Miscellaneous Quiz / Dementia Drugs

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Can you name the Dementia Drugs?

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Effect: Improved cognitive & psychomotor function. Reduction on care dependence. Neuroprotective - slows dz progression
Donepezil class
Natural alkaloid derived from daffodil
Use: Moderate to severe AD. Pending approval for mild AD. In trials for moderate vascular dementia
SE: Higher CNS affinity --> less PNS side effects
SE: GI
Clinical efficacy similar to donepezil and tacrine
P-kinetics: Multiple daily dosages & a slow dosage titration to limit GI side effects. Partial metabolism via CYP450, renal excretion.
Use: Mild to moderate AD (viable 1st line tx). May also be beneficial in treating s/s of vascular dementia & dementia w/ Lewy Bodies
P-kinetics: Once daily dosing, 100% oral bioavailability. Metabolism by cytochrome p450
Use: Mild to moderate AD & mild to moderate dementia in Parkinson's dz. In phase III trials for Lewy Body dementia & mild cognitive impairment
1st drug for improving cognitive s/s in AD. Reduces deterioration in cognitive performance (MMSE & CGIC) in the first 3 mo - no evidence it delays long term course of AD
P-kinetics: Partial hepatic metabolism (not p450 - few rx interactions). T1/2 = 60-80 hrs, clearance decreased in alkaline & increased in acidic urine. ER formulation available.
HintAnswer
Use: Symptom management in mild, moderate, & severe AD. Improves global function, cognition, behavior, and delays time to institutionalization. Does not alter long term prognosis.
SE: Many. Hepatotoxic -- not drug of choice
Inhibits AChE. Increases effect of remaining cholinergic afferents. May reduce A-beta 1-42 by stimulating Ab production. May help control some behavioral symptoms.
SE: Mostly GI - available in patch with less side effects.
P-kinetics: Metabolized by cholinesterase at CNS sites
P-kinetics: Poor oral bioavailability
MOA: NMDA receptor antagonist (use-dependent, non-competitive)
Tacrine class
Long-acting AChE inhibitor, muscarinic modulator & nicotinic agonist, also may be MAOI, decreases GABA release, increases release of NE, DA, 5-HT
Galantamine class
SE: Tolerated well - side effect frequency similar to placebo
Rivastigimine class

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