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Pharm for Dementia

From ANCC Review

QuestionAnswer
Cholinesterase inhibitors cognex, aricept, razadyne, exelon
initiation of cholinesterase inhibitor start low and go slow
anticipate this with this population greater sensitivity to medication side effects be alert to impact on general medical conditions employ polypharm with care
initiate medication based on severity of symptoms
When do you treat psychosis and agitation pharmacologically when behavior is dangerous or upsetting
should treat this with dementia depression
this should be given to help cognitive faculties in addition Vitamin E at 2000IU/day
NPs should educate these individuals caregivers as well
stabilization and maintenance of dementia alzheimer dementia is progressive so needs will continually need to be reassessed
if pt is experiencing GI problem, there is less of one with this medication patch
for mild to moderate alzheimers give this cholinesterase inhibitor
a cholinesterase inhibitor works by making more ACh available.
a cholinesterase inhibitor treats these issue behavioral, psychological and cognitive symptoms
adverse effects of cholinesterase inhibitors N/V/D appetite loss and increased gastric acid secretion
donepezil (Aricept) dosage 5-10mg HS with slow titration
First line treatment for dementia Aricept
Aricept does this increase LFTs less GI upset
tacrine (Cognex) dosage 40-160mg/day
tacrine (Cognex) monitoring monitor LFTs
tacrine (Cognex) is not the first line anymore because hepatotoxic many drug interactions
galantamine (Razadyne ) dosing 16-24mg/day
rivastigmine (Exelon) 6-12mg in two doses orally 9.5mg/24 hrs for the patch
treat agitation associated with dementia with these drugs SSRIs
for severe alzheimers use NMDA glutamate receptor antagonist
An NMDA glutamate receptor antagonist example Namenda
Namenda works by blocking low level overexcitation of glutamate receptors and stabilizes neurodegenerative process
Namenda is nice because it is well tolerated and low incidence of adverse effects. it promotes synaptic plasticity can be used in combination with cholinesterase inhibitors
memantine (Namenda) dosage 10mg BID
Created by: jonquil