Alzheimer's Disease Flashcards
What drugs are Acetylcholinesterase Inhibitors?
- donepezil
- rivastigmine
- galantamine
What is the indication of Acetycholinesterase Inhibitor?
- donepezil= mild-severe dementia
- rivastigmine= mild-moderate disease, parkinson’s disease dementia, lewy body dementia
- galantamine= mild-moderate disease
What Acetylcholinesterase Inhibitor has a patch formulation?
rivastigmine
and may be used for mild-severe dementia
What are the adverse effects of acetylcholinesterase inhibitor?
- cholinergic SE (nausea, vomiting, diarhea, weightloss, exacerbate GI bleed)
- myalgia/muscle cramps
- decreased HR
- dizziness
- sleep changes
- longe term treatment is associated with bradycardia and syncope
What is the indication of Memantine?
moderate-severe disease
What drug may mitigate acetylcholinesterase inhibitor SE?
memantine
What are the adverse effects of memantine?
- confusion
- headache
What is the indication of amyloid beta-directed monoclonal antibodies?
early alzheimer’s disease/mild dementia
What are the contraindications of amyloid beta-directed monoclonal antibodies?
uncontrolled seizures
What are the types of amyloid-related imaging abnormalities (ARIA)?
- ARIA-E= edema, cerebral
- ARIA-H= hemosiderin deposition (microhemorrhages, superficial siderosis)
What are the potential S/S of amyloid-related imaging abnormalities?
- headache
- confusion
- visual changes
- dizziness
- nausea
- gait difficulties
When would suspending dosing of amyloid beta-directed monoclonal antibodies?
- moderate to severe ARIA OR
- symptomatic ARIA-H
- intracerebral hemorrhage > 1 cm
What drug class to treat alzheimer’s disease requires MRI at baseline?
amyloid beta-directed monoclonal antibodies (abucanumab, lecanemab, and donanemab)
What drugs are amyloid beta-directed monoclonal antibodies?
- aducanumab
- lecanemab
- donanemab
What drug can be considered to be stopped once plaque levels on PET are reduced?
donanemab
When should treatment be initiated according to guidelines?
at the time of diagnosis, but complete benefit, risk, and expectations should be discussed extensively with family
What drug may be continued despite no improvement due to withdrawal risk?
donepezil
When may drug therapy change be considered?
intolerable SE or no benefit (MMSE drop > 2-4 points after 1 year of treatment)
50-70% of pt who don’t respond to donepezil respond to rivastigmine
What are the ways that treatment benefit can be measured?
- improvement in memory as observed by the caregiver
- improvement or maintenance in ADLs
- improvement in behavior disturbances
- stable MMSEs (decline of less than 2 points/year)
- reduction in the rate of cognitive, physical, social decline
What drug has an FDA approved indication for agitation management in dementia?
brexpiprazole
What antidepressants may be used in dementia patients?
citalopram or sertraline
