Iszard: Drugs for Dementia

Question 1

Which 4 AChE inhibitors are preferred for Dementia?

Answer 1

• Donepezil
• Rivastigmine
• Galantamine
• Physostigmine

Question 2

What is the MOA of Memantine used in dementia?

Answer 2

- Antagonist of the NMDA type of glutamate receptors

• Binds the intra-pore Mg²⁺ site, functioning as an effective receptor blocker only under conditions of excessive stimulation

____________________

Glutamate contributes to AD by overstimulating receptors leading to excitatory cell death

Question 3

Pt’s w progressive dementia have a deficiency intact __ neurons

Answer 3

Pt’s w progressive dementia have a deficiency intact cholinergic neurons

Question 4

What are the two meds available for cognition and global functioning of dementia?

Answer 4

Memantine

AchE inhibitors

Question 5

What are the formulations of the 3 AchE inhibitor drugs?

Answer 5

• Donepezil: once daily sublingual tab
• Galantamine: twice daily tab & ER once daily tab
• Rivastigmine: twice daily cap & 24hr transdermal patch

Question 6

What conditions must you think of when using Galantamine and Rivastigmine?

Answer 6

• Galantamine: end-stage kidney dis & severe hepatic impairment
• Rivastigmine: hepatic impairment & low body weight

Question 7

Indications for Donepezil?

Answer 7

Mild, moderate, & severe dementia of AD

Question 8

Indications for Galantamine?

Answer 8

Mild to moderate dementia of AD

Question 9

Indications for Rivastigmine?

Cautions?

Answer 9

Mild to moderate dementia of AD & PD

Caution = monitor weight

Question 10

What drug is capable of regenerating active AchE?

What is the MOA?

Answer 10

Pralidoxime = antidote for organophosphate poisoning

MOA: removal of a PO4 group from the active site of the enzyme

Question 11

Why would we use Memantine before AchE inhibitor?

Answer 11

Memantine (NMDA antagonist) has fewer SE