Alzheimer's Dementia Flashcards
Alzheimer’s Dementia Stats
The 6th leading cause of death in the U.S.
Accounts for 60 to 80% of dementia in the elderly
Affects approximately 5.1 million Americans
Direct and indirect costs per year amounts to over $144 billion in the United States
Alzheimer’s dementia is _____ or _________ in nature.
degenerative
progressive
Neuronal degeneration results in reduced levels of
acetylcholine
Cognitive symptoms of Alzheimer’s dementia
Impaired memory, disorientation
Language difficulties, impaired judgment
Non-cognitive symptoms of Alzheimer’s dementia
Agitation
Anxiety
Psychosis
Depression
Goals of pharmacotherapy in Alzheimer’s Dementia
No cure
Delaying tactic only
Azheimer’s dementia drug groupings
Anticholinesterases
NMDA receptor antagonists
Alzheimer’s dementia - mild cognitive impairment
Impairment that doesn’t meet the criteria for dementia
Criteria imprecise
Amnestic MCI
Non-amnestic MCI
Drug therapy for mild cognitive impairment in AD
Drug therapy
None recommended or approved
Cerebral vasodilators a thing of the past
Anticholinesterases
Rivastigmine (Exelon)
Donepezil (Aricept)
Galantamine (Razadyne)
MOA of anticholinesterases
Offset a deficiency
Try to preserve as much acetylcholine as possible.
Indications for Donepezil
Treatment of mild, moderate, or severe dementia of the Alzheimer’s type
Indications for Galantamine
Treatment of mild-to-moderate dementia of Alzheimer’s disease
Dosing for Galantamine
Maintenance: 12 mg twice a day (IR); 24 mg once a day (ER)
Anticholinesterase dosing
Nighttime
reduce impact of GI problems
Avoid or manage anticholinesterases in
pts with CVD
pts with PUD
Anticholinesterases drug interaction with
cholinesterase inhibitor
causes bradycardia, cholinergic effects, lowers seizure threshold.
Anticholinesterases ADRs
Nausea Insomnia Headache Blurred vision Symptomatic bradycardia Syncope
Anticholinesterases Class Drug
Donepezil
Donepezil
Donepezil
10 mg
Once a day in the evening
NMDA Receptor Agonist Class Drug
Memantine (Namenda)
NMDA Receptor Agonist MOA
Binds n-methyl-D-aspartate receptors, may slow calcium influx and nerve damage.
NMDA Receptor Agonist kinetics
Dose reduction for severe renal impairment (below 30 mL/minute)
No hepatic impairment adjustment recommended
ADRs of NMDA Receptor Agonist
Ataxia, hypokinesia
Emotional agitation, confusion, dizziness, depression, fatigue
Constipation
