Psychopharm - Geriatric

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from class 5/14

Characteristics of elderly and psychopharmacology

- age-associated pharmacokinetic changes tend to prolong half-life and potential toxicity of drugs
- older patients tend to be more sensitive to side effects of drugs

What is NOT true about geriatric patients?

have increased liver metabolism and hence require higher doses of medication

What are some common causes for reversible dementia?

- Depression (Psuedodementia)
- Overmedication with BDZ or anticholingerics
- Polypharmacy
- UTI or kidney infections

Reversible dementias may be reversible in up to __% of cases.

20%

What medications are used in the treatment of degenerative dementias?

1) CHOLINESTERASE INHIBITORS:
- Tacrine/Cognex (hepatotoxic - increased risk of liver damage; seldom used)
- Donepezil/Aricept
- Rivastigmine/Exelon
- Galantamine/Razadyne

2) GLUTAMATE NMDA RECEPTOR ANTAGONIST
- Memantine/Namenda

What is the rationale for the use of cholinesterase inhibitors in dementia?

- the acetylcholine (ACh) M1 sub receptor is key for cortico-cerebral memory functions
- there is decreased cholinergic function in the degenerative dementias, especially Alzheimer's
- acetylcholinesterase and butyrylcholinesterase are the enzymes that break down acetylcholine
- inhibiting the cholinesterase increases acetylcholine

How do cholinesterase inhibitors work?

slow down the break down of acetylcholine

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