27: Anti-Dementia

What is the brand name for Memantine

-Namenda
-Namenda XR

What is the generic name for Namenda, Namenda XR

Memantine

What is the pharmacologic category for Memantine (Namenda, Namenda XR)

N-Methyl-D-Aspartate Receptor Antagonist

What is the brand name for Donepezil

Aricept

What is the generic name for Aricept

Donepezil

What is the pharamacologic category for Donepezil (Aricept)

Acetylcholinesterase inhibitor

What are the dosage forms for Memantine (Namenda, Namenda XR)

-Solution
-Tablet
-Capsule ER

What are the indications for Memantine (Namenda, Namenda XR)

-Alzheimer Disease

What is the MOA for Memantine (Namenda, Namenda XR)

Activation of NMDA receptors by glutamate is believed to contribute to the symptomatology of Alzheimer disease. It is believed to act as an uncompetitive (open-channel) NMDA receptor antagonist that binds preferentially to the NMDA receptor-operated cation channels. There is no evidence that it prevents or slows neurodegeneration in patients with Alzheimer disease.

What are the contraindications for Memantine (Namenda, Namenda XR)

-Hypersensitivity

What drug interacts with:

-Urinary Alkalinizers

Memantine (Namenda, Namenda XR)

What are the efficacy monitoring parameters for Memantine (Namenda, Namenda XR)

Improvement in cognitive function and ability to take part in activities of daily living. Prevention of decreased cognition following whole brain irradiation.

What are the monitoring parameters for Memantine (Namenda, Namenda XR)

Seek medical attention if severe adverse effects occur; BP, eye exams, LFTs, electrolytes, SCr.

What are the counseling points for Memantine (Namenda, Namenda XR)

May be taken with or without food. The oral solution is packaged with a dosing device that should be used to administer the medication.

What are the dosage forms for Donepezil (Aricept)

-Tablet
-ODT
-Transdermal Patch

What are the indications for Donepezil (Aricept)

-Alzheimer Disease
-Dementia

What is the MOA for Donepezil (Aricept)

Enhances the action of acetylcholine by reversibly inhibiting acetylcholinesterase (AChE), the enzyme responsible for its hydrolysis. It has a high degree of selectivity for AChE in the CNS, which might explain the relative lack of peripheral side effects.

What are the contraindications for Donepezil (Aricept)

-Hypersensitivity
-Prior rash with patches

What drug interacts with:

-Tolterodine
-Oxybutynin
-Ramelteon

Donepezil (Aricept)

What are the common adverse reactions for Donepezil (Aricept)

-Asthenia
-Diarrhea
-Nausea

What are the efficacy monitoring parameters for Donepezil (Aricept)

Improvement in symptoms of Alzheimer-type dementia; however, only slowed decline rather than improvement may be seen.

What are the toxicity monitoring parameters for Donepezil (Aricept)

Symptoms of active or occult GI bleeding, particularly if patient has history of ulcer disease or is receiving concomitant NSAIDs. Monitor for bradycardia, particularly in patients with sick-sinus syndrome or conduction abnormalities. Monitor weight and appetite.

What are the counseling points for Donepezil (Aricept)

Take at bedtime, with or without food. Allow disintegrating tablet to dissolve on tongue and follow with a glass of water. Additionally, the 23 mg immediate-release tablet should be swallowed whole and not divided, chewed, or crushed due to the tablet coat. The transdermal patch should be stored in the fridge until use. When applying the patch, ensure it reaches room temperature prior to applying. Adverse effects may be more frequent at dose escalation and tend to resolve with continued use. Report signs/symptoms of GI bleeding.