Dementia Flashcards
Types of dementia?
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.
Name drugs with antimuscarinic effects?
Amitriptyline, paroxetine, chlorphenamine, promethazine, olanzapine, quetiapine, solifenacin, tolteridone
First line treatment in mild-to-moderate Alzheimer’s disease?
mono therapy with donepezil, galantamine, rivastagmine
If acetylcholinesterase inhibitors are not tolerated or contra-indicated, what would be suitable alternative in moderate Alzheimers disease?
memantine
……….is the drug of choice in patients with severe Alzheimer’s disease ?
Memantine
What should be given to patients with mild-to-moderate dementia with Lewy bodies?
donepezil or rivastagmine ( both unlicensed for this indication )
When would Acetylcholinesterase inhibitors [unlicensed indication] or memantine hydrochloride [unlicensed indication] can be considered in patients with vascular dementia ?
if they have suspected co-morbid Alzheimer’s disease, Parkinson’s disease dementia, or dementia with Lewy bodies.
How does ANTICHOLINESTERASE drugs work?
They prolong the action of acetylcholine by inhibiting the action of the enzyme acetylcholinesterase.
ANTICHOLINESTERASES contraindications?
Intestinal obstruction; urinary obstruction
ANTICHOLINESTERASES cautions?
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
In elderly when would ANTICHOLINESTERASES be inappropriate to prescribe ? ( STOPP criteria)
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).
ANTICHOLINESTERASES side effects?
Abdominal cramps; diarrhoea; excessive tearing; hypersalivation; nausea; vomiting
ANTICHOLINESTERASES signs of overdose?
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.
When should donepezil be given?
at bedtime
What are the directions for administration of donepezil orodispersable tablets ?
placed on the tongue, allowed to disperse, and swallowed
Common or very common side effects of donepezil ?
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
Uncommon side effects of donepezil ?
Bradycardia; gastrointestinal haemorrhage; hypersalivation; seizure
Donepezil maximum daily dose?
10 mg
What patient advice should be given when dispensing galantamine?
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.
Galantamine common or very common side effects?
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
Galantamine uncommon side effects?
Atrioventricular block; dehydration; flushing; hyperhidrosis; hypersomnia; hypotension; muscle weakness; palpitations; paraesthesia; seizure; taste altered; tinnitus; vision blurred
What are the monitoring requirements for patients who are taking rivastigmine?
Body weight
When treatment with rivastigmine should be interrupted?
if dehydration resulting from prolonged vomiting or diarrhoea occurs and withheld until resolution—retitrate dose if necessary.
Uncommon side effects of rivastigmine transdermal patch ?
gastric ulcer
Common or very common side effect of rivastigmine (With oral use) ?
confusion; gait abnormal; hallucinations; malaise; parkinsonism; sleep disorders
What advice should be given regarding rivastigmine transdermal patch application ?
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).
How should rivastigmine capsules be taken ?
Label 21 - Take with or just after food, or a meal
Label 25 - Swallow this medicine whole. Do not chew or crush
To which drug class memantine belongs?
NMDA receptor antagonists ( other drugs ketamine, esketamine )
Memantine cautions ?
Epilepsy; history of convulsions; risk factors for epilepsy
Memantine Common or very common side effects ?
Balance impaired; constipation; dizziness; drowsiness; dyspnoea; headache; hypersensitivity; hypertension
Uncommon memantine side effects ?
Confusion; embolism and thrombosis; fatigue; fungal infection; hallucination; heart failure; vomiting
Memantine directions for administration for both oral solution and soluble tablets ?
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.
Name all cholinergic side effects?
Diarrhoea Urination Muscle weakness, muscle cramps, miosis Bronchospasm Bradycardia Emesis Lacrimation ( teary eyes ) Salivation/sweating
