Pharm - Dementia Flashcards

1
Q

are cholinesterase inhibitors neuroprotective?

A

nope

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2
Q

if a patient is not benefiting or is having significant side effects, how should therapy be altered

A

therapy should be discontinued

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3
Q

which dementia drug comes as a once-daily tablet and a once-daily disintegrating sublingual tablet

A

donezapil

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4
Q

which dementia drugs comes as a twice-daily tablet or solution and an extended-release once-daily capsule

A

galantamine

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5
Q

which dementia drug comes as a twice-daily capsule, a twice-daily solution, and a 24 hour transdermal patch

A

rivastigmine

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6
Q

cholinesterase inhibitors are contraindicated in what patients

A

those with baseline bradycardia or known cardiac conduction system disease (sick sinus syndrome, incomplete heart block)

–> due to risk of syncope, falls, and fractures

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7
Q

cholinesterase inhibitors should be prescribed with caution when the patient is already taking what other drugs

A

drugs that induce bradycardia or alter AV nodal conduction

  • beta blockers
  • calcium channel blockers
  • lacosamide
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8
Q

what extra measures does the rivastigmine patch require once prescribed

A

dose adjustments for hepatic impairment and low body weight

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9
Q

galantamine should not be used in what patients

A

those with end-stage kidney dz or severe haptic impairment

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10
Q

indications for donazepil

A

treatment of dementia of the Alzheimer’s type

- mild, moderate, and severe

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11
Q

contraindications for donazepil

A

hypersensitivity to donepezil HCL or piperidine derivatives

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12
Q

warnings and precautions for prescribing anti cholinesterase inhibitors

A

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

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13
Q

adverse effects donazepil

A

N/V/D, insomnia, muscle cramps, fatigue, anorexia

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14
Q

indications for galantamine

A

treatment of mild to moderate dementia of the Alzheimer’s type

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15
Q

contraindications for galantamine

A

hypersensitivity to galantamine hydrobromide or any excipients

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16
Q

warnings and precautions for galantamine

A

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

17
Q

with what patients should you use caution when prescribing galantamine

A

those with history of severe asthma or COPD –> can cause respiratory adverse events

18
Q

adverse effects galantamine

A

N/V/D, dizziness, HA, decreased appetite, weight loss

19
Q

indications for rivastigmine

A

1) mild to moderate dementia of Alzheimer’s type

2) mild to moderate dementia associated w/ Parkinson’s dz

20
Q

contraindications for rivastigmine

A

pts w/ known hypersensitivity to rivastigmine or other carbamate derivatives

21
Q

adverse effects rivastigmine

A

N/V (can be severe)

22
Q

warnings and precautions for rivastigmine

A

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

23
Q

what are the other cholinesterase inhibitors that are older and have more adverse effects

A
  • ambenonium
  • echothiophate
  • edrophonium
  • neostigmine
  • physostigmine
  • pyridostigmine
24
Q

list the antimuscarinic compound used to treat dementia

25
list the cholinesterase reactivator used to treat dementia
pralidoxime
26
MOA pralidoxime
cholinesterase regenerator | - regenerates active AChE enzyme by removing the phosphorus group from the active site of the enzyme
27
when does pralidoxime need to be given
soon after AChE inhibitor exposure
28
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)
29
compare adverse effects of memantine to the cholinergic medications
memantine has fewer AEs