Pharmacology for Exam 1 Nursing 201
1. Indirect-Acting -Used in the treatment of Alzheimer's disease and advanced dementia.
Cholinergic -Slow progression of the disease, not reverse, goal is for better neuron communi-
Agents/Cholinesterase
cation.
Inhibitors -Therapeutic action-reversibly blocking acetylcholinesterase at the synaptic cleft.
-Pharmacokinetics-well absorbed after oral administration, excretion in the urine.
-Clinically important drug-drug interactions include NSAIDS (risk of GI bleeding)
and Cholinergic drugs (too many can cause crisis/toxic level of medications caus-
ing SLUD reaction (salivation, lacrimation, urination, defecation)).
2. Indirect-Acting -Contraindications/cautions-allergy, bradycardia, intestinal or urinary tract ob-
Cholinergic struction.
Agents/Cholinesterase
-Asthma, coronary disease, peptic ulcer, arrhythmias, epilepsy, and parkinsonism
Inhibitors-Con- could be exacerbated by the effects of parasympathetic stimulation.
traindica- -Hepatic or renal dysfunction-could cause interference with metabolism and ex-
tions/Cautions cretion leading to toxicity.
3. Indirect-Acting Adverse effects-stimulation of the parasympathetic nervous system causing:
Cholinergic -GI symptoms-increased appetite, nausea, vomiting, diarrhea, or increased sali-
Agents/Cholinesterase
vation.
Inhibitors-Ad- -Cardiovascular-bradycardia, heart block, hypotension, cardiac arrest.
verse Effects Urinary tract-increased urgency.
-CNS-blurred vision, dizziness, drowsiness, headache.
Stimulation of the cholinergic receptors in the sympathetic nervous system includ-
ing flushing and diaphoresis.
4. Donepezil (Ari- Indirect-Acting Cholinergic Agent/Cholinesterase Inhibitor used to manage
cept) Alzheimer's disease and severe dementia
5. Galantamine Indirect-Acting Cholinergic Agent/Cholinesterase Inhibitor used to manage mild
(Razadyne) to moderate Alzheimer's, can delay progression.
6. Rivastigmine (Ex-
elon)
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, Pharmacology for Exam 1 Nursing 201
Indirect-Acting Cholinergic Agent/Cholinesterase Inhibitor used to manage mild to
moderate Alzheimer's disease and treat dementia related to Parkinson's disease.
Comes in a patch.
7. N-Methyl-D-As- -Used in the treatment of Alzheimer's disease, approved in 2003.
partate (NMDA) -Therapeutic Actions-Not a cure, is a unique medication that blocks various recep-
Receptor tor sites in the brain and slows the buildup of plaque on the axons, helping slow
Antagonist the effects of the disease
8. N-Methyl-D-As- -Headache, dizziness, confusion, constipation
partate (NMDA)
Receptor
Antagonist-Ad-
verse Effects
9. N-Methyl-D-As- -Renal Impairment-consider dose reduction
partate (NMDA) -Alkalinized urine-avoid taking with anything that alkalinizes urine (acetazolamide
Receptor for glaucoma, sodium bicarb, Alka-Seltzer). Alkaline urine pH results in reduced
Antagonist-Spe- renal excretion and renal clearance increasing the risk of toxicity.
cial
Considerations
10. Memantine (Na- N-Methyl-D-Aspartate (NMDA) Receptor Antagonist, the only drug in its class
menda)
11. Antipsychotics -Pseudo parkinsonism-stooped posture, shuffling gait, rigidity, bradykinesia,
for Alzheimer's, tremors at rest, pill-rolling motion of the hand.
Dementia and -Acute dystonia-facial grimacing, involuntary upward eye movement, muscle
Delirium-Side spasms of the tongue, face, neck and back (back muscle spasms cause trunk to
Effects arch forward), laryngeal spasms.
-Akathisia-restless, trouble standing still, paces the floor, feet in constant motion,
rocking back and forth.
