Treatment of Alzheimer's Disease

Question 1

Cholinergic hypothesis

Answer 1

Inolved iwth learning and memory

Question 2

Ach synthesis

Answer 2

Choline and acetyl-oA synthesize to Ach by CAT

Transported across

Degraded to choline and acetate

Recylcled by uptake

Question 3

Cholinergic dysfunctio in AD

Answer 3

Damaged early

Los of nuclei that produce Ach

Also decline in nicotonic but NOT muscarinic receptor

Question 4

Effects of cholinergic agents

Answer 4

Decreased apathy, psychosis, agitation, anxiety, depression

Question 5

Tacrine

Answer 5

For mild to moderate

Reversible AchE inhibitor

Dosed 1QID

Low bioavailability

Gender bias (higher [] in females)

CYP1A2 metab

Question 6

Tacrine contra and SE and tx for overdose

Answer 6

Liver and CV dz

Diarrhea (butyrylcholinesteease)

Atropi en IV

Question 7

Donepezil compared to tacrine

Answer 7

More selective for AchE vs. Butyryl

Completely bioavailable

Single dose

Better tolerated

All stages

Question 8

Galantamime

Answer 8

For mild to mod

Both AchE inhibitor and nicotinic receptor modulator

May provide some protection

Question 9

Rivastigmine tartrate

Answer 9

Ache inhibitor
Tablets, liquid, patch

Mild to mod

Can get more serious side effects

Question 10

Excitotoxic hypothesis

Answer 10

Excitatory NT in CNS and pruning of CNS neurons by targeted neurotoxicity

Question 11

Memantine

Answer 11

Non-competitive antagonist of NMDA receptor

Binds when open to reduce glutamate release

Mod to severe

HIgh available

Some evidence it can slow

Question 12

Duration for
Donepizil
Galantamine
rivastigmine

Answer 12

2
1
1

Question 13

Tacrine other adverse effects and dosage

Answer 13

Take on empty stomach

Hepatotoxicity

Question 14

How to target low mood,irritability
Anxiety, restlessness, verbal disruptive
Hallucinations

Answer 14

Citalopram (abnormal heart rhythms)
Anxiolytics
Anti-psychotics (be careful)

Start low