Dementia

Question 1

Types of dementia?

Answer 1

Alzheimer’s disease is the most common type of dementia; other common types of dementia include vascular dementia (due to cerebrovascular disease), dementia with Lewy bodies, mixed dementia, and frontotemporal dementia.

Question 2

Name drugs with antimuscarinic effects?

Answer 2

Amitriptyline, paroxetine, chlorphenamine, promethazine, olanzapine, quetiapine, solifenacin, tolteridone

Question 3

First line treatment in mild-to-moderate Alzheimer’s disease?

Answer 3

mono therapy with donepezil, galantamine, rivastagmine

Question 4

If acetylcholinesterase inhibitors are not tolerated or contra-indicated, what would be suitable alternative in moderate Alzheimers disease?

Answer 4

memantine

Question 5

……….is the drug of choice in patients with severe Alzheimer’s disease ?

Answer 5

Memantine

Question 6

What should be given to patients with mild-to-moderate dementia with Lewy bodies?

Answer 6

donepezil or rivastagmine ( both unlicensed for this indication )

Question 7

When would Acetylcholinesterase inhibitors [unlicensed indication] or memantine hydrochloride [unlicensed indication] can be considered in patients with vascular dementia ?

Answer 7

if they have suspected co-morbid Alzheimer’s disease, Parkinson’s disease dementia, or dementia with Lewy bodies.

Question 8

How does ANTICHOLINESTERASE drugs work?

Answer 8

They prolong the action of acetylcholine by inhibiting the action of the enzyme acetylcholinesterase.

Question 9

ANTICHOLINESTERASES contraindications?

Answer 9

Intestinal obstruction; urinary obstruction

Question 10

ANTICHOLINESTERASES cautions?

Answer 10

Arrhythmias; asthma (extreme caution); atropine or other antidote to muscarinic effects may be necessary (particularly when neostigmine is given by injection) but not given routinely because it may mask signs of overdosage; bradycardia; epilepsy; hyperthyroidism; hypotension; parkinsonism; peptic ulceration; recent myocardial infarction; vagotonia

Question 11

In elderly when would ANTICHOLINESTERASES be inappropriate to prescribe ? ( STOPP criteria)

Answer 11

known history of persistent bradycardia (heart rate less than 60 beats per minute), heart block, or recurrent unexplained syncope, or concurrent treatment with drugs that reduce heart rate (risk of cardiac conduction failure, syncope and injury).

Question 12

ANTICHOLINESTERASES side effects?

Answer 12

Abdominal cramps; diarrhoea; excessive tearing; hypersalivation; nausea; vomiting

Question 13

ANTICHOLINESTERASES signs of overdose?

Answer 13

Signs of overdosage include bronchoconstriction, increased bronchial secretions, lacrimation, excessive sweating, involuntary defaecation, involuntary micturition, miosis, nystagmus, bradycardia, heart block, arrhythmias, hypotension, agitation, excessive dreaming, and weakness eventually leading to fasciculation and paralysis.

Question 14

When should donepezil be given?

Answer 14

at bedtime

Question 15

What are the directions for administration of donepezil orodispersable tablets ?

Answer 15

placed on the tongue, allowed to disperse, and swallowed

Question 16

Common or very common side effects of donepezil ?

Answer 16

Aggression; agitation; appetite decreased; common cold; diarrhoea; dizziness; fatigue; gastrointestinal disorders; hallucination; headache; injury; muscle cramps; nausea; pain; skin reactions; sleep disorders; syncope; urinary incontinence; vomiting

Question 17

Uncommon side effects of donepezil ?

Answer 17

Bradycardia; gastrointestinal haemorrhage; hypersalivation; seizure

Question 18

Donepezil maximum daily dose?

Answer 18

10 mg

Question 19

What patient advice should be given when dispensing galantamine?

Answer 19

Manufacturer recommends that patients are warned of the signs of serious skin reactions; they should be advised to stop taking galantamine immediately and seek medical advice if symptoms occur. Serious skin reactions (including Stevens-Johnson syndrome and acute generalized exanthematous pustulosis) have been reported—manufacturer advises discontinue at the first appearance of skin rash.

Question 20

Galantamine common or very common side effects?

Answer 20

Appetite decreased; arrhythmias; asthenia; depression; diarrhoea; dizziness; drowsiness; fall; gastrointestinal discomfort; hallucinations; headache; hypertension; malaise; muscle spasms; nausea; skin reactions; syncope; tremor; vomiting; weight decreased

Question 21

Galantamine uncommon side effects?

Answer 21

Atrioventricular block; dehydration; flushing; hyperhidrosis; hypersomnia; hypotension; muscle weakness; palpitations; paraesthesia; seizure; taste altered; tinnitus; vision blurred

Question 22

What are the monitoring requirements for patients who are taking rivastigmine?

Answer 22

Body weight

Question 23

When treatment with rivastigmine should be interrupted?

Answer 23

if dehydration resulting from prolonged vomiting or diarrhoea occurs and withheld until resolution—retitrate dose if necessary.

Question 24

Uncommon side effects of rivastigmine transdermal patch ?

Answer 24

gastric ulcer

Question 25

Common or very common side effect of rivastigmine (With oral use) ?

Answer 25

confusion; gait abnormal; hallucinations; malaise; parkinsonism; sleep disorders

Question 26

What advice should be given regarding rivastigmine transdermal patch application ?

Answer 26

Apply patches to clean, dry, non-hairy, non-irritated skin on back, upper arm, or chest, removing after 24 hours and siting a replacement patch on a different area (avoid using the same area for 14 days).

Question 27

How should rivastigmine capsules be taken ?

Answer 27

Label 21 - Take with or just after food, or a meal

Label 25 - Swallow this medicine whole. Do not chew or crush

Question 28

To which drug class memantine belongs?

Answer 28

NMDA receptor antagonists ( other drugs ketamine, esketamine )

Question 29

Memantine cautions ?

Answer 29

Epilepsy; history of convulsions; risk factors for epilepsy

Question 30

Memantine Common or very common side effects ?

Answer 30

Balance impaired; constipation; dizziness; drowsiness; dyspnoea; headache; hypersensitivity; hypertension

Question 31

Uncommon memantine side effects ?

Answer 31

Confusion; embolism and thrombosis; fatigue; fungal infection; hallucination; heart failure; vomiting

Question 32

Memantine directions for administration for both oral solution and soluble tablets ?

Answer 32

For oral solution, manufacturer advises solution should be dosed onto a spoon or into a glass of water.

For soluble tablets, manufacturer advises drink resulting solution immediately when dissolved in water.

Question 33

Name all cholinergic side effects?

Answer 33

Diarrhoea
Urination
Muscle weakness, muscle cramps, miosis 
Bronchospasm 
Bradycardia
Emesis
Lacrimation ( teary eyes )
Salivation/sweating