Dementia

Question 1

Donepezil/Aricept
class
MOA
SE

Answer 1

Acetylcholin-esterase inhibitor
Centrally-acting reversible ACh-ase inhibitor
Increases cortical ACh

Bradycardia, nausea, diarrhea, anorexia, Abd pain, vivid dreams

Question 2

Donepezil/Aricept

Characteristics

Answer 2

Helps w/ sleep apnea/insomnia associated w/ Alzheimer’s
Off-label use:
- Lewy body dementia
- Vascular dementia
Can potentially increase vocabulary/expressive language of kids w/ Autism

Oral bioavailability: 100%, easily crosses BBB
½ life: 70 hours

Delays disease progression

Question 3

Rivastigmine/Exelon

Class MOA

Answer 3

Acetylcholin-esterase inhibitor
Centrally-acting reversible ACh-ase inhibitor

Might also inhibit butyrylcholinesterase (associated w/ symptom progression)

Question 4

Rivastigmine/Exelon

Charcteristics

Answer 4

PO, transdermal patch (reduces SE)
Mind-moderate dementia d/t Alzheimer’s or Parkinson’s
Appears to show most benefit in patients w/ more aggressive course of disease (younger onset, poor nutrition, delusions/hallucinations present)
Multi-infarct dementia: may have slight improvement of cognitive function/behavior
Schizophrenia: possible tx option, no evidence

Question 5

Galantamine/razadyne

Class
MOA
char

Answer 5

Acetylcholin-esterase inhibitor
Inhibits ACH-ase = more ACh present

“Brain enhancer” to improve memory in brain-damaged adults

Question 6

Memantine/ Namenda
CLass
MOA
SE

Answer 6

Novel class

NMDA receptor antagonist:
- Antagonizes glutamatergic NMDA receptor sites
- Inhibits prolonged Ca2+ influx – plays important role in neuronal exitotoxicity
5HT3 non-competitive antagonist
D2 agonist
Nicotinic ACh-R antagonist

Confusion, dizziness, drowsiness, insomnia, HA, agitation, hallucinations

Less common: vomiting, anxiety, increased libido

Question 7

Memantine/ Namenda

Char

Answer 7

Clinical significant of 5HT3 activity = unknown for Alzheimer’s tx

1 trial: induce reversible neurologic impairment, possible MS tx but trial was stopped

Review of RTC: small positive effect on cognition, mood, behavior, ability to perform daily activities in moderate-severe Alzheimer’s
- Unknown effect in mind-moderate dz

Improves cognition, function, behavior if added to Aricep

Question 8

OD for al AchEI

• S/SX
• TX

Answer 8

• Nausea, vomiting, salivation, sweating, bradycardia, hypotension, convulsions, circulatory collapse
• Tx: Atropine (anticholinergic)