dementia

Question 1

cholinergic hypothesis

Answer 1

the destruction of the forebrain cholinergic neurons causes dec cholinergic transmission which causes the neurologic deficits in alzheimers
**main MOA for alzheimer’s drugs is acetylcholinesterase inhibitors to get more ACh into the brain(anti-cholinesterases)

Question 2

anti-cholinesterases

Answer 2

-prevent the breakdown of acetylcholine by cholinesterase
-believed to inc synaptic cleft conc. of acetylcholine- enchanced cholinergic transmission
-may cause potent parasympathetic effects- bradycardia, hypotension, inc urination & lacrimation, broncho constriction, GI tract hypermobility, N/V
donepezil
galantamine
rivastigmine

Question 3

donepezil/ aricept

Answer 3

centrally acting reversible AChE inhibitor
for tx of alzheimer’s, off label for lewy body dementia, vascular dementia
MOA- increased cortical ACh
SE- bradycardia, nausea, diarrhea, anorexia, abdominal pn, vivid dreams
-2 studies that suggest it can improve vocab & speech of children w/autism

Question 4

rivastigmine/ exelon

Answer 4

centrally acting reversible AChE inhibitor
for mild to moderate demetia of alzheimer’s & PD- better for pts exhibiting more aggressive dz(younger), poor nutritional status(do to not eating), those w/sxs of delusions &/or hallucinations
MOA- increased cortical ACh
PO, TRANSDERMAL PATCH(reduces prevelence of SE)

Question 5

galantamine/ razadyne

Answer 5

centrally acting AChE inhibitor

for mild to moderate alzheimers & vascular dementia- “brain enhancer” to improve brain-damaged adults

Question 6

overdose in acetylcholinesterase

Answer 6

N/V, salivation, sweating, bradycardia, hypotension, convulsions, circulatory collapse
**ATROPINE IS AN ANTIDOTE

Question 7

memantine/ NaMenDA

Answer 7

NMDA receptor blockers- new class- antagonist of glutamatergic NMDA receptor sites
associated with a moderate dec in clinical alzheimer’s dz
MOA- inhibits the prolonged influx of Ca2+ into neurons. non-competative antagonist of 5HT3 receptor- clinical significance is unknown. agonist of dopamine D2 receptor. antagonist at nicotinic acetylcholine receptor sites
SE- >1% of pts- confusion, dizziness, drowiness, insomnia, HA, agitation, hallucinations. less commonly- vomiting, anxiety, inc libido