dementia drugs Flashcards
What class of drugs should be avoided in Lewy body dementia and why?
Antipsychotics
greatly increased risk of SEs
3 classes of drugs that impair cognition?
neuroleptics
sedative
tricyclics
types of non-pharma therapy for dementia?
Non-cognitive symptoms (eg agitation) may respond to measures such as
aromatherapy, multisensory stimulation, massage, music, and animal-assisted therapy
Mx of depression in dementia?
SSRI - if severe mirtazapine
Cognitive behavioural
therapy can help with social withdrawal and catastrophic thinking
How to combat carer stress?
A care coordinator - can coordinate various teams and services available (laundry, car badge for priority parking, Help from occupational therapist, district nurses, and community psychiatric nurses)
Day services
Moral support
Combatting challenging behaviour - First rule out pain, infection, and depression.
Then consider trazodone (50–300mg at night) or lorazepam (0.5–1mg/12–24h
PO). Haloperidol (0.5–4mg) can be useful in the short term.
How to combat challenging behaviour in dementia?
First rule out pain, infection, and depression.
Then consider trazodone (50–300mg at night) or lorazepam (0.5–1mg/12–24h
PO). Haloperidol (0.5–4mg) can be useful in the short term.
Mx of Alzheimer’s disease?
Refer to a specialist memory service
Acetylcholinesterase inhibitors
BP control
Acetylcholinesterase inhibitors examples? SEs? Usage?
Donepezil, rivastigmine, galantamine
all modestly effective in treating AD and are recommended by NICE
dementia of Parkinson’s disease
Rivastigmine may improve behavioural symptoms in Lewy body dementia.
Don’t use in mild disease and discontinue if no worthwhile effect.
SEs: cholinergic effects may exacerbate peptic
ulcer disease and heart block - ask about symptoms and do an ECG first.
Antiglutamatergic treatment example? MOA? usage? SE?
Memantine (NMDA antagonist)
effect in late-stage AD - in patients with severe disease
or those with moderate disease in which AChE inhibitors are not tolerated
SE: hallucinations, confusion,
hypertonia, hypersexuality.
Antipsychotics in dementia usage? when to avoid? adverse effect?
Consider in severe, non-cognitive symptoms only (eg psychosis or
extreme agitation).
Avoid in mild-to-moderate: Lewy body dementia
(risk of neuroleptic sensitivity reactions), AD, and vascular dementia.
Possible increased risk of stroke/TIA so discuss risks and assess cerebrovascular risk factors.
Which vitamin may have a modest benefit in delaying functional progression in mild
to moderate AD?
E
