CNS: Pharmacological Management of Alzheimer's Disease

Question 1

Alzheimer’s Disease

Answer 1

Most common type of dementia (accounts for 80%)

Dementia – progressive impairment in multiple cognitive and behavioral/psychological domains

Memory, language and speech, visuospatial ability, executive functioning, and mood/personality

Question 2

Cholinesterase Inhibitors (ChEIs)

Answer 2

Used for treatment of mild, moderate, and severe disease
Temporarily improve cognition or slow the rate of cognitive decline but not a cure
Agents
Donepezil (Aricept®)
Galantamine (Razadyne®, Razadyne ER®)
Rivastigmine tartate (Exelon®) – PO and transdermal

Question 3

Donepezil (Aricept®)

Answer 3

Approved for mild, moderate, and severe disease
ADEs
N/V/D
Muscle cramps
Urinary incontinence
Syncope
Bradycardia
fatigue
Caution when using in people with cardiac conduction conditions or with history of falls or syncope

Question 4

Galatamine (Razadyne®, Razadyne ER®)

Answer 4

Approved for mild and moderate Alzheimer’s Disease only

ADEs- same as donezepil

Question 5

Rivastigmine tartrate (Exelon®)

Answer 5

Approved for mild and moderate Alzheimer’s Disease only
ADEs
N/V/D
Anorexia
Less muscle cramping
Cautions same as for donepezil and galantamine

Question 6

NMDA AntagonistMemantine (Namenda®)

Answer 6

Used for moderate to severe AD
MOA
Reduces overstimulation of the NMDA receptor by glutamate
ADEs
H/A, dizziness, sedation, agitation, constipation
Cautions
Severe renal impairment

Question 7

Other Pharmacotherapeutic Agents

Answer 7

Selegiline (Eldepryl®)
Vitamin C , E, B6, B12
Estrogen or HRT 
Gingko biloba
NSAIDs
Cholesterol-lowering drugs (statins)
Behavior-controlling drugs
Benzodiazepines
Antidepressants
Typical/atypical antipsychotics 
Anticonvulsants