Dementia Drugs

Question 1

Dementia Drug Classes

Answer 1

Acetylcholinesterase inhibitors (since ACh gets depleted with degeneration in dementia, want to preserve/increase ACh)

Question 2

Galantamine (Razadyne)

Answer 2

• competitive cholinesterase inhibitor
• metabolized by CYP2D6/3A4
• Use to treat mild/moderate AD

Question 3

Donepezil (Aricept)

Answer 3

• NONcompetitive cholinesterase inhibitor
• CYP2D6/3A4 metabolism
• Used for mild-severe AD (only CI for severe)

Question 4

Rivastigmine

Answer 4

NONcompetitive cholinesterase inhibitor

-Mild-moderate AD and PD

Question 5

Cholinesterase Inhibitors

Answer 5

• treat AD symptoms, not disease
• slow decline and behavioral dysfunction in AD
• Also used for LBD and vascular dementia
• Adverse Effects: bradycardia, syncope
• cross BBB (duh)

Question 6

Memantine

Answer 6

Noncompetitive NMDA receptor antagonist
-used to treat mod-severe AD
-prevents excessive NMDA activation (preventing glutamate neurotoxicity), reducing cognitive deterioration in AD
-can also use for LBD and vascular dementia
Side Effects: headache, dizziness (minimal)

Question 7

BPSD (Behavorial and psychiatric dementia)

Answer 7

see anxiety, depression, irritation, paranoia, wandering
Treat with
1) serotonergic antidepressents
2) atypical antipsychotics (increased risk stroke/mortality)
3) Halperidol for acute aggression
-latter 2 can cause parkinsonism

Question 8

Drugs to avoid in AD

Answer 8

• anticholinergics
• benzodiazepines
• sedatives/hypnotics