Acetylcholinesterase inhibitors Flashcards
Example of an Acetylcholinesterase inhibitors
Donepezil
How do Acetylcholinesterase inhibitors work?
Current theories on the pathogenesis of the cognitive signs and symptoms of Alzheimer’s disease attribute some of them to a deficiency of cholinergic neurotransmission.
Donepezil hydrochloride is postulated to exert its therapeutic effect by enhancing cholinergic function. This is accomplished by increasing the concentration of acetylcholine through reversible inhibition of its hydrolysis by acetylcholinesterase. There is no evidence that Donepezil alters the course of the underlying dementing process.
Indications for Acetylcholinesterase inhibitors
Treatment of dementia of the Alzheimer’s type.
Contraindications for Acetylcholinesterase inhibitors
in patients with known hypersensitivity to Donepezil hydrochloride or to piperidine derivatives.
Donepezil hydrochloride, as a cholinesterase inhibitor, is likely to exaggerate succinylcholine-type muscle relaxation during anesthesia.
Side effects of Acetylcholinesterase inhibitors
Anesthesia: Llikely to exaggerate succinylcholine-type muscle relaxation during anesthesia.
Cardiovascular Conditions: Because of their pharmacological action, cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes. This effect may manifest as bradycardia or heart block in patients both with and without known underlying cardiac conduction abnormalities. Syncopal episodes have been reported in association with the use of Donepezil hydrochloride.
Nausea and Vomiting
Peptic Ulcer Disease and GI Bleeding: Through their primary action, cholinesterase inhibitors may be expected to increase gastric acid secretion due to increased cholinergic activity. Therefore, patients should be monitored closely for symptoms of active or occult gastrointestinal bleeding, especially those at increased risk for developing ulcers, e.g., those with a history of ulcer disease or those receiving concurrent nonsteroidal anti-inflammatory drugs (NSAIDs).
Weight Loss
Genitourinary Conditions: cholinomimetics may cause bladder outflow obstruction.
Neurological Conditions: Seizures: Cholinomimetics are believed to have some potential to cause generalized convulsions. However, seizure activity also may be a manifestation of Alzheimer’s disease.
Interactions of Acetylcholinesterase inhibitors
Cholinesterase inhibitors have the potential to interfere with the activity of anticholinergic medications
A synergistic effect may be expected with concomitant administration of succinylcholine, similar neuromuscular blocking agents, or cholinergic agonists as bethanechol
Patient information on Acetylcholinesterase inhibitors
Donepezil hydrochloride should be taken in the evening, just prior to retiring.
Donepezil hydrochloride can be taken with or without food.
Advise the patient to read the FDA-approved patient labeling (Patient Information).
Instruct patients and caregivers to take Donepezil hydrochloride only once per day, as prescribed.
Instruct patients and caregivers that Donepezil hydrochloride can be taken with or without food.
Advise patients and caregivers that Donepezil hydrochloride may cause nausea, diarrhea, insomnia, vomiting, muscle cramps, fatigue, and decreased appetite.