-Tardive dyskinesia-protrusion and rolling of the tongue, sucking and smacking
2/8
1. Indirect-Acting -Used in the treatment of Alzheimer's disease and advanced dementia.
Cholinergic -Slow progression of the disease, not reverse, goal is for better neuron communi-
Agents/Cholinesterase
cation.
Inhibitors -Therapeutic action-reversibly blocking acetylcholinesterase at the synaptic cleft.
-Pharmacokinetics-well absorbed after oral administration, excretion in the urine.
-Clinically important drug-drug interactions include NSAIDS (risk of GI bleeding)
and Cholinergic drugs (too many can cause crisis/toxic level of medications caus-
ing SLUD reaction (salivation, lacrimation, urination, defecation)).
2. Indirect-Acting -Contraindications/cautions-allergy, bradycardia, intestinal or urinary tract ob-
Cholinergic struction.
Agents/Cholinesterase
-Asthma, coronary disease, peptic ulcer, arrhythmias, epilepsy, and parkinsonism
Inhibitors-Con- could be exacerbated by the effects of parasympathetic stimulation.
traindica- -Hepatic or renal dysfunction-could cause interference with metabolism and ex-
tions/Cautions cretion leading to toxicity.
3. Indirect-Acting Adverse effects-stimulation of the parasympathetic nervous system causing:
Cholinergic -GI symptoms-increased appetite, nausea, vomiting, diarrhea, or increased sali-
Agents/Cholinesterase
vation.
Inhibitors-Ad- -Cardiovascular-bradycardia, heart block, hypotension, cardiac arrest.
verse Effects Urinary tract-increased urgency.
-CNS-blurred vision, dizziness, drowsiness, headache.
Stimulation of the cholinergic receptors in the sympathetic nervous system includ-
ing flushing and diaphoresis.
4. Donepezil (Ari- Indirect-Acting Cholinergic Agent/Cholinesterase Inhibitor used to manage
cept) Alzheimer's disease and severe dementia
5. Galantamine Indirect-Acting Cholinergic Agent/Cholinesterase Inhibitor used to manage mild
(Razadyne) to moderate Alzheimer's, can delay progression.
6. Rivastigmine (Ex-
elon)
1/8
, Pharmacology for Exam 1 Nursing 201
Indirect-Acting Cholinergic Agent/Cholinesterase Inhibitor used to manage mild to
moderate Alzheimer's disease and treat dementia related to Parkinson's disease.
Comes in a patch.
7. N-Methyl-D-As- -Used in the treatment of Alzheimer's disease, approved in 2003.
partate (NMDA) -Therapeutic Actions-Not a cure, is a unique medication that blocks various recep-
Receptor tor sites in the brain and slows the buildup of plaque on the axons, helping slow
Antagonist the effects of the disease
8. N-Methyl-D-As- -Headache, dizziness, confusion, constipation
partate (NMDA)
Receptor
Antagonist-Ad-
verse Effects
9. N-Methyl-D-As- -Renal Impairment-consider dose reduction
partate (NMDA) -Alkalinized urine-avoid taking with anything that alkalinizes urine (acetazolamide
Receptor for glaucoma, sodium bicarb, Alka-Seltzer). Alkaline urine pH results in reduced
Antagonist-Spe- renal excretion and renal clearance increasing the risk of toxicity.
cial
Considerations
10. Memantine (Na- N-Methyl-D-Aspartate (NMDA) Receptor Antagonist, the only drug in its class
menda)
11. Antipsychotics -Pseudo parkinsonism-stooped posture, shuffling gait, rigidity, bradykinesia,
for Alzheimer's, tremors at rest, pill-rolling motion of the hand.
Dementia and -Acute dystonia-facial grimacing, involuntary upward eye movement, muscle
Delirium-Side spasms of the tongue, face, neck and back (back muscle spasms cause trunk to
Effects arch forward), laryngeal spasms.
-Akathisia-restless, trouble standing still, paces the floor, feet in constant motion,
rocking back and forth.
-Tardive dyskinesia-protrusion and rolling of the tongue, sucking and smacking
2/8
