Flashcards in Dementia Drugs Deck (13):
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
Which class or classes of drugs is (are) used once Alzheimer's has started progressing? MODERATE-SEVERE AD
CHOLINESTERASE INHIBITOR (GRD) + NMDA ANTAGONIST (MEMANTINE)
Which agents should be AVOIDED when treating pts with dementia?
Drugs that AGGRAVATE cognitive impairment:
2) BENZODIAZEPINES + Sedatives/Hypnotics
3) SECONDARY ANTI-CHOLINERGICS - DIPHENHYDRAMINE (benadryl anti-histamine) + TCAs [e.g. IMIPRAMINE]
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
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
CLASS 1 CHOLINESTERASE INHIBITORS: Name the 3 common cholinesterase inhibitors for cognitive decline.
GALANTAMINE - competitive inhibitor
RIVASTIGMINE - non-competitive inhibitor
DONEPEZIL - non-competitive inhibitor
CLASS 2 NMDA ANTAGONIST: Name the 1 NMDA antagonist used for Alzheimer's Disease.
BPSD: What are the behavioral and psychiatric symptoms of dementia?
Paranoia/ delusional thinking
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
BPSD: Which drugs are useful for treating the irritability, agitation, and psychosis of BPSD?
ATYPICAL ANTIPSYCHOTICS -
* Olanzapine and risperidone - limited due to Parkinsonism, sedation, and falls*
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
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