Dementia

Question 1

What drug class are Donezipil, Galantamine, Rivastigmine? And when are they recommended?

Answer 1

acetylcholiesterase inhibitors. Treatment of mild to mod dementia.

Question 2

What is a suitable alternative if acetylcholinesterase inhibiors are CI/ unsuitable?

Answer 2

Memantine, drug of choice in severere dementia

Question 3

Some pts can develop non-cognitive symptoms such as delusions or anxiety and behaviours that challenge, agitation or aggression. In this case when should pharmacological treatment be used?

Answer 3

If they are severely distressed or there is an immediate risk of harm to the patient or others

Question 4

When should antipsychotics not be prescribed?

Answer 4

In mild-mod non cognitive symptoms due to alzeihmers, vascular dementia, mixed dementia or lewy body dementia. in severe disease causing distress an antipsychotic can be used. An acetylcholinesterase inhibitor may be used in mild-mod non cognitive symptoms due to alzeihmers

Question 5

What are the cautions for prescribing antipsychotics in the elderly for dementia?

Answer 5

MHRA has reported a clear increase of stroke and small increase in death. RIsk balance needs to be considered incl risk of stroke and risk factors for CVD e.g HT, diabetes, smoking

Question 6

If IM administartion is needed for behavioural control what can be given?

Answer 6

Lorazepam, haloperidol, olanzipine. Diazepam and chlorpromazine not recommdended