Alzheimer's and Parkinson's Flashcards
Anticholinesterases include
Rivastigmine (Exelon)
Donepezil (Aricept)
Galantamine (Razadyne)
MOA of anticholinesterases
decrease amount of acetylcholine breaking down in cleft
What drugs should anticholinesterases not be given with?
anticholinergics
ADRs of anticholinesterases
Nausea Insomnia HA Blurred vision Symptomatic bradycardia Syncope
Which anticholinestease is approved for dementia of Alzheimer’s disease AND dementia with Parkinsons?
Rivastigmine (Exelon)
Dose a anticholinesterase for the treatment of mild to moderate, or severe dementia of Alzheime’s type
Donepezil 10mg once a day in the EVENING
Anticholinesterases may be avoided in pts with
cardiovascular disease
peptic ulcer disease
NMDA receptors include
Memantine (Namenda)
When does Namenda dose need to be adjusted?
Renal impairment (<30) no hepatic adjustment required
ADRs of NMDA
ataxia, hypokinesia
emotion agitation, confusion, dizzy, depression, fatigue
constipation
Dose an nmda receptor antagonist
Namenda 10mg one tablet twice a day
How do you pick drug regimen for dementia?
Clinical judgement
- anticholinesterase alone or
- anticholinesterase + memantine (Namenda)
Others often thrown into mix: (BUT THEY DONT DEFINETIVLEY WORK) NSAIDs estrogen tx antioxidant vitamins statins nutraceuticals
Patients with Parkinson’s have decreased levels of
Dopamine
Patients with Alzheimer’s dementia have decreased levels of
Acetylcholine
When should you initiate medical therapy for Parkinsons?
Debatable!
not disease modifying
Disrupt withdrawal of Levodopa can lead to
neuroleptic malignant syndrome (NMS)
Dopamine precursors include
Levodopa/Carbidopa (Sinemet)
ADRs of levodopa
Nausea
Somnolence, dizzy, HA
Elderly- may have confusion, hallucinations, delusions, agitation, psychosis
Possible neurotoxicity?
Dose a dopamine precursor
Levodopa/carbidopa (variable) every 8 hours
Dopamine agonists include
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
MOA of dopamine agonists
direct action at dopamine receptor sites
Are dopamine agonists better than dopamine precursors?
Possibly more s/e
also has withdrawal syndrome
ADRs of dopamine agonists
Postural hypotension hallucinations nausea somnolence worsen dyskinesias induce compulsive behavior (gambling)
Dose a dopamine agonist
Requip XL 12mg two tablet one a day
