Dementia/Alzheimer's Disease Flashcards
What are the primary patho features of Alzheimer’s?
- neurofibrillary tangles (tau protein)
- beta amyloid plaques
What is the association between anticholinergics and dementia?
exposure to anticholinergics in the 10 years prior to diagnosis is associated with dementia
risk does NOT diminish even if the drug is stopped
What agents are indicated for mild Alzheimer’s?
- donepezil (Aricept)
- rivastigmine (Exelon)
- galantamine (Razadyne)
- lecanemab (Leqembi)
- donanemab (Kisunla)
What is required for a patient to start mAb therapy for Alzheimer’s?
mild cognitive impairment WITH confirmed presence of beta amyloid patho
What agents are indicated for moderate Alzheimer’s?
- donepezil (Aricept)
- rivastigmine (Exelon)
- galantamine (Razadyne)
- memantine (Namenda)
What agents are indicated for severe Alzheimer’s?
- donepezil (Aricept)
- rivastigmine (Exelon)
- memantine (Namenda)
What Alzheimer’s agent is available as a patch?
What is the benefit of it’s patch formulation?
rivastigmine (Exelon)
less GI upset compared to PO formulation
What are the class ADR of AChE inhibitors?
SLUDGE (cholingeric)
Sialorrhea
Lacrimation
Urination
Defecation
GI (diarrhea)
Emesis
List the AChE inhibitor Alzheimer’s agents:
- donepezil (Aricept)
- rivastigmine (Exelon)
- galantamine (Razadyne)
What is the MOA for memantine (Namenda)?
NMDA receptor antagonist
What are the class CI for AChE inhibitors?
baseline bradycardia/known cardiac conduction system disease
Which Alzheimer’s agents have NO CYP metabolism?
- rivastigmine (Exelon)
- memantine (Namenda)
What is the purpose of using Nazmaric (memantine ER + donepezil) over just donepezil or memantine?
produces slower decline than donepezil alone
What is required to initiate Nazmaric (memantine ER + donepezil)?
stabilization on 10 mg donepezil dose
What is the BBW for mAbs indicated for Alzheimer’s?
ARIA and increased risk in ApoE4 homozygotes
How do you decrease the risk of ARIA for lecanemab (Leqembi) & donanemab (Kisunla)?
titrate does slowly and frequently monitor MRI for ARIA
What mAbs have an indication for Alzheimer’s?
- lecanemab (Leqembi)
- donanemab (Kisunla)
What is ARIA?
ARIA-E?
ARIA-H?
amyloid related imaging abnormalities
cerebral EDEMA
cerebral microHEMORRHAGES
How is lecanemab (Leqembi) dosed?
What is it for?
weight based IV infusion every 2 weeks
mild cognitive impairment w/ presence of beta amyloid
How is donanemab (Kisunla) dosed?
What is it for?
IV infusion every 4 weeks
mild cognitive impairment w/ presence of beta amyloid
Where can rivastigmine (Exelon) patches be applied?
back, chest or arm
What agents (classes) should be avoided in patients with Alzheimer’s when managing their mood or sleep?
anticholinergics, benzos & sedative/hypnotics
What antipsychotics can be used for agitation in dementia?
- aripiprazole
- olanzapine
- quetiapine
- risperidone
- brexipiprazole
What agent is indicated for treatment of agitation associated with dementia due to Alzheimer’s disease?
brexipiprazole (Rexulti)
How is brexipiprazole (Rexulti) administered for agitation associated with dementia due to Alzheimer’s disease?
NOT USED PRN
daily dosing 0.5 mg-3 mg (titrated)
What is the frequency of gradual dose reduction?
within 1st year of LTC admission
- attempt GDR in 2 separate quarters at least 1 mo apart
after 1st year
- attempt GDR annually
What agents does gradual dose reduction guidelines apply to?
antipsychotics
sedative/hypnotics
other CNS active meds (antidepressants, mood stabilizers)
