Dementia

Question 1

AChE inhibitors

Answer 1

Donepezil
Galantamine
Rivastigmine

-less enzyme -> more Ach available (for synaptic transmission)

Question 2

NMDA antagonists

Answer 2

Memantine

-antiglutaminergic treatment

Question 3

Donepezil

Answer 3

For mild. Moderate & severe alzheimers
-take in evening

Adverse effects:

• nausea, vomiting, GIT disturbances
• vivid dreams, insomnia
• muscle cramps, fatigue

Question 4

Galantamine

Answer 4

Mild to moderate alzheimers

-caution in porphyria

Drug interactions:

• Ketoconazole, erythromycin (CYP3A4)
• Amytriptylene, fluoxetine, fluvoxamine, paroxetine, Quinidine, Ritonavir (CYP2D)

Question 5

Rivastigmine

Answer 5

Mild to moderate Alzheimers

• additional use in idiopathic Parkinson’s disease (to treat Dementia)
• interactions same as Galantamine

Question 6

Memantine

Answer 6

Moderate to severe Alzheimers (but 2nd line treatment)

-renal clearance reduced in alkaline urine conditions
Contraindication - moderate/severe renal impairment

Question 7

Altered circadian rhythm treatment

Answer 7

Trazadone

Question 8

Trazadone

Answer 8

• 5HT2A antagonist
• anxiolytic, antidepressant, mild hypnotic

(Also circadian rhythm disorder and agitation)