4.6 Alzheimers Therapeutics

Nickelson Study Guide

class: tacrine

cholinesterase inhibitors

class: donepezil

cholinesterase inhibitors

class: rivastigmine

cholinesterase inhibitors

class: galantamine

cholinesterase inhibitors

class: memantine

NMDA antagoinst

class: iecanemab

monoclonal antibody

class: donanemab

monoclonal antibody

MOA: cholinesterase inhibitors

increases ACh through inhibition of acetylcholinesterase

MOA: NMDA antagonist

blocks the NMDA receptors to stop overexcitation of glutamate activity

MOA: iecanemab

directed against aggregated beta-amyloid (targets smaller forms of protein before form into plaques)

MOA: donanemab

targets amyloid

pharmacologic tx options for alzheimers

cholinesterase inhibitors

NMDA antagonists

psychiatric drugs

cholinesterase inhibitors help with…

cognition 

NMDA antagonists help with…

activities of daily living (ADLs)

cognition and short term memory is based on the actions of …

ACh

drugs that ____ ACh can protect cognition and memory

increase

which cholinesterase inhibitors are indicated for mild to moderate AD?

rivastigmine and galantamine

rivastigmine and galantamine are indicated for…

mild to moderate AD

which cholinesterase inhibitor is indicated for mild/moderate/ an severe AD?

donepezil 

donepezil is indicated for…

mild, moderate, and severe AD

galantamine titration

titrate upwards every 4 weeks if tolerated

avoid taking galantamine in pts with…

severe hepatic insufficiency or severe renal impairment 

which AD tx option should be avoided in pts with severe hepatic insufficiency or severe renal impairment?

galantamine

rivastigmine titration

titrate upwards every 2-4 weeks

memantine indication 

moderate to severe AD

mild to moderate dementia

normal levels of _____ are integral in neural pathways associated with learning and memory

glutamate

excessive glutamate in the CNS leads to…

neuronal toxicity and impaired learning

memantine titration

titrate up for 4 weeks

tx rec:

mild to moderate dementia

cholinesterase inhibitor

(donepezil, rivastigmine, and galantamine)

tx rec: 

moderate to advanced dementia

cholinesterase inhibitor + memantine

memantine alone 

tx rec:

severe dementia

continue memantine

adjunctive medications for AD

antidepressants

antipsychotics

dextromethorphan and quinidine