1. You have 9 seconds left…
Let’s Play!

2. Which color is missing?
?

3. Guess who’s who?
Let’s Play!

4. Impressive!
Scoreboard:
• Dr. A
• Dr. G
• Dr. S
• Dr. T

5. By the way,
what is
today’s date?

6. Memory is
powerful.
but not until
we lose it that
we fully realize
its significance

7. Aging
Beautifully:Visions & Realities
Part III: Dementia
http://www.goodlifeguide.net/wp-content/uploads/2012/09/beach-seniors-X-license.jpg
By Christine Hortillosa
Pharm.D. 2013 Candidate
University of Texas at Austin College of Pharmacy
5. 9. 2013

8. Delirium
Dementia
Acute
Two of the following:
•Misinterpretation, illusions, hallucinations
•Incoherent speech
•Disturbance in sleep-wake cycle
•Change in psychomotor activity
Related to medical illness + medications
Reversible
Progressive
Marked by memory impairment
Not a normal part of aging
Irreversible

9. Most common form
of dementia is…
Alzheimer’s
disease

10. mild
moderate
severe
20-
24
Short-term memory loss;
word-finding problems
Loss of IADLs
10-19
Disorientation to time, place,
inability to engage in activities
Needs assistance with ADLs
<10
Loss of speech and
ambulation, incontinence of bowel
and bladder
Dependency in basic ADLs; often requires
around-the-clock care
*ADLS= activities of daily living (bathing, dressing); IADLS=
instrumental activities of daily living (housekeeping); MMSE=
Mini-Mental Status Examination
MMSE Examples of cognitive loss
Examples of functional loss
Stages

11. Drugs for Treatment
of Alzheimer’s
Donepezil
Rivastigmine
Galantamine
Memantine

12. Donepezil
Starting Dose 5 mg/day; No dose change for renal
impairment
Maintenance Dose 10mg/day
May also increase to 23mg/day
Properties Cholinesterase inh; partly metabolized
by CYP 2D6 and 3A4
Indication For all stages of Alzheimer’s
Adverse Effects Bradycardia, syncope, weight loss,
N/V/D, Insomnia
DDI Anticholinergics, Antipsychotics, Beta-
blockers, Alcohol
Administration At bedtime without regard to food

13. Starting Dose 1.5mg BID; No dosage change for
renal impairment
Maintenance Dose 3-6mg BID
Properties Cholinesterase inh
Indication For mild to moderate Alzheimer’s and
mild-to moderate dementia with
Parkinson’s
Adverse Effects Has most intense cholinergic (N/V/D)
ADE, bradycardia, syncope, dizziness,
EPS
DDI Anticholinergics, Antipsychotics, Beta-
blockers, Alcohol
Administration With meals; for patch (avoid application
to same spot for 14 days)
Rivastigmine

14. Starting Dose 4 mg BID; Use not reco’d for CrCl
<9ml/min
Maintenance Dose 8-12mg BID or 8-24mg ER Qday
Properties Cholinesterase inh and nicotine
receptor modulator; partly metabolized
by CYP 2D6 and 3A4
Indication For mild-to-moderate Alzheimer’s
Adverse Effects Bradycardia, syncope, weight loss,
N/V/D
DDI Anticholinergics, Antipsychotics, Beta-
blockers, Alcohol
Administration With meals; if therapy is interrupted for
3+ days, restart at lower dose and
increase to current dose
Galantamine

15. Memantine
Starting Dose 5 mg/day (max dose of 20mg for CrCl
30-49 and max dose 5mg for CrCl 5-
29)
Maintenance Dose 10mg BID
Properties Blocks glutamate transmission
Indication For moderate to severe Alzheimers;
may be used in combination with
donepezil
Adverse Effects Hypertension, confusion
DDI Sodium bicarbonate, Trimethoprim
Administration Without regard to food

16. Start with cholinesterase inhibitors
Caution: statistically significant difference ≠ clinical meaningful improvement
http://inc1979.com/wp-content/uploads/2012/03/tumblr_ljtm2uPiD11qf0uwco1_1280.jpg

17. How long should
the therapy be?
• Evaluation at 3-6 months for prevention of
decline or improvement
• Conflicting evidence in unresponsive patients
• Taper upon discontinuation
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18. http://www.toledoblade.com/image/2012/01/22/800x_b1_cCM_z_cT/pharmacist-bryan-01-23-2012.jpg
Pharmacists are
critical in
effective
alzheimer’s
disease
management.

19. With your help,
I can preserve
my memories a
little bit longer.
http://1dentalhealthblog.files.wordpress.com/2010/07/elderly-woman.jpg

20. Discussion.