Pharm - Dementia Flashcards
are cholinesterase inhibitors neuroprotective?
nope
if a patient is not benefiting or is having significant side effects, how should therapy be altered
therapy should be discontinued
which dementia drug comes as a once-daily tablet and a once-daily disintegrating sublingual tablet
donezapil
which dementia drugs comes as a twice-daily tablet or solution and an extended-release once-daily capsule
galantamine
which dementia drug comes as a twice-daily capsule, a twice-daily solution, and a 24 hour transdermal patch
rivastigmine
cholinesterase inhibitors are contraindicated in what patients
those with baseline bradycardia or known cardiac conduction system disease (sick sinus syndrome, incomplete heart block)
–> due to risk of syncope, falls, and fractures
cholinesterase inhibitors should be prescribed with caution when the patient is already taking what other drugs
drugs that induce bradycardia or alter AV nodal conduction
- beta blockers
- calcium channel blockers
- lacosamide
what extra measures does the rivastigmine patch require once prescribed
dose adjustments for hepatic impairment and low body weight
galantamine should not be used in what patients
those with end-stage kidney dz or severe haptic impairment
indications for donazepil
treatment of dementia of the Alzheimer’s type
- mild, moderate, and severe
contraindications for donazepil
hypersensitivity to donepezil HCL or piperidine derivatives
warnings and precautions for prescribing anti cholinesterase inhibitors
1) they can exaggerate succinylcholine-type muscle relaxation during anesthesia
2) they can have vagotonic effects on the SA and AV nodes manifesting as bradycardia or heart block
adverse effects donazepil
N/V/D, insomnia, muscle cramps, fatigue, anorexia
indications for galantamine
treatment of mild to moderate dementia of the Alzheimer’s type
contraindications for galantamine
hypersensitivity to galantamine hydrobromide or any excipients
warnings and precautions for galantamine
1) serious skin reactions can occur (discontinue at first sight)
2) bradycardia and AV block
3) active or occult GI bleeding
4) bladder outflow obstruction
5) respiratory adverse events
with what patients should you use caution when prescribing galantamine
those with history of severe asthma or COPD –> can cause respiratory adverse events
adverse effects galantamine
N/V/D, dizziness, HA, decreased appetite, weight loss
indications for rivastigmine
1) mild to moderate dementia of Alzheimer’s type
2) mild to moderate dementia associated w/ Parkinson’s dz
contraindications for rivastigmine
pts w/ known hypersensitivity to rivastigmine or other carbamate derivatives
adverse effects rivastigmine
N/V (can be severe)
warnings and precautions for rivastigmine
1) dose should be titrated as prescribed and re-initiated at the lowest dose if interrupted for more than a few days
2) weight should be monitored during patch therapy
what are the other cholinesterase inhibitors that are older and have more adverse effects
- ambenonium
- echothiophate
- edrophonium
- neostigmine
- physostigmine
- pyridostigmine
list the antimuscarinic compound used to treat dementia
atropine
list the cholinesterase reactivator used to treat dementia
pralidoxime
MOA pralidoxime
cholinesterase regenerator
- regenerates active AChE enzyme by removing the phosphorus group from the active site of the enzyme
when does pralidoxime need to be given
soon after AChE inhibitor exposure
MOA memantine
antagonist of NMDA type glutamate receptor
- binds to the intra-pore magnesium site, blocking the NMDA receptor from being activated
(glutamate may contribute to pathogenesis of Alzheimer’s dz)
compare adverse effects of memantine to the cholinergic medications
memantine has fewer AEs
