Dementia Drugs Flashcards Preview

Class: Neuro > Dementia Drugs > Flashcards

Flashcards in Dementia Drugs Deck (13):
1

Which class of drugs should be used for EARLY STAGE Alzheimer's disease? What is the goal of starting this class of drugs?

CHOLINESTERASE INHIBITORS (GALANTAMINE + RIVOSTIGMINE + DONEPEZIL) - Goal is to induce temporary reprieve from progression OR reduce decline rate

2

Which class or classes of drugs is (are) used once Alzheimer's has started progressing? MODERATE-SEVERE AD

CHOLINESTERASE INHIBITOR (GRD) + NMDA ANTAGONIST (MEMANTINE)

3

Which agents should be AVOIDED when treating pts with dementia?

Drugs that AGGRAVATE cognitive impairment:
1) ANTICHOLINERGICS
2) BENZODIAZEPINES + Sedatives/Hypnotics
3) SECONDARY ANTI-CHOLINERGICS - DIPHENHYDRAMINE (benadryl anti-histamine) + TCAs [e.g. IMIPRAMINE]

4

Pathogenesis of Alzheimer's: Which 2 neurons are degenerated with progression of Alzheimer's?

LOSS of hippocampal and cortical neurons -> Memory and cognitive impairment in Alzheimer's

7

CLASS 1 CHOLINESTERASE INHIBITORS: What are the 2 rationales/hypotheses for using CHOLINESTERASE inhibitors for Alzheimer's?

Hypothesis 1) Ach deficiency = Cognitive Loss in Alzheimer's
Hypothesis 2) Central cholinergic antagonists (ATROPINE) = Induces confusional state resembling dementia

8

CLASS 1 CHOLINESTERASE INHIBITORS: Name the 3 common cholinesterase inhibitors for cognitive decline.

"GRD"
GALANTAMINE - competitive inhibitor
RIVASTIGMINE - non-competitive inhibitor
DONEPEZIL - non-competitive inhibitor

9

CLASS 2 NMDA ANTAGONIST: Name the 1 NMDA antagonist used for Alzheimer's Disease.

MEMANTINE

10

BPSD: What are the behavioral and psychiatric symptoms of dementia?

Depression/Anxiety
Irritability/agitation
Paranoia/ delusional thinking
Wandering

11

BPSD: Which drugs are useful for treating the ANXIETY and DEPRESSION symptoms of BPSD (behavioral and psychiatric symptoms of dementia)?

SSRIs: FLUOXETINE, FLUVOXAMINE, PAROXETINE, SERTRALINE, CITALOPRAM, ESCITALOPRAM

12

BPSD: Which drugs are useful for treating the irritability, agitation, and psychosis of BPSD?

ATYPICAL ANTIPSYCHOTICS -
OLANZAPINE
RISPERIDONE
ARIPIPRAZOLE
QUETIAPINE
* Olanzapine and risperidone - limited due to Parkinsonism, sedation, and falls*

13

BPSD: Which drug is useful to treat BPSD, ONLY if aggression is presented for ACUTE ALZHEIMER'S? What are side effects of this drug that limit its usage?

TYPICAL ANTI-PSYCHOTIC (HALOPERIDOL) - Sedation and EPS limit its usage

14

CLASS 2 NMDA ANTAGONIST: What is the mechanism of action of MEMANTINE?

Non-competitive NMDA-Glu receptor antagonist -> Reduces Glu activity without impairing its function

15

CLASS 2 NMDA ANTAGONIST: What stage of Alzheimer's does MEMANTINE treat?

Moderate-Severe AD
Decreases AD deterioration rate