Neurodegenerative/Alzheimer's Disease Flashcards
Stages of neurodegenerative dz.
- loss of higher cortical functions
- deterioration of emotional state and behavior
- functional deterioration - can’t remember how to walk, brainstem forgets how to breathe
You can retard the disease process, but you cannot ________.
reverse it - or bring memories back
AD patients are better at remembering new/old memories.
Old
What accumulates in the brain that is associated with AD?
Beta amyloid plaque
The patients seem to deficient in ______ in the CNS. How do you increase this in the brain?
ACh
AChesterase inhibitors
Name a reversible and irreversible ACHesterase inhibitors.
Irreversible - insectisides (nerve gas)
Reversible - stigmines
What are the side effects of a direct acting agent AChesterase inhibitors?
GI UPSET - diarrhea
bradycardia
Should you avoid anticholinergic drugs in AD?
YES - you are trying to increase ACh and you do not want SEDATION (so no sedatives…)
Why are multiple dosage forms necessary for AD?
because patients not want to take pills or be able to
What is the antiquated AD drug? Why is it no longer used?
Tacrine - reversible ACHesterase inhibitor
GI side effects (not CNS specific) and needs to be taken 3x per day
What drug is like tacrine, but has fewer GI symptoms and is dosed once at bedtime? What GI disorder may this drug worsen however?
Donepezil (more lipophilic)
PUD
What are the AE of donepezil?
syncope or bradycardia (thats why you need to take it ad bedtime)
What is a step up from Donepezil?
Rivastigmine - less reversible
What is a good option for a patient who cannot tolerate pills or oral solutions? AE?
Rivastigmine - comes as a patch
irritation from patch
What is a step up from Rivastigmine? Why so?
Galantamine - ACh esterase inhibitor and ACh agonist - rings door bell
