Pharm of Dementia Flashcards
What is a contraindication to cholinesterase inhibitors?
They enhance vagal tone and can’t be used in pt w/ baseline bradycardia or a cardiac conduction system disease
Can cause syncope, falls, and fractures
What drugs should you avoid using w Ch inhibitors?
Anything that causes bradycardia or alters AV nodal conduction (beta blockers, Ca channel blockers, Lacosamide)
Which drug should not be used if a pt has end stage kidney disease?
Galantamine
Which drug needs dose adjustments for hepatic impairment and low body weight?
Rivastigmine patch!
Donezepil indications
Dementia of Alzheimers type
Has efficacy in mild, moderate, severe
What are CIs to donezepil?
Hypersensitive to donepezil HCLor piperidine derivatives
What are some precautions w donezepil?
Exaggerates muscle relaxation in anesthesia and has vagotonic effects on SA and AV nodes - bradycardia or heart block
Most common severe reactions to the cholinesterase inhibitors?
Diarrhea, insomnia, vomiting, nausea, muscle cramps, fatigue, anorexia
Galantamine indications
Mild to moderate Alzheimer’s dementia
Warnings for Galantamine (5)
- Serious skin reactions
- Adverse effects on cardiac conduction
- Active/occult GI bleeding - esp if at risk for ulcers
- Bladder outflow obstruction
- Asthma or COPD can cause respiratory adverse events
What is Rivastigmine indicated for?
Mild to moderate Alzheimers dementia
Mild to moderate Parkinson’s w dementia
What is the only patch dementia drug (probs not important at all tbh)?
Rivastigmine
What are the main adverse effects seen w rivastigmine?
Nausea and vomiting
What is the purpose of pralidoxime in dementia pharmacology?
Regenerates active AChE enzyme by removal of the phosphorus group from active site of enzyme
Restores response w/in minutes but needs to be given soon after AChE inhibitors
What would you typically combine to tx AChE inhibitors?
Atropine, pralidozime, and a benzo (do you remember the benzos?)
When is atropine needed in dementia pharm?
Used w maintenance of vital signs and decontamination if there’s an AChE overdose/adverse reaction
Ineffective against peripherial nAChRs!
Memantine MOA
antagonist of NMDA glutamate receptors - binds to intra-pore Mg site w longer swell time and acts as receptor blocker under excessive stimulation conditions
Why is memantine useful in dementia?
glutamate might over stimulate receptors and lead to excitotoxicity and cell death in AD
