Dementia Drugs and Indications Flashcards
What are the cholinesterase inhibitors (drug names) available in Aus?
- Donepezil
- Galantamine
- Rivastigmine
Indications for Cholinesterase inhibitors
Alzheimers - statistical benefit found in mild-moderate AD
Vascular Dementia & Lewy body dementia - some evidence for efficacy but not yet approved for these conditions
When is galantamine contraindicated?
Severe renal failure
Common adverse effects of cholinesterase inhibitors
**nausea, vomiting, diarrhoea
(reducable with dose titration)
also: bronchoconstriction (esp if have asthma), bradycardia, crams, vivid dreams
How do cholinesterases work?
Inhibit the acetylcholinesterase enzyme from breaking down acetylcholine
Thus they increase both the level and duration of action of the neurotransmitter acetylcholine within the synapse
When is memantine indicated?
Moderate-severe alzheimers
Vascular dementia
*Available on PBS for patients who do not tolerate cholinesterase inhibitors
How does memantine work?
Non-competitive antagonist of the NDMA Glutamate receptors.
Works with the Ca++ dysregulation hypothesis of AD
Thought to protect neurons from overstimulation and excitory damage associated with increased glutamate transmission and Ca++ overload
How is memantine therapy initiated?
Titrated over 1 month to minimise
- agitation
- hallucinations
- headache
- can also increase risk of seizure activity
IN whom is memantine contraindicated?
Renal impairment. (excreted in urine)
What is the premise of targeting PPAR-mediated transcription?
In mice, use of Bexarotene has enhanced clearance of AB and cognitive function.
ApoE (Apolipoprotein) usually facilitates clearance of AB from the brain
ApoE production is under the control of PPARy, in combination with Liver X Receptors (LXR) and Retinoid X Receptors (RXR).
Baroxetine is LXR and RXR agonist, and thus increases ApoE production, and increases AB clearance from the brain
This has been shown to improve cognitive function in mice
Drugs indicated for treating delirium associated with dementia & Why
(symptoms of delerim are?)
clouding of conscious state, disorientation, imaired attention and memory
Thiamine (B1) course can be trialled (thiamine deficiency can lead to wernicke’s encephalopathy and korsakoff’s psychosis - especially in those whom abuse alcohol)
Benzodiazepines: can treat delirium by addressing associated anxiety, agitation, aggression, hallucinations and delusions
Treatment of depression associated with dementia?
SSRIs
Treatment Insomnia associated with dementia?
Insomnia in dementia patients different to insomnia in healthy people. Best managed with environmental maniplation rather than medication
Treatment of behavioural disturbances associated with dementia?
Haloperidol: can be used, but the extrapyramidal side-effects deter long-term use
Antipsychotics: help with hallucinations and delusions, but are of limited use for other behavioural issues
