Medications for Alzheimer Disease: Nursing Pharmacology

Overview

• Alzheimer disease is the most common cause of dementia.
• There is no cure for Alzheimer's, but certain medications can help mitigate symptoms and improve quality of life.
• Medications are divided into two main classes:
  • Acetylcholinesterase inhibitors
  • NMDA receptor antagonists

Acetylcholinesterase Inhibitors

• Common Drugs:
  • Rivastigmine (Exelon)
  • Galantamine (Razantine)
  • Donepezil (Aricept)
• Mechanism of Action:
  • Inhibit enzyme acetylcholinesterase, increasing acetylcholine in synaptic cleft.
  • Enhances cholinergic transmission potentially improving Alzheimer symptoms.
• Administration:
  • Oral (PO)
  • Rivastigmine also available as a transdermal patch.
• Side Effects:
  • Cholinergic side effects: miosis, blurred vision, drowsiness, dizziness.
  • Respiratory: bronchoconstriction, increased secretions.
  • Cardiovascular: bradycardia, hypotension, heart block.
  • Gastrointestinal: nausea, vomiting, diarrhea, increased salivation.
  • Urinary: urgency.
• Contraindications and Cautions:
  • Bradycardia, intestinal/urinary obstruction.
  • Use caution during pregnancy, breastfeeding.
  • Asthma, COPD, epilepsy, severe hepatic or renal impairment.

NMDA Receptor Antagonists

• Common Drug: Memantine (Namenda)
• Mechanism of Action:
  • Blocks NMDA receptors preventing excessive calcium influx that causes neuronal damage.
• Administration:
  • Oral (PO)
• Side Effects:
  • Drowsiness, headache, agitation.
  • Gastrointestinal: nausea, vomiting, constipation, diarrhea.
• Contraindications and Cautions:
  • Pregnant or breastfeeding clients.
  • Epilepsy, severe hepatic or renal impairment.

Nursing Considerations

• Assessment and Monitoring:
  • Baseline weight, vital signs, hepatic/renal function.
  • Cardiac and respiratory function assessment.
  • Monitor cognitive and behavioral function.
• Client Education:
  • Change positions slowly to avoid dizziness.
  • Take medication with food to reduce gastric upset.
  • Report symptoms like cough, breathing trouble, urinary urgency.
  • Store medications at room temperature, in dry place.
  • Maintain a balanced diet to promote balanced urine pH.