dementia pharm

Question 1

dementia= a deficiency of _____

Answer 1

intact cholinergic neurons

Question 2

what drug class is used for Alz Ds, and how does it work

Answer 2

Ache-I

inhibit Ach breakdown @ synaptic cleft– modest sx benefit

Question 3

what drug classes are used for to improve Cognition+ Global Functioning w dementia? how work?

Answer 3

Ache-Is and Memantine only
-act @ nucleus basalis of Maynert
= sympathetic therapy, NOT neuroprotective, NO change disease trajectory

Question 4

indications for Ache-I

Answer 4

ds of the eye, NMJ, heart, + Alx

Question 5

contraindications for Ache-I in Alz Ds

Answer 5

increased vagal tone–> badycardia, sick sinus syndrome, incomplete heart block, increased risk of syncope = more falls and frx

caution w use w b blockers, CCBs or lacosamide

Question 6

DONEPEZIL

why he a good choice??
indications
contra
warnings
AEs

Answer 6

=easy to use, once daily

I= dementia, mild, mod, severe Alz

C= known hypersensitivity to donepezil HCl or piperidine derivatives

W= will exaggerate succinylcholine type M relaxation during anesthesia.
vagotonic on SA+AV nodes-> bradycardia/heart block

AE= N/V/D, insomnia, M cramps, fatigue, anorexia

Question 7

GALANTAMINE

indications
contra
warnings
AEs

Answer 7

I= mold to mod Alz

C= hypersensitivity to galantamine or carrier, ESRD, hepatic impairment

W= skin rxns, adverse effects on cardiac conduction- bradycardia, AV block

AE= N/V/D, dizzy, HA, dec appetite, dec weight

Question 8

RIVASTIGMINE

what make he special???
indications
contra
warnings
AEs

Answer 8

he a patch!!

I= mild to mod dementia associated w Alz/Parkinsons

C= known hypersensitivity to it or carbamate derivatives

W= titrate the dose as prescribed . re-initiate at lowest dose if interrupted, hepatic impair, or low body weight
-weight should be monitored.

AE= N/V will be significant if the dose taken»prx

Question 9

list AchE-I

which ones are used for dementia

Answer 9

donepezil, galantamine, rivastigmine = USED

other=
ambenonium
neostigmine
echothiopate
physostigmine
edophonium
pyridostigmine

Question 10

what is the antiMachR + AcheE +Benzo combination used for dementia

how work?

Answer 10

= atropine + pralidoxime

atropine=antiMachR= use in combo w maintenance of vital signs and decontamination, ineffective against peripheral nAchR

pralidoxime= regenerate actie AchE enzymes be removing the Ph-group from the active site of enzymes
-will restore teh response to stimulation w/in minutes
=MUST be given soon after AchE-I

Question 11

Memantine

indication
how work
why use he rather than others?

Answer 11

=NMDA antagonist–> stop overstimulation of glutamate associated with Alz

-binds intrapore Mg ions that transiently block the NMDA receptor +keep it there

ONLY WORK UNDER EXCESSIVE STIMULATION (no effect on normal neurotransmission)

less AEs than cholinergic meds