Pharmacology of Dementia

Question 1

What MOA is the first-line therapy for AD?

Answer 1

AChE inhibitor (Donepezil)

Co

Question 2

How are the following medications taken?

Donepezil
Galantamine
Rivastigmine

Answer 2

Donepezil - once-daily sublingual tablet
Galantamine - twice-daily tablet or solution and once-daily ER capsule
Rivastigmine - twice-daily capsule, twice-daily solution and a 24-hr. transdermal patch

Question 3

What are the contraindications/precautions for use of AChE inhibitors as a group? (2)

Answer 3

Baseline bradycardia or known cardiac conduction system disease.

Do not use in comboination with drugs that induce bradycardia or alter AV nodal conduction (BBs, CCBs, etc.)

Question 4

Galantamine should not be used in which patients?

Rivastigmine has what unique requirements?

Answer 4

Galantamine: ESRD or hepatic impairment.

RIvastigmine: patch requires dose adjustment for hepatic impairment and low body weight.

Question 5

Donepazil contraindications:

Warning:

Adverse-reactions:

Answer 5

Known hypersensitivity to dopepezil HCl or piperidine derivatives.

Exaggeration of succinylcholine muscle relaxants during anesthesia.

N/V, diarrhea, insomnia, vomiting, cramps, fatigue.

Question 6

Galantamine indication:

Contraindications:

Warnings:

Adverse-effects:

Answer 6

Mild to moderate AD.

Known hypersensitivity to the drug.

Serious skin reactions
Active or occult GI bleed
Bladder outflow obstruction

N/V, diarrhea, insomnia, vomiting, cramps, fatigue.

Question 7

Rivastigmine indications:

Adverse-effects:

Answer 7

Mild to moderate AD
Mild to moderate PD

GI-related

Question 8

Memantine MOA:

What is the benefit of this drug?

Answer 8

NMDA (glutamate-type receptor) antagonist

Adverse events are less than cholinergic meds.