Alzheimers

Question 1

Name 2 drug classes and examples that have good evidence in treating Alzheimer’s

Answer 1

Cholinesterase inhibitors
• donepezil
• galantimine
• rivastigmine

N-methyl - d-aspartate NMDA antagonists
• memantine

Can use both together until the end.

Question 2

Moa cholinesterase inhibitors?

Answer 2

Prevent (delay) breakdown ach within synaptic cleft

Enhance endogenous cholinergic activity within CNS and peripheral tissues

Question 3

Name 3 cholinesterase inhibitors

Answer 3

• Donepezil!
. Rivastigmine
• Galantamine

Question 4

Indication cholinesterase inhibitors?

Answer 4

Eg donepezil

Mild to moderate dementia in Alzheimer’s

Question 5

Name 5 adverse effects cholinesterase inhibitors

Answer 5

• Nausea
• vomiting
• diarrhoea
• anorexia
• agitation

Question 6

Name NMDA antagonist for treatment Alzheimer’s

Answer 6

Memantine

Question 7

Indications memantine (2)

Answer 7

• Second line treatment Alzheimer’s

* first line severe Alzheimer’s

Question 8

Name 5 adverse effects memantine

Answer 8

• Headache
• dizzy
• drowsy
• hallucinations
• confusions
• vomiting
• HYPERtonia

Question 9

Name 6 drug interactions with memantine

Answer 9

• Other NMDA antagonists (ketamine, amantadine): CNS toxicity, increased severity other adverse effects
• anticholinergics, levodopa, dopaminergics: enhanced effects
• barbiturates, antipsychotics: reduced effects
• agents that raise urine ph ( carbonic anhydrase inhibitors, sodium bicarb): reduce renal elimination memantine, possible accumulation
• drugs that undergo renal cationic tubular secretion ie compete for secretion (cimetidine, nicotine, ranitidine, quinidine): altered plasma levels of drugs
• Hydrochlorothiazide’s reduced effect

Question 10

Which neurotransmitters are implicated in Alzheimer’s? (a)

Answer 10

• Ach (decrease)

. Glutamate (increase)

Question 11

Memantine decrease effects of which 2 drugs?

Answer 11

Barbiturates and antipsychotics