Dementia

Question 1

Side effects of AChEI

Answer 1

i. CNS: abnormal dreams, insomnia
ii. CVS: syncope, uncommonly bradycardia
iii. GI: N&V, anorexia
iv. GU: urinary frequency.
v. MSK: muscle cramps

Question 2

Difference in drug interactions between the 3 AChEI

Answer 2

• donepezil and galantamine both interact with Cyp 3A4 so interacts with grapefruit

Question 3

Rivastigmine advantages and disadvantages

Answer 3

1) Patch so less NV side effects
2) Easier for compliance.
3) If oral tablet, less convenient b/c BID dosing.

Question 4

Memantine SE

Answer 4

-Well tolerated and does not cause livido reticularis (blotchy pattern on legs ) as opposed to amantadine

Question 5

How to dementia patients respond to antidepressants and which ones to use?

Answer 5

1) Preferably SSRI and not TCA since TCA causes anti-cholinergic effects
2) Takes longer time for drug to take effect, i.e. 4-6 weeks to take effect
3) SSRI’s could cause hyponatremia which could affect cognitive functioning in this elderly population.

Question 6

How about psychosis?

Answer 6

1) Increased risk of stroke and death.

2) Patient very sensitive to effects of anti-psychotics so use very low doses.

Question 7

How to monitor for efficacy of ACHEI?

Answer 7

1) Normally decline at least 2 points of MMSE over 1 year so if decline less than 2 points than effective.