Chapter 70: Alzheimer's Disease

Question 1

Key drugs that can worsen dementia

Answer 1

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)

Question 2

The MMSE is a screening tool used for dementia. What score indicates a memory disorder with this tool

Answer 2

< 24

Question 3

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

Answer 3

Centrally-acting anticholinergics

Question 4

Which supplements have possible benefit for Alzheimer’s dementia & what risk is included with them

Answer 4

Vitamin E and gingko biloba

Increase bleeding risk

Question 5

Which medication class is the mainstay of treatment in AD

Answer 5

Acetylcholinesterase inhibitors (e.g., donepezil)

Question 6

Which drug is approved for use alone or with donepezil in moderate-severe AD

Answer 6

Memantine

Question 7

Memantine brand name

Answer 7

Namenda

Question 8

T/F: Memantine and donepezil can prevent AD

Answer 8

False - they can slow the clinical progression of disease

Question 9

Which drug can be used with mild-moderate AD

Answer 9

Acetylcholinesterase inhibitor (donepezil, rivastigmine, galantamine)

Question 10

Which drug(s) can be used with moderate-severe AD

Answer 10

Acetylcholinesterase inhibitor (donepezil, rivastigmine, galantamine) and/or memantine

Question 11

What is the name of the combination of donepezil and memantine

Answer 11

Namzaric

Question 12

Patients stabilized on what dose of donepezil can be switched to Namzaric

Answer 12

10 mg

Question 13

MOA of Acetylcholinesterase inhibitors

Answer 13

inhibit centrally-active Acetylcholinesterase, which is responsible for the hydrolysis of Ach

Question 14

Donepezil brand name

Answer 14

Aricept

Question 15

Rivastigmine brand name

Answer 15

Exelon

Question 16

What time of day is donepezil taken

Answer 16

QHS

Question 17

How often is rivastigmine patch changed

Answer 17

daily

Question 18

Acetylcholinesterase inhibitors warnings

Answer 18

Cardiac effects, including tachycardia

Question 19

Acetylcholinesterase inhibitors side effects

Answer 19

Nausea, diarrhea, insomnia, decreased appetite/weight loss

Question 20

Why is donepezil dosed QHS

Answer 20

to help decrease nausea

Question 21

Which 2 drugs/formulations have less GI side effects

Answer 21

Exelon patch and donepezil ODT

Question 22

Patients using Exelon patch should rotate sites and the same site should be avoided for ____ days

Answer 22

14

Question 23

MOA of memantine

Answer 23

Blocks NMDA receptors, which inhibits glutamate (an excitatory NT) from binding and decreasing abnormal neuron activation

Question 24

Memantine side effects

Answer 24

dizziness, confusion, HA

Question 25

T/F: memantine ER capsule and Namzaric should not be crushed or chewed, but capsules can be opened and sprinkled on applesauce

Answer 25

True

Question 26

Acetylcholinesterase inhibitors drug interactions

Answer 26

• 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

Question 27

Where should Exelon patch be placed

Answer 27

Upper or lower back or upper arm or chest