Alzheimer's

Question 1

Key Drugs That Worsen Dementia

Answer 1

Antipsychotics
-Aripiprazole
-Chlorpromazine

CNS Depressants
-Phenobarbital (Barbs)
-Alprazolam, clonazepam (BZDs)
-Hydrocodone, morphine (Opioids)
-Eszopiclone, zolpidem (Hypnotics)
-Carisoprodol (Muscle relaxants)

AC Effects
-Prochlorperazine (Antiemetics)
-Diphenhydramine, doxylamine (Antihistamines)
-Benztropine, oxybutynin, dicyclomine, tolteridone (Anticholinergics)
-Amitriptyline (Tricyclic AD)

Question 2

Supplements for Alzheimer’s

Answer 2

-Vitamin E (2000 QD) may slow rate of decline
-Acetyl-L-carnitine
-Ginkgo biloba
-Vinpocetine

Question 3

Alzheimer’s: Brexpiprazole (Rexulti) (BBW)

Answer 3

Only FDA-approved antipsychotic for the treatment of agitation
associated with dementia due to Alzheimer’s disease

-Olanzapine/quetiapine may be used off-label

BBW: increased death in the elderly (last-line)

Question 4

Alzheimer’s: Drug TX

Answer 4

Mild-Mod = ACi
-Donepezil
-Rivastigmine
-Galantamine

Mod-Sev = ACi +/- Memantine
*combo more effective

DR GM

Question 5

Alzheimer’s: Acetylcholinesterase inhibitors (MOA/AE)

Answer 5

Donepezil, Rivastigmine, Galantamine
-MOA: inhibit acetylcholinesterase (enzyme that does hydrolysis of acetylcholine), this causes an increase in acetylcholine

Warnings:
-Cardiac effects (Brady, AVB, syncope = ABS)
-GI (NVD, anorexia)
-Skin reactions (all formulations)

AE:
-Insomnia
-Dizziness

Donepezil + memantine = Namzaric

DRG in SD CIG

Question 6

Alzheimer’s: Donepezil Specifics

Answer 6

-Dosed QHS to decrease nausea
*if insomnia, may do morning

-If stable on donepezil 10 mg, can switch to Namzaric (memantine
7 mg/donepezil 10 mg QHS) and titrate weekly

Done NIN

Question 7

Alzheimer’s: Adlarity (Donepezil) Patch

Answer 7

Store in refrigerator; before use, remove patch from refrigerator and allow to reach RT (apply within 24hrs)

Apply a new patch at the same time each week to the upper or lower back (preferred site), upper buttocks or upper outer thigh
-Do not use same site within 14d
-Leave on for 7d, then remove

If transitioning from oral donepezil, apply patch at the same time as the last oral dose

AD = FSW 14

Question 8

Alzheimer’s: Exelon (Rivastigmine) Patch

Answer 8

If transitioning from oral rivastigmine, apply patch the day after the last oral dose

Some products may contain metal (remove before MRI)

Apply a new patch at the same time each day to the upper or lower back (preferred sites if patient might removepatch), or the upper arm or chest
-Do not use the same site within 14d

Keep on 24 hours, then remove

My EX is MAD 14

Question 9

Alzheimer’s: Rivastigmine Specifics

Answer 9

-Allergic contact dermatitis
-Take with food

Take my Derm to the River for Food

Question 10

Alzheimer’s: Galantamine Specifics

Answer 10

-SJS
-Take with food
-Solution can be mixed with liquid, drink immediately

galS in SF

Question 11

Alzheimer’s: Memantine (Namenda)

Answer 11

+ donepezil (combo) = Namzaric

Warnings:
-Caution with drugs (sodium bicarbonate or acetazolamide) or conditions (UTIs) that increase urine PH = can decrease clearance of memantine

AE:
-Dizzy
-Confusion
-HA
-Constipation

ER/Namzaric: DO NOT crush/chew
*capsules can be opened and sprinkled on apple sauce (swallow asap)
*oral solution = use syringe and squirt into mouth

MY MAN USA CDC (same for all ER, no crushing/chewing but can open/sprinkle)