B1. Alzheimer’s and other dementias (Pharmacological treatment) PART IV

Question 1

What drugs are used to treat the symptoms of AD ?

Answer 1

• Cholinesterase inhibitors by augmenting the cholinergic pathways
• NMDA receptor antagonist
• Management of behavioural and psychological symptoms using non pharmacological and pharmacological treatment
• Palliative care at end stage disease

Question 2

What are the goals of treatment of AChEIs ?

Answer 2

Enhancing quality of life and maximising functional performance by improving cognition, mood and behaviour

Question 3

True or false.

There is a loss of ACh activity in patients with AD which correlates to severe AD?

Answer 3

True

Question 4

How does AChEIs work?

Answer 4

This drug inhibits the acetylcholinesterase activity by inhibiting the breakdown of ACh into choline and acetate which there by increases ACh within the synaptic cleft and increases the availability of ACh for post synaptic and presynaptic nicotinic and muscarinic ACh receptor s

This increases the likelihood of neurotransmittion occurring which then increases memory function

Question 5

Give examples of UK licences ACHEIs ?

Answer 5

Donepezil
Rivastigmine
Galantamine

Question 6

Why are the drugs ACHEI only effective in patient with mild to moderate AD disease ?

Answer 6

In patients with more advanced AD they may not have intact neurones or destroyed that produce ACh , therefore an increase in ACh will not lead to any benefits

Question 7

True or false ACHEI only works on a symptomatic manor?

Answer 7

True

Question 8

What are the side effects of the use of anti-cholinergic drugs in dementia patients ? How can these drugs make dementia worse ?

Answer 8

palpitations, memory impairment, dizziness, drowsiness, blurred vision,
increased heart rate, confusion, hyperthermia, delirium, constipation, sedation, increased number of falls (due to hypotension), dry mouth, dry lips, dry eyes and urinary retentioN

Can block action of ACh at the receptor site. These drugs should be minimised in patients with dementia

Question 9

Give an example of an NMDA receptor antagonist ?

Answer 9

Memantine which is licences in the UK

Question 10

How does memantine work?

Answer 10

Patients with AD have an increased amount of glutamate

The excess binding of glutamate the NMDA receptor leads to an increase in cl- (chronic exposure of cl-) leading to the cell degradation.

This causes neuronal death leading to AD

Memantine blocks the NMDA receptor causing glutamate to not have access to the receptor, reducing the likelihood of the above pathway from occurring

Reduces cognitive deterioration in patients with AD

Question 11

When is memantine recommended ?

Answer 11

Moderate AD who are intolerant or contraindicated to AChEi or severe Alzheimer’s disease

Question 12

What are the common side effects

Answer 12

Hallucination 
Confusion 
Dizziness 
Headache 
Tiredness 
But most people do not suffer from side effects

Question 13

What are the common causes of BPSD?

Answer 13

Patient
Care giver
Environment

Question 14

What are the non-pharmacological treatment of BPSD ?

Answer 14

Educate care giver

Investigate and treat any associated problems

Environmental interventions

Behavioural interventions

Optimise and review current medication

Add new medication sparingly

Question 15

What pharmacological management can be used in BPSD ?

Answer 15

Anti-depressant 
Hypnotic 
Paracetamol 
AChEi
Antipsychotics

Question 16

What would a care plan have ?

Answer 16

Biological intervention
Psychotherapeutic intervention
Social interventions
Family interventions