Alz meds

Question 1

Donepezil dosing

Answer 1

start 5 QD (this is min therapeutic dose)
after 4 weeks can increase to 10 QD
max= 10 QD

Question 2

Galantamine dosing

Answer 2

8 QD
after 4 weeks increase to 16 QD (min dose)
after 4 weeks can increase to 24 QD
Max= 24 QD

Question 3

Rivastigmine dosing

Answer 3

1.5 BID with food
after 2 weeks increase to  3 BID
after 2 weeks increase to  4.5 BID
Max 6 BID
need to restart titration if missed doses for several days

Question 4

Memantine dosing

Answer 4

5 QD
Increase Q week by 5
Max 10 BID

Question 5

ACE-I contraindications, precautions

Answer 5

:

known hypersensitivity to drug (or piperidine for donepezil)
conduction ab (except Rt BBB)
Unexplained syncope
Severe hepatic impairement (galantamine, rivastigmine)
severe renal impairement (galantamine)

Precautions: 
wt loss
ulcers, GIB
SZ
Asthma and COPD
succynyl choline ms relaxants

Question 6

ACE-I side effects

Answer 6

Nausea (worst with Riva, take W food)
vomitting
diarrhoea
headache
insomnia(D)
pain (D)
dizziness(G)

Question 7

Memantine # and precautions

Answer 7

#:
hypersensitivity
caution:
CVD
Sz
Renal tubular acidosis and increase urine PH decreases excretion
opthalmic conditions
do not combine wwith ketamine, amantadine, dextromethorphan

Question 8

Memantine SE

Answer 8

dizziness
headache
HTN
confusion
constipation

Question 9

CEI used for?

Answer 9

Alz
mixed Alz+vascular
PDD
no evidence for pure vascular (though older sources say OK)
no evidence in FTD
no evidence for BPSD in Alz
1st line for BPSD in LBD

Question 10

BSPD meds

Answer 10

Conssnsus GL update 2012:
severe aggression: AA (OAR) regular
intermittent aggression : Ativan PRN
depression or labilty: SSRI, trazodone

? ACEI and memantine

Not valproate

CCSMH 2006:
Cholinesterase inhibitors and memantine may delay
the emergence of behavioral symptoms associated
with dementia. Preliminary evidence suggests that
these medications may also play a role in the
treatment of behavioural symptoms, especially in
Lewy Body Dementia and in residents with psychosis
associated with Parkinson’s disease. More clinical
trials are needed.

Question 11

worst SE with donepezil

Answer 11

one source says insomnia 18%
nausea: 11%
diarrhea 10% and headache 10%