Dementia- Pharm

Question 1

AchE-I

• quad charged- distribution and examples
• tertiary uncharged- distribution and examples
• which are used to treat dementia

Answer 1

AchE-I
Quad charged- no CNS distribution; n/p-stigmine, echo, edrop, ambenonium

Tertiary uncharged- CNS distribution; physostigmine, donepezil, galantamine, rivastigmine, tacrine

Dementia- donepezil, galantamine, rivastigmine, tacrine (obsolete)

Question 2

AchE-I

• MOA
• effects- CNS (low and high [ ]) and NMJ

Answer 2

AchE-I
MOA- inhibit AchE
CNS- low [ ]- diffuse activation on EEG; high [ ]- convulsions
NMJ- strengthen m contraction by prolonging and intensifying Ach activation; high [ ] cause fibrillations and fasciculations; continual activation progresses from depol blockade to nondepol blockade

Question 3

AchE-I
AE- tacrine and acute intoxication
Treating AE

Answer 3

AchE-I
Tacrine AE- hepatotoxicity- no longer used
Acute intoxication- miosis, sweat, salivate, bronchoconstrict, diarrhea (GI symptoms first), confusion, convulsion, coma, death due to resp failure

Treat AE- atropine (ineffective at nAchR); pralidoxine (regen AchE at NMJ); combo treat w/ pralidoxine, atropine, and benzodiazepam

Question 4

Memantine
MOA
AE

Answer 4

Memantine
MOA- NMDA glutamate R antagonists binds Mg binding site to prevent excessive activation and Ca influx but still allows nml neurotransmission
AE- dizzy, confusion, hallucination