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Flashcards in Dementia Drugs Deck (13)
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1
Q

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

A

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

2
Q

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

A

CHOLINESTERASE INHIBITOR (GRD) + NMDA ANTAGONIST (MEMANTINE)

3
Q

Which agents should be AVOIDED when treating pts with dementia?

A

Drugs that AGGRAVATE cognitive impairment:

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

4
Q

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

A

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

7
Q

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

A

Hypothesis 1) Ach deficiency = Cognitive Loss in Alzheimer’s

Hypothesis 2) Central cholinergic antagonists (ATROPINE) = Induces confusional state resembling dementia

8
Q

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

A

“GRD”
GALANTAMINE - competitive inhibitor
RIVASTIGMINE - non-competitive inhibitor
DONEPEZIL - non-competitive inhibitor

9
Q

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

A

MEMANTINE

10
Q

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

A

Depression/Anxiety
Irritability/agitation
Paranoia/ delusional thinking
Wandering

11
Q

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

A

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

12
Q

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

A
ATYPICAL ANTIPSYCHOTICS - 
OLANZAPINE 
RISPERIDONE
ARIPIPRAZOLE
QUETIAPINE
* Olanzapine and risperidone - limited due to Parkinsonism, sedation, and falls*
13
Q

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?

A

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

14
Q

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

A

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

15
Q

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

A

Moderate-Severe AD

Decreases AD deterioration rate