Neurology

Question 1

By what pathway does oxybutynin act on the bladder, and what are some important systemic considerations when prescribing this medication

Answer 1

Anti-cholinergic - avoid administration if concerns of cognitive impairment

Question 1

Name 3 evidence based strategies to slow the rate of cognitive decline where able.

Answer 1

1. Minimise anticholinergic drugs
2. Correct sensory impairment (e.g. hearing/ visual impairment)
3. Offer group cognitive stimulation therapy

Note: there is insufficient evidence for souvenaid in reducing progression of cognitive impairment

Question 2

Name 2 pharmacological therapies that may be used in the treatment on Alzheimer’s Disease.

Answer 2

1. Acetylcholinerstase inhibition (donepezil, galantamine, rivastigmine)
2. NMDA receptor antagonism (memantine)
3. Emerging anti-amyloid therapies (lecanemab/ donanemab)
   - Risk of ARIA-E and ARIA-H (largely asymptomatic, detected on MRI screening)

Question 3

What are some key side effects of acetylcholinesterase inhibitors ?

Answer 3

Mainly GIT side effects
- Nausea, vomiting, diarrhoea
- Anorexia, weight loss

Bradycardia, dizziness, syncope
Vivid dreams

Contraindications include: PUD, Ureteric obstruction, HB or bradyarrhythmia

Question 4

Which medication has the strongest evidence in treating agitation in dementia?

Answer 4

Citalopram (SSRI)

Note: if a patient has severe symptoms including psychosis or aggression, risperidone has the best evidence.