Drugs for Dementia (Wolff) Flashcards
Donepezil
What is its MOA, what condition is it used for, and how is it administered?
MOA: reversible/noncompetitive inhibits centrally active acetylcholine-esterase = inc. ACh available at synaptic transmission of CNS
- used for ALZHEIMER DEMENTIA (off-label for other dementias)
- administered by TABLET 1x/day
Donepezil
What are 3 toxicities it can cause (C/NV/AD) and what 3 conditions can it worsen (PU/COPD/BOO)?
Cause: prolong QT interval (TORSADES de POINTES)
- nausea/vomiting/diarrhea
- abrupt discontinuation = rapidly changing mood
Worsens: Peptic Ulcers, COPD/asthma, bladder outflow obstruction
What reversible AChE inhibitor for dementia can be offered as a TRANSDERMAL patch?
Rivastigmine
Memantine
What is its MOA, what is it used for and how, and how is it administered?
MOA: NMDA receptor antagonist that binds to Mg site on receptor and makes rapidly firing neurons LESS likely to fire
- used for moderate-severe Alzheimers as monotherapy OR combo with AChE inhibitors
- administered orally 1x/day
Memantine
What are 3 toxicities of use (C/SHS/AD)?
Toxicities: confusion/dizziness/headache
- severe skin hypersensitivity (RARE)
- avoid Abrupt Discontinuation –> altered mental status, inc. anxiety/agitation, delusions
What drugs are used for these neuropsychiatric symptoms of dementia:
- Depression (C)
- Antipsychotic Agents (O/R)
- Apathy (CI/AD/M)
What type of dementia is at HIGH RISK of severe side-effects with neuroleptic medications?
- Citalopram
- Olanzapine or Risperidone
- cholinesterase inhibitor, antidepressant, methylphenidate
dementia with Lewy Bodies is at high risk of severe side effects –> use low dose atypical antipsychotics
What are the 2 most common clinical complications of advanced dementia?
- Feeding Problems
- use finger foods, small portions, nutritional supplements, hand feeding
- Recurrent Infections
- excessive misuse of antimicrobials is VERY common
