
- Vivid dreams
- Urinary incontinence
- Tremor
- Cramps
- Bradycardia
- Dizziness
- Drowsiness
Describe the benefit-harm profile of acetylcholinesterase inhibitors.
Due to their adverse effects, the benefit–harm profile of acetylcholinesterase inhibitors varies depending on patient factors.
What are 3 points of monitoring which should be performed before initiating an acetylcholinesterase inhibitor?
Before starting an acetylcholinesterase inhibitor, perform an electrocardiogram (ECG), record the patient’s weight and assess their falls risk.
Are the adverse effects associated with acetylcholinesterase inhibitors dose-related?
Most adverse effects are dose-related
Describe the difference in ease-of-use of the different acetylcholinesterase inhibitors.
Donepezil, galantamine and the rivastigmine transdermal patch are easier to use than oral rivastigmine because they are dosed once daily and the dose can be more easily titrated.
Describe the effectiveness of memantine.
Memantine offers a small, short-term improvement or stabilisation in cognition and function for people with moderate to severe Alzheimer dementia (regardless of whether it is given as monotherapy or in combination with an acetylcholinesterase inhibitor).
If the response to an acetylcholinesterase inhibitor is inadequate in a patient with moderate to severe Alzheimer dementia, what can be done?
Consider adding memantine.
Besides adding memantine, what should be done if the response to an acetylcholinesterase inhibitor is inadequate for a patient with moderate to severe Alzheimer dementia?
Also consider whether the acetylcholinesterase inhibitor should be continued
If memantine is considered appropriate to treat cognitive impairment in a patient with moderate to severe Alzheimer dementia (eg a patient who cannot take an acetylcholinesterase inhibitor), what is the standard dose?
Memantine 5 mg orally, daily for 1 week. Increase the dose by 5 mg each week to a maximum of 20 mg.
Describe the effectiveness of acetylcholinesterase inhibitors in the treatment of dementia with Lewy bodies
The acetylcholinesterase inhibitors, donepezil and rivastigmine, modestly improve or stabilise cognition, alertness and function, and reduce hallucination frequency.
Describe the routine monitoring for adverse effects when starting an acetylcholinesterase inhibitor or memantine for dementia
Assess the patient for adverse drug effects and adjust the dose or treatment accordingly within 1 month of starting treatment, then again within 6 months (usually after 2 to 3 months of therapy at the maximum tolerated dose), and thereafter every 6 months.
How long should drug therapy for dementia be continued?
If the patient tolerates and appears to benefit from an acetylcholinesterase inhibitor or memantine, continue it for as long as quality of life is maintained—that is, until the patient has end-stage dementia (i.e. lost independent mobility, can no longer swallow) and therapy is no longer achieving their goals and preferences.
