Alzheimers (NAPLEX)

Pathophys of alzheimers

Neuropathic changes (amyloid beta plaques) that lead to the death of cholinergic neurons, resulting in decreased acetylcholine

Signs of dementia (5)

• Memory loss

• Difficulty planning

• Getting lost

• Repeating words

• Delusions & agitations

Alzheimers screening tool

MMSE (mini-mental state exam)

What vitamin deficiency can cause memory impairment? (2)

• B12

• Vitamin D

Medications that can worsen dementia * (studygal lots)

• Antipsychotics

• CNS depressants (barbiturates, benzos, opioids, hypnotics, skeletal muscle relaxants)

• Drugs with anticholinergics (prochlorperazine, antihistamines, benztropine, oxybutynin, dicyclomine, TCA)

CAM for dementia (2)

• Vitamin E

• Gingko biloba

Mainstay TX for alzheimers

• Mild-mod: Acetycholinesterase inhibitors (donepezil)

• Mod-severe: ^ + memantine

Acetycholinesterase inhibitor examples (3)

• Donepezil (aricept ODT, adlarity patch weekly), donepezil/memantine (Namzaric)

• Rivastigmine (Exelon)

• Galantamine

NMDA blocker example (1)

• Memantine (Namenda), memantine/donepezil (Namzaric)

Memantine MOA

NMDA receptor blocker

When should you take donepezil tablets?

QHS to decrease nausea, but if insomnia occurs you can do AM dosing

Donepezil patch is dosed _____

weekly

Rivastigmine patch is dosed ____

daily

acetycholinesterase inhibitors adverse effects (5)

• Bradycardia

• QT prolongation (donepezil)

• N/v

• Diarrhea

• Insomnia

What patch is stored in the fridge?

Donepezil (adlarity)

Memantine adverse effects (3)

• Dizziness

• Confusion

• Headache