Drugs for Alzheimer's Disease
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| Alzheimer's disease: risk factor (major one) | Advancing age; onset is usually 65 years old
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| Alzheimer's disease: risk factors | Family hx, female, production of apoE4, high levels of homocysteine, low levels of folic acid
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| Alzheimer's disease: mild symptoms | Memory loss, confusion, disorientation, problems with routine tasks, changes in judgement and personality
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| Alzheimer's disease: moderate symptoms | Difficulty with ADLs, anxiety, suspiciousness, agitation, sleep disturbances, wandering pacing, difficulty recognizing family and friends
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| Alzheimer's disease: severe symptoms | Loss of speech, loss of appetite, weight loss, loss of bladder and bowel control, total dependence on caregiver
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| Alzheimer's disease: cholinesterase inhibitors drugs | Donepezil, galantamine, rivastigmine, and tacrine
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| Alzheimer's disease: NDMA antagonist | Memantine
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| Cholinesterase inhibitors: mechanism of action | Prevents breakdown of Ach by AchE, increasing availability of Ach at cholinergic synapses
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| Cholinesterase inhibitors: uses | Mild to moderate symptoms
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| Cholinesterase inhibitors: adverse effects | Anticholinergic effects in periphery, bronchoconstriction, bradycardia
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| Cholinesterase inhibitors: drug interaction that reduces therapeutic effects | Drugs that block cholinergic receptors
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| Cholinesterase inhibitors: drug interactions | Antihistamine, tricyclic antidepressants, antipsychotics
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| Tacrine: mechanism of action | Reversible inhibition of AchE
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| Tacrine: adverse effect | Liver damage
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| Tacrine: disadvantage | Dosing is 4 times a day
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| Donepezil: mechanism of action | Reversible inhibition of AchE
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| Donepezil: adverse effects | Better tolerated. nausea, diarrhea, bradycardia
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| Memantine: mechanism of action | Blocks calcium influx when glutamate is low, and permits calcium influx when glutamate is high
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| Memantine: uses | Moderate to severe AD
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| Memantine: pharmacokinetics | Renal excretion. Contraindicated in patients with severe renal impairment
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| Memantine: adverse effects | Dizziness, headache, confusion, constipation
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| Memantine: drug interaction that increases therapeutic effects | NMDA antagonist, sodium bicarbonate
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