Chapter 70: Alzheimer's Disease Flashcards
Key drugs that can worsen dementia
Antiemetics
Antihistamines
Antipsychotics
Barbiturates
Central anticholinergics (e.g., benztropine)
Peripheral anticholinergics (including incontinence and IBS drugs)
Skeletal muscle relaxants
Other CNS depressants (opioids, sedative hypnotics)
The MMSE is a screening tool used for dementia. What score indicates a memory disorder with this tool
< 24
Which class of drugs should be avoided in the elderly according to the BEERS criteria since it can cause acute cognitive impairment and occasionally psychosis and hallucinations
Centrally-acting anticholinergics
Which supplements have possible benefit for Alzheimer’s dementia & what risk is included with them
Vitamin E and gingko biloba
Increase bleeding risk
Which medication class is the mainstay of treatment in AD
Acetylcholinesterase inhibitors (e.g., donepezil)
Which drug is approved for use alone or with donepezil in moderate-severe AD
Memantine
Memantine brand name
Namenda
T/F: Memantine and donepezil can prevent AD
False - they can slow the clinical progression of disease
Which drug can be used with mild-moderate AD
Acetylcholinesterase inhibitor (donepezil, rivastigmine, galantamine)
Which drug(s) can be used with moderate-severe AD
Acetylcholinesterase inhibitor (donepezil, rivastigmine, galantamine) and/or memantine
What is the name of the combination of donepezil and memantine
Namzaric
Patients stabilized on what dose of donepezil can be switched to Namzaric
10 mg
MOA of Acetylcholinesterase inhibitors
inhibit centrally-active Acetylcholinesterase, which is responsible for the hydrolysis of Ach
Donepezil brand name
Aricept
Rivastigmine brand name
Exelon
What time of day is donepezil taken
QHS
How often is rivastigmine patch changed
daily
Acetylcholinesterase inhibitors warnings
Cardiac effects, including tachycardia
Acetylcholinesterase inhibitors side effects
Nausea, diarrhea, insomnia, decreased appetite/weight loss
Why is donepezil dosed QHS
to help decrease nausea
Which 2 drugs/formulations have less GI side effects
Exelon patch and donepezil ODT
Patients using Exelon patch should rotate sites and the same site should be avoided for ____ days
14
MOA of memantine
Blocks NMDA receptors, which inhibits glutamate (an excitatory NT) from binding and decreasing abnormal neuron activation
Memantine side effects
dizziness, confusion, HA
T/F: memantine ER capsule and Namzaric should not be crushed or chewed, but capsules can be opened and sprinkled on applesauce
True
Acetylcholinesterase inhibitors drug interactions
- Caution with other drugs that can lower HR (e.g., BB, diltiazem, verapamil, digoxin) & with drugs that can cause dizziness (e.g., antipsychotics, alpha-blockers, skeletal muscle relaxants, hypnotics, opioids)
- Drugs that have anticholinergic effects can reduce the efficacy of Acetylcholinesterase inhibitors. D/c incontinence drugs if there is no benefit
- Use cautiously with NSAIDs d/t risk of GI bleed
Where should Exelon patch be placed
Upper or lower back or upper arm or chest
