Alzheimer's Disease (AD) Borghol
Terms in this set (61)
Donezepil brand name
Aricept, Aricept ODT
Aricept is available as
Aricept must be taken with food. T or F
False — can be taken with or without food
Initial dose of aricept
5mg daily in the evening
Target doses for aricept
Mild-mod: 5-10mg daily
Mod-severe: 10-23mg daily
Weight loss is associated with the ____ dose of Aricept
Rivastigmine brand name
Exelon, Exelon Patch
Exelon is available as
Capsule, oral soln, patch
Exelon must be taken without food. T or F
False — take with food!!
Exelon initial dose
1.5 mg BID (capsule, oral soln)
4.6 mg/day (patch)
Exelon target dose
3-6mg BID (capsule, oral soln)
9.5-13.3 mg/day (patch)
Exelon is also indicated for
Parkinson's disease dementia
What to do if renal/liver impairment or low body weight with Exelon capsule/oral soln?
Lower the dose
What to do if mild-mod liver impairment or low body weight with exelon patch?
Max daily dose is 4.6mg/day
Razadyne, Razadyne ER
Razadyne comes as
Tablet, oral soln, ER capsule
Razadyne must be taken with meals. T or F
Razadyne initial dose
4mg BID (tablet, oral soln)
8mg daily in the morning (ER capsule)
Razadyne target dose
8-12mg BID (tablet, oral soln)
16-24mg/day (ER capsule)
What to do if moderate renal or hepatic impairment on Razadyne?
Max daily dose of 16mg
What to do if CrCl <30 or severe hepatic impairment on Razadyne?
Do not use!!!
Donezepil mild-mod dosing
5mg/day x 4-6 weeks then increase to 10mg/day
Donezepil mod-severe dosing
5mg/day x 4-6 weeks, then increase to 10mg/day x 3 months, then increase to 23mg/day
If a patient is taking <6mg of oral rivastigmine daily, which patch is equivalent?
If a patient is taking 6-12mg of oral rivastigmine daily, which patch is equivalent?
When can you increase the patch to 13.3mg/day?
If pt tolerates 9.5mg/day for 4 weeks (1 month)
How should the Exelon patch be applied?
At the same time each day
Do not use same site within 14 days!!
Do not apply to oily or hairy skin
Namenda, Namenda XR
Namenda initial dose
7mg daily (XR)
Namenda target dose
28mg daily (XR)
Namenda is available as
XR capsule, tablet, oral soln
Which formulation of Namenda must be taken with food or drink?
XR capsule — can be opened and sprinkled on applesauce
What to do if severe hepatic impairment in Namenda?
give with caution
What to do if several renal impairment in Namenda (CrCl <30)?
Split doses in half
Max dose of 5mg BID (tablet, oral soln)
Max dose 12mg daily (XR)
Memantine + Donezepil brand name
Namzaric initial dose
7mg (M)/10mg (D)
Namzaric target dose
14-28mg (M)/10mg (D)
The dose of donezepil in Namzaric does not exceed
Namzaric is available as
XR memantine capsule + donezepil tablet
Namzaric must be taken with food. T or F
False — can be taken with or without food — can open capsule and sprinkle contents on apple sauce
What to do if severe renal impairment (<30mL/min) on Namzaric?
If patient is stable on 10mg donezepil and naive to memantine, start combo at 7mg/10mg and increase to 14mg/10mg
Any score less than ____ on the MMSE indicates memory disorder
Which drugs are used for mild-mod?
Which drugs are used for mod-severe?
Donezepil (high dose)
What to do if rivastigmine or galantamine tx is interrupted for >3 days?
Restart at lowest dose and titrate to current dose (true for all formulations)
What to do when switching from one cholinesterase inhibitor to another?
A washout period is recommended due to side effect intolerance
An overnight switch is preferred to minimize clinical deterioration if lack of initial benefit/tx failure
If a pt experiences GI side effects with ChEi?
Change to patch, ODT, or long-acting formula
If a pt experiences insomnia with ChEi?
Take earlier in the day
ADRs of Exelon
ADRs of Razadyne
Serious skin reactions (Stevens-Johnson syndrome and acute exanthematous pustulosis)
ADRs of all ChEi's
N/v/d (most common), dizziness, syncope, bradycardia, arrhythmia, seizures, weight loss
ADRs of Namenda
HA, confusion, dizziness, hallucinations, constipation
Other potential treatments of AD
Statins (lipid-lowering agents)
Ginkgo Biloba (antioxidant, anti-platelet)
Huperazine A (ChEi)
Turmeric (decreases amyloid plaques)
Ginkgo Biloba should be avoided in/cautioned in
Avoided in pts on anticoagulant or antiplatelet therapy and used in caution in pts taken NSAIDs
Non-pharm tx is the first step in
treating non-cognitive symptoms
Treating psychotic behavior
Treating disruptive behavior
Wax and wane with disease progression
Some behaviors lack evidence of response to medication
Concurrent use of ____ with ____ should be avoided and non-pharm tx should be started (if possible)
Anticholinergic meds with ChEi's
Other drugs that can worsen dementia
Oxybutinin (Oxytrol) - peripheral anticholinergic
Benztropine - central anticholinergic
other CNS depressants