Alzheimer disease

Question 1

Enhancement of which neurotransmitter is beneficial in AD?

Answer 1

Acetylcholine.

Question 2

Central acetylcholinesterase inhibitors used in AD - 3 drugs

Answer 2

Donepezil
Rivastigmine
Galantamine

Question 3

Donepezil - adverse effects

Answer 3

Bradycardia

Diarrhea, GI bleeding, nausea vomiting.

Question 4

Rivastigmine, galantamine - adverse effects

Answer 4

Bradycardia and AV block.

Nausea, vomiting, anorexia, weight loss.

Question 5

Rivastigmine - interactions

Answer 5

Nicotine use increases oral clearance.

Question 6

Galantamine - interactions

Answer 6

Inhibitors of CYP2D6 increase serum levels.

Question 7

Drugs used for AD - other than central acetylcholinesterase inhibitors - 4 drugs

Answer 7

Memantine
Caprylidene
Dextromethorphan+quinidine

Question 8

Memantadine - MOA

Answer 8

Antagonist at NMDA receptors. Attenuates the excitotoxic effects of glutamate.

Question 9

Memantadine - adverse effects

Answer 9

Confusion, dizziness, drowsiness, headache, insomnia.

Question 10

Memantadine - interactions

Answer 10

Carbonic anhydrase inhibitors reduce elimination

Question 11

In AD there is a decrease glucose uptake by the brain. Which drug can help, and MOA

Answer 11

Caprylidene.

Metabolized into ketone bodies that the brain can use instead of glucose

Question 12

Caprylidene - indications

Answer 12

Age-associated memory impairment, AD

Question 13

Dextromethorphan + quinidine - why are they combined for neurodegenerative diseases?

Answer 13

Dextromethorphan: Reduces emotional lability.
Quinidine: inhibits CYP2D6 – increases levels of dextromethorphan which is metabolized by CYP2D6

Question 14

Dextromethorphan + quinidine: indications

Answer 14

Emotional lability (psuedobulbar affect) in AD, MS, ALS

Question 15

Dextromethorphan - MOA

Answer 15

Inhibits excitatory glutamate release by agonist action at σ1-receptors and block NMDA receptors