Cognitive Disorders Flashcards
only cholinesterase inhibitor that crosses BBB?
donepezil
donepezil
- for tx of Alzheimer’s; cholinesterase inhibitor
- long 1/2 life = 1/d dosage
- s/e = N/V/D
rivastigmine
- tx for Alzheimer’s (mild to moderate)
- s/e = N/V, headaches, anorexia
- must be given w/ food
galatamine
- mild to moderate Alzheimer’s
- s/e = N/V/D, weight loss, anorexia
memantine
- mild Alzheimer’s and vascular dementia
- removes NMDA toxicity = how it slows degeneration process
- s/e = dizziness, delusion, confusion, hallucination
- used in combo w/ cholinesterase inhibitors for advanced Alzheimer’s
vitamin E supplements
- can slow/improve symptoms as prophylaxis
- use for pts at high risk for developing Alzheimer’s
- increased risk of death for pts w/ coronary disease
frontotemporal dementia
- focal degeneration of frontal and temporal lobes
- problems w/ 5HT and DA systems; cholinergic system fine
- **abnormal tau or TDP43 protein aggregation
what can’t you use cholinesterase inhibitors to tx frontotemporal dementia?
- in FTD the cholinergic system is spare
- so cholinesterase inhibitors will do nothing but cause you problems w/ a system that is functioning normally to being w/
what would you use to tx frontotemporal dementia?
- SSRIs = sertraline, paroxetine, fluvoxamine
- anti-psychotics as a last resort at low doses = quetiapine, olanzapine, aripiprazole
would bapineuzumab (beta-amyloid antibody) be effective in FTD tx?
- no b/c in FTD there are no beta-amyloid plaques; that’s a characteristic of Alzheimer’s
- in FTD the problem is tau proteins building up
Lewy body dementia
- Parkinson’s
- tx w/ cholinesterase inhibitors = rivastigmine, donpenzil, galatamine
tx for REM sleep disorders
- clonazepam
- quetiapine
vascular dementia
- infarcts = chronic ischemia in periventricular areas
- usually from DM or lipid metabolism disorders
- tx w/ anti-HTN drugs = diuretics, ACE inhibitors, beta-blockers
- manage DM w/ statins; could give anti-platelet drugs or Ca-channel blockers
drug-induced amnesia
- caused by date rape drug = rohypnol
- tx w/ midazolam, flunitrazepam
methylhenidate
- tx of ADHD
- inhibits reuptake of norepi and DA
- s/e = weight loss, decreased appetite, insomnia, addiction, mania
dextroamphetamine and lisdexamfetamine
- both for tx of ADHD (also narcolepsy)
- increase norepi and DA transmission in the brain
- s/e = MI, tachycardia, sudden cardiac arrest, seizures, anaphylaxis
atomoxetine
- can be used to tx ADHD
- selective norepi reuptake inhibitor; can increase norepi transmission at synapses in brain
- s/e = prolong QT interval, seizures, priapism, sudden cardiac death, angioedema
desipramine
- tx of depression and ADHD in kids
- blocks reuptake of norepi and serotonin in brain
- s/e = fatigue, dizziness, somnolence, sudden cardiac arrest, MI
- neuroleptic malignant syndrome = suicidal thoughts, hepatitis, jaundice
clonidine and guanfacine
- tx of ADHD
- centrally-acting alpha-2 receptor agonist
- guanfacine s/e = peeling of skin, xerostoma, bradyarrhythmias
- clonidine s/e = AV block, somnolence
bupropion
- tx for ADHD, smoking cessation, bipolar
- inhibits reuptake of norepi and DA
- s/e = agitation, arthralgia, arrhythmias, xerostomia, suicidal thoughts, mania
