Cholinesterase inhibitors and Beta-Adrenergic Antagonists

Question 1

cholinesterase inhibitors indications

Answer 1

alzheimer’s disease

Question 2

Cholinesterase inhibitors

Answer 2

Donepezil (Atricept)
and Rivastigmine (Exelol)

Question 3

Donepezil (Atricept)
and Rivastigmine (Exelol)
pharmacodynamics

Answer 3

reversibly and non-competitively inhibiting centrally active acetylcholinesterase which results in increased levels of acetylcholine available for synaptic transmission in the CNS.

Question 4

Donepezil (Atricept)
and Rivastigmine (Exelol) ADRs

Answer 4

dizziness, headache, agitation, falls, weight loss, insomnia, tremor, to name some.

They can exacerbate extra pyramidal side effects if this patient also has Parkinson’s which unfortunately can happen. If a patient takes too much of these pills, they forget.

donazepil: prolonged QT interval
toxicity: constricted pupils, excessive salvation, diarrhea

Question 5

Donepezil (Atricept)
and Rivastigmine (Exelol)
caution and contraindications

Answer 5

renal and hepatic impairement,
caution with seizure disorders,
avoid in combination with anticholinergic drugs.

Question 6

NMDA receptor antagonist

Answer 6

memantine (namenda)

Question 7

memantine (namenda) pharmacodynamics

Answer 7

It has low to moderate non-competitive antagonists at NMDA receptors. And persistent stimulation of an NMDA receptors by glutamate is thought to possibly contribute to the symptomatology of Alzheimer’s disease.

Question 8

memantine (namenda) ADRs

Answer 8

confusion, dizziness, constipation, headache, somnolence, hypertension, diarrhea, hypersensitivty reaction

Question 9

memantine (namenda) caution and contraindications

Answer 9

cardiovascular disease,
renal impairment,
seizure disorder

Question 10

beta blockers

Answer 10

metoprolol, atenolol

atenolol has longer half life

Question 11

beta blocker (metoprolol) indications

Answer 11

heart failure, HTN, afib, angina, post acute MI

Question 12

metoprolol, atenolol pharmacodynamics

Answer 12

They block beta 1 receptors at the SA node to decrease heart rate, decrease contractility in the atria and ventricles and conduction velocity and slow conduction at the AV node.

Question 13

what happens with abrupt withdrawal of beta blockers

Answer 13

rebound HTN, tachyardia, MI

Question 14

metoprolol, atenolol caution and contraindications

Answer 14

hx of bronchospasm,
2nd or 3rd degree hear block,
peripheral vascular disease,
diabetes (can mask s/s of hypoglycemia),
hyperlipidemia (decreases HDL and increases triglycerides,
cation in elderly,
use other agents (labetalol) in pregnancy.
BB contraindicated in first trimester.

Question 15

metoprolol, atenolol ADRs

Answer 15

hypertension, bradycardia, dizziness, fatigue, depression can occur, impotence can occur, decreased libido, and rarely anaphylactic reactions.

Question 16

non selective beta blocker

Answer 16

propranalol (inderal)

Question 17

propranalol (inderal) indications

Answer 17

Afib, tremor, migrane prohylaxis, HTN, stable angina, thryoid storm

Question 18

propranalol (inderal) pharmacodynamics

Answer 18

competitively blocks response to beta 1 and beta 2 stimulation, which results in decreased heart rate, myocardial contractility, blood pressure, and myocardial oxygen demand.

Question 19

propranalol (inderal) pt education

Answer 19

do not stop abruptly

Question 20

propranalol (inderal) caution and contraindications

Answer 20

avoid in bronchospasm, 
avoid in 2nd or 3rd degree heart block,
caution in diabetic,
caution in PVD,
other agents preferred for pregancy and laction,
caution in elderly