6. Common medications

Question 1

Name cognitive enhancers (4)

Answer 1

• donepezil (Aricept)
• galantamine (Reminyl)
• rivastigmine (Exelon)
• memantine (Ebixa®/Namenda® (Can)/(U.S.))

Question 2

Describe: donepezil (Aricept)

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 2

• Dosing Schedule: 5-10 mg PO daily
• Indications: Moderate to severe dementia of Alzheimer’s type
• Contraindications:
  
  • Known hypersensitivity
  • caution in untreated obstructive airways disease
  • cardiac conduction abnormalities
  • Active Peptic Ulcer Disease
  • seizure disorder
  • syncope not yet diagnosed (NYD)
• ​Side Effets: N/V, diarrhea, anorexia, falls, hip fracture, increased need for pacemaker insertion
• Mechanism of Action: Reversible inhibition of acetylcholinesterase

Question 3

Describe: galantamine (Reminyl®)

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 3

• Dosing Schedule: 8-12 mg PO bid
• Indications: Mild to moderate dementia of Alzheimer’s type
• Contraindications:
  
  • Known hypersensitivity
  • caution in untreated obstructive airways disease, cardiac conduction
  • abnormalities
  • Active Peptic Ulcer Disease
  • seizure disorder
  • syncope not yet diagnosed
• Side Effets: N/V, diarrhea, anorexia, falls, hip fracture, increased need for pacemaker insertion
• Mechanism of Action: Reversible inhibition of acetylcholinesterase

Question 4

Describe: rivastigmine (Exelon®)

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 4

• Dosing Schedule: 1.5 mg PO daily (starting) up to 6 mg PO bid
• Indications: Mild to moderate dementia of Alzheimer’s type
• Contraindications:
  
  • Known hypersensitivity
  • severe hepatic disease
  • caution in untreated obstructive airways disease
  • cardiac conduction abnormalities
  • active peptic ulcer disease
  • seizure disorder
  • syncope not yet diagnosed
• Side Effets: N/V, diarrhea, anorexia, falls, hip fracture, increased need for pacemaker insertion
• Mechanism of Action: Acetylcholinesterase inhibition (reversible but very slow)

Question 5

Describe: memantine Ebixa®/Namenda® (Can)/(U.S.)

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 5

• Dosing Schedule: 5 mg PO daily (starting) up to 10 mg PO bid
• Indications: Mild to moderate dementia of Alzheimer’s type
• Contraindications:
  
  • Known hypersensitivity
  • conditions that alkalinize urine
  • caution in renal failure
  • seizures
• Side Effets: Agitation, fatigue, dizziness, headache, hypertension, constipation
• Mechanism of Action: NMDA-receptor antagonist

Question 6

Name different laxatives (6)

Answer 6

• bran (All-Bran®)
• psyllium
  • Metamucil®
  • Prodiem Plain®
• lactulose
  
  • Chronulac®
  • Cephulac®
  • Kristalose®(U.S.)
  • Acilac
  • Apo-Lactulose®
  • Laxilose
  • PMS-Lactulose (Can)
• senna
  
  • Senokot®/Ex-lax®
  • Glysennid®
• PEG 3350 (polyethyleneglycol)
  
  • Lax-A-Day®,RestoraLAX®,Pegalax® (Can)
  • Gavilax®,Healthylax® (U.S.)
• bisacodyl (Dulcolax®)

Question 8

Describe: bran (All-Bran®)

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 8

• Dosing Schedule: 1 cup OD
• Indications: Constipation
• Contraindications: -
• Side Effets: Bloating, flatus
• Mechanism of Action: Bulk-forming laxative

Question 9

Describe: psyllium

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 9

• Dosing Schedule: 1 tsp PO tid
• Indications: Constipation, hypercholesterolemia
• Contraindications: N/V, abdominal pain, obstruction
• Side Effets: Bloating, flatus
• Mechanism of Action: Bulk-forming laxative

Question 10

Describe: lactulose

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 10

• Dosing Schedule: 15-30 cc PO OD/bid
• Indications:
  
  • Constipation
  • hepatic encephalopathy
  • bowel evacuation following barium exam
• Contraindications:
  
  • Patients on low galactose diets
  • Abdominal pain
  • N/V
• Side Effets: Flatus, cramps, nausea, diarrhea
• Mechanism of Action: Hyperosmolar agent, lowers pH of colon to decrease blood ammonia levels

Question 11

Describe: senna

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 11

• Dosing Schedule: 1-2 tabs PO daily or 10-15 cc syrup PO daily
• Indications: Constipation
• Contraindications: Abdominal pain, N/V
• Side Effets: Cramps, N/V , diarrhea
• Mechanism of Action: Stimulant laxative

Question 12

Describe: PEG 3350 (polyethylene glycol)

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 12

• Dosing Schedule: 17 g (~1 heaping tablespoon) dissolved

in 120 to 240 mL (4 to 8 ounces) of beverage, OD

• Indications: Constipation, bowel prep (different dosing schedule)
• Contraindications: Known/suspected bowel

obstruction, known hypersensitivity, renal impairment

• Side Effets: Abdominal cramps, bloating of the stomach, diarrhea, flatulence, nausea
• Mechanism of Action: Osmotic laxative

Question 13

Describe: bisacodyl

• Dosing Schedule
• Indications
• Contraindications
• Side Effets
• Mechanism of Action

Answer 13

• Dosing Schedule: 5-15 mg PO (10 mg PR)
• Indications: Constipation
• Contraindications: Ileus, obstruction, abdominal pain, N/V, severe dehydration
• Side Effets: Cramps, pain, diarrhea
• Mechanism of Action: Stimulant laxative

Question 14

Describe pharmacologic tx of Parkinson’s Disease (3)

Answer 14

• mainstay of treatment: levodopa/carbidopa (Sinemet®) or levodopa/benserazide (Prolopa®)
  
  • Levodopa is a dopamine precursor; carbidopa and benserazide decrease peripheral metabolism of levodopa, decreasing side effects and increasing half-life of levodopa
    
    • levodopa-related fluctuation: delayed onset of response (affected by mealtime), end-of-dose deterioration (“wearing-off ”), random oscillations of on-off symptoms
    • major adverse effect of levodopa is dyskinesia
• treatment of early PD: dopamine agonists, amantadine, MAOI
• adjuncts: dopamine agonists, MAOI, anticholinergics (especially if prominent tremors), catechol-O-methyltransferase inhibitors