Pharm - Dementia

Question 1

are cholinesterase inhibitors neuroprotective?

Answer 1

nope

Question 2

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

Answer 2

therapy should be discontinued

Question 3

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

Answer 3

donezapil

Question 4

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

Answer 4

galantamine

Question 5

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

Answer 5

rivastigmine

Question 6

cholinesterase inhibitors are contraindicated in what patients

Answer 6

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

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

Question 7

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

Answer 7

drugs that induce bradycardia or alter AV nodal conduction

• beta blockers
• calcium channel blockers
• lacosamide

Question 8

what extra measures does the rivastigmine patch require once prescribed

Answer 8

dose adjustments for hepatic impairment and low body weight

Question 9

galantamine should not be used in what patients

Answer 9

those with end-stage kidney dz or severe haptic impairment

Question 10

indications for donazepil

Answer 10

treatment of dementia of the Alzheimer’s type

- mild, moderate, and severe

Question 11

contraindications for donazepil

Answer 11

hypersensitivity to donepezil HCL or piperidine derivatives

Question 12

warnings and precautions for prescribing anti cholinesterase inhibitors

Answer 12

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

Question 13

adverse effects donazepil

Answer 13

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

Question 14

indications for galantamine

Answer 14

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

Question 15

contraindications for galantamine

Answer 15

hypersensitivity to galantamine hydrobromide or any excipients

Question 16

warnings and precautions for galantamine

Answer 16

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

Question 17

with what patients should you use caution when prescribing galantamine

Answer 17

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

Question 18

adverse effects galantamine

Answer 18

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

Question 19

indications for rivastigmine

Answer 19

1) mild to moderate dementia of Alzheimer’s type

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

Question 20

contraindications for rivastigmine

Answer 20

pts w/ known hypersensitivity to rivastigmine or other carbamate derivatives

Question 21

adverse effects rivastigmine

Answer 21

N/V (can be severe)

Question 22

warnings and precautions for rivastigmine

Answer 22

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

Question 23

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

Answer 23

• ambenonium
• echothiophate
• edrophonium
• neostigmine
• physostigmine
• pyridostigmine

Question 24

list the antimuscarinic compound used to treat dementia

Answer 24

atropine

Question 25

list the cholinesterase reactivator used to treat dementia

Answer 25

pralidoxime

Question 26

MOA pralidoxime

Answer 26

cholinesterase regenerator

- regenerates active AChE enzyme by removing the phosphorus group from the active site of the enzyme

Question 27

when does pralidoxime need to be given

Answer 27

soon after AChE inhibitor exposure

Question 28

MOA memantine

Answer 28

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)

Question 29

compare adverse effects of memantine to the cholinergic medications

Answer 29

memantine has fewer AEs