Real Life Pharmacology Podcast: Acetylcholinesterase Inhibitors

Host

• Eric Christensen, Pharmacist

Topic

• Acetylcholinesterase Inhibitors, focusing on Donepezil (brand name: Aricept)

Uses

• Primarily for managing dementia, mainly Alzheimer's dementia

Mechanism of Action

• Targets low cholinergic activity in Alzheimer's
• Aims to preserve acetylcholine in the brain, aiding memory recall and cognitive function
• Important Points:
  • Does not stop or reverse dementia
  • Helps with symptoms but progression continues

Dosing

• Initial Dose: 5 mg
• Increase Dose: Up to 10 mg after 4-6 weeks
• High Doses: Up to 20 mg (expensive and comes with higher adverse effects)
• Discussion with Patients/Caregivers: Balance clinical risk vs. benefit

Adverse Effects

• GI Issues: Nausea, diarrhea, GI upset (most common)
• Insomnia: Possible in < 10% of patients, but medication usually dosed at night
• Weight Loss: Due to GI side effects, challenging to assess in dementia patients
• Bradycardia: Potential but rare
• CNS Side Effects: Psychiatric changes (confusion, hallucination, anxiety)
• Urinary Incontinence/Frequency: May exacerbate these conditions

Comparing to Anticholinergic Effects

• Adverse effects often opposite to anticholinergic drugs (e.g., anticholinergics cause constipation while acetylcholinesterase inhibitors cause diarrhea)

Drug Interactions

• Anticholinergic Drugs: Oppose effects of acetylcholinesterase inhibitors (e.g., tricyclic antidepressants, older generation antihistamines like diphenhydramine, hydroxyzine, oxybutynin)
• Bradycardia Meds: Be cautious with beta blockers, certain calcium channel blockers (diltiazem, verapamil) as they may exacerbate low pulse rate

Resources and Sponsor

• Med Ed 101: Support for students and graduates, various resources for pharmacists and nurse practitioners (audible books, hard copy books, online resources)
• Free PDF: Top 200 drugs resource available for followers

Conclusion

• Reminder: Leave a rating/review on iTunes
• Thank You: Appreciation for listeners and supporters

Close

• Signing off and wishing a great day to listeners