Donepezil (Aricept) - ANS ✓-Reversible, long-acting selective inhibitor of
acetylcholinesterase (AChE),
-transient gastrointestinal side effects
-Taken once daily
Galantamine - ANS ✓AChE inhibition and positive allosteric modulation (PAM)
of nicotinic cholinergic receptors.
-Cholinesterase inhibitor, enhances actions of acetylcholine
-Contraindicated in patients with renal or hepatic impairment
Rivastigmine - ANS ✓Cholinesterase inhibitor
Available as oral and transdermal
The oral formulation may result in more gastrointestinal side effects than
donepezil,
-inhibition of both AChE and butyrylcholinesterase (BuChE) in the periphery.
Memantine - ANS ✓-NMDA receptor antagonist
-Stops the excessive glutamate from interfering with the resting glutamate
neuron's physiological activity and thus improving memory.
Biomarkers of Alzheimer's - ANS ✓-Presymptomatic stage of Alzheimer's
disease, A-beta peptides are slowly and relentlessly deposited into the brain
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NURS660
, NUR
rather than eliminated via the CSF, plasma, and liver. CSF levels of amyloid beta
decrease.
-With progression, tau and phosphorylated tau protein levels in the CSF increase.
-Brain amyloid seen on amyloid-PET scans
Pathophysiology of Alzheimers - ANS ✓-Extracellular amyloid plaque build up-
Intracellular formation of neurofibrillary tangles (made up of Tau protein)
Impulsivity is hypothesized to be related to the _____, while compulsivity is
hypothesized to be related to the _____. - ANS ✓Ventral striatum, dorsal
striatum
DC
IV
Naltrexone - ANS ✓Opioid antagonist
Blocking mu-opioid receptors interrupts reward pathways in brain.
Contraindicated in pts with severe liver impairment
Can't use until patient has been off opioids for 7-10 days, long half-life
IM 30 day option (trial oral first)
Disulfiram - ANS ✓Used in tx of alcohol cessation. Antabuse
Inhibits acetaldehyde dehydrogenase-->increased acetaldehyde when drinking
(toxic)-->N/V, flushing, hypotension-->incentive not to drink
Can't initiate until pt hasn't drank alcohol for 12 hours+. Long half-life, can take
up to two weeks to clear.
May react to any alcohol/ethanol, including hand sanitizer, kombucha, etc.
Acamprosate - ANS ✓Decreases unpleasant effects resulting from abstinence
like dysphoria, anxiety, restlessness.
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