10.4 Alzheimer’s Drugs

Alzheimer's disease pharmacotherapy targets neurotransmitter imbalances to slow cognitive decline. Medications like cholinesterase inhibitors and NMDA receptor antagonists aim to improve memory and daily functioning in patients with this progressive neurological disorder.

Understanding the mechanisms, indications, and side effects of Alzheimer's medications is crucial for effective patient care. Nurses play a vital role in monitoring treatment efficacy, managing side effects, and providing essential education to patients and caregivers.

Alzheimer's Disease Pharmacotherapy

Mechanisms of Alzheimer's drugs

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Top images from around the web for Mechanisms of Alzheimer's drugs

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  Frontiers | The Role of P2X7 Receptor in Alzheimer’s Disease View original

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• Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) increase acetylcholine levels by inhibiting the enzyme acetylcholinesterase which breaks down acetylcholine, leading to improved cognitive function, memory, and daily living activities
• NMDA receptor antagonist memantine blocks excessive glutamate activity at NMDA receptors, preventing overstimulation and cell damage, slowing cognitive decline in moderate to severe Alzheimer's disease
• These medications target specific neurotransmitters involved in memory and cognition

Pathophysiology and Drug Targets

• Alzheimer's disease is characterized by the accumulation of amyloid plaques and tau proteins in the brain
• These abnormal protein deposits contribute to neurodegeneration, leading to cognitive decline and memory loss
• Alzheimer's drugs aim to slow the progression of symptoms by addressing neurotransmitter imbalances and promoting neuroplasticity

Indications and effects of Alzheimer's medications

• Indications
  • Mild to moderate Alzheimer's disease treated with cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
  • Moderate to severe Alzheimer's disease managed with memantine or a combination of memantine and cholinesterase inhibitors
• Side effects
  • Cholinesterase inhibitors cause gastrointestinal issues (nausea, vomiting, diarrhea, anorexia), cardiovascular problems (bradycardia, syncope), and central nervous system effects (dizziness, headache, insomnia)
  • Memantine leads to dizziness, confusion, headache, constipation, and hypertension
• Drug interactions
  • Cholinesterase inhibitors interact with anticholinergics, reducing their effectiveness, and beta-blockers, increasing the risk of bradycardia
  • Memantine interacts with drugs that alkalinize urine, increasing its elimination, and carbonic anhydrase inhibitors, reducing its elimination

Nursing considerations for Alzheimer's drugs

• Assess cognitive function, behavior, and daily living activities before and during treatment to monitor drug effectiveness and adjust dosage as needed
• Monitor for side effects, especially gastrointestinal (nausea, vomiting) and cardiovascular (bradycardia) issues
• Administer cholinesterase inhibitors with food to minimize gastrointestinal side effects and improve patient comfort
• Titrate doses gradually to minimize side effects and achieve optimal therapeutic response without overwhelming the patient
• Monitor renal function in patients taking memantine as it is primarily eliminated through the kidneys
• Be aware of potential drug interactions (anticholinergics, beta-blockers) and adjust medications accordingly to prevent adverse reactions
• Consider the blood-brain barrier when evaluating drug effectiveness and potential side effects

Patient education for Alzheimer's medications

• Emphasize the importance of regular medication administration (same time each day) for optimal effectiveness in managing symptoms
• Instruct on proper administration techniques, such as taking with food or titrating doses, to minimize side effects and improve adherence
• Discuss common side effects (nausea, dizziness) and when to contact the healthcare provider for severe or persistent symptoms
• Encourage maintaining a consistent daily routine and engaging in cognitive stimulation activities (puzzles, reading) to support treatment
• Stress the importance of regular follow-up appointments to monitor treatment response and adjust medications as needed based on disease progression
• Provide resources for caregiver support and education on Alzheimer's disease management, including support groups and educational materials