Alzheimer, Memon Tyne, Mechanism Of Action discussed on Real Life Pharmacology - Pharmacology Education for Health Care Professionals
Hey, all air christianson here with the real life pharmacology podcasts. Thanks for listening today. I remember to go. Check out the real life, pharmacology dot com website, snag your free. Thirty one page PDF. Great little resorts for pharmacy students nursing students med students. Just as kind of a quick study guide on important pearls with the top two hundred drugs. So certainly at no cost to you. And simply I subscribing to follow the podcast with that today. I'm gonna cover Memon Tyne pharmacology so brand name drug here is no meadow. And this drug is primarily used for dementia. Now in important factor with dementia in dealing with patients, and caregivers and these type of medications that work in Alzheimer's dementia. You've got to remember that patients sometimes have unrealistic expectations. Kate these drugs, do not stop dementia, and they do not reverse dementia. There may be some symptomatic improvements, maybe initially, but ultimately that disease progression with Alzheimer's will not be stopped in the long run. Now, it it may help maybe delay the progression. Or allow functioning a little more functioning for a period of time. But again, not gonna reverse not gonna stop. So very important to remember that now the mechanism of action with this medication. So it's classified as an an MD. A receptor antagonist and the big thing with the outer the theory is that glutamate which binds this receptor glutamate from that binding and activation can put ten -cially be a contributing factor or cause in contributing to Alzheimer's dementia. So that's a very important thing to think about that that glutamate might be causing that, and if we can block the activity of that glutamate by blocking the receptor an MBA that it binds to we're going to help hopefully, you know, prevent the worsening of some of those symptoms. So that's kind of a little bit of a background about the mechanism of action in clinical practice patients generally classified as moderate to severe. Veer Alzheimer's dementia, and I'm not gonna get into classifications in the this podcast, but patients with moderate to severe showed the best benefit in clinical trials. So that's why indicated in patients with moderate to severe Alzheimer's now, I definitely have seen a tried in patients with maybe less severe dementia yet off label I've seen combinations with the seat Aucoin, ashtrays inhibitors. And actually there's some evidence for use in combination with these local industries inhibitors drugs like dinette Bazil brand name era sept-, for example. So that that's definitely something. You're going to see in clinical practice. Now. If you're monitoring these patients on this medication and monitoring for efficacy it's going to be really hard to tell if it's working or doing any. Anything in? That's just the reality of the drugs. The only way we can tell is if we compare groups of patients in research trials now again, you might see you don't maybe some modest symptomatic improvement. I have seen that in my career, of course. But again, that's it's not generally the norm with Menton in in these type of agents and the dementia type of agents in general. Let's talk about side effects a little bit with Nemenzo. Primarily what I've seen in practice is central nervous system type side effects with this medications with this medication. If patients have them, so maybe some sedation, maybe some dizziness I have seen situations where it's actually maybe worsened symptoms potentially. And obviously in in that that type of situation the medication was just discontinued. So again, you know, I there may be changes in mood. I've I've seen that happen as well. And sometimes it's kinda difficult obviously, timing is very important when the medication started, and when you're seeing adverse effects, but with dementia is sometimes it's very very difficult to know, if it's part of the disease process, or if it's part of medications or something else going on as well. So can. A little bit challenging to identify side effects would say overall usually pretty well tolerated. I'm with one exception. I do want to remind you about and that's kidney function. So this drug is primarily eliminated through the kidney. So you've got to remember that if a patient has declining kidney function, which pretty much all patients do as they age this drug can slowly accumulate over time or more quickly. If it's more of an acute change in kidney function there where the Craton is rising and the Craton clearances falling that drug can accumulate and potentially caused some issues. So keep an eye for I o for dose adjustments on that medication dosage forms. I didn't want to cover this specifically. So there is an amendment Xsara formulation versus an amendment immediate release formulation the immediately says much cheaper. And you know in in my experience, I've. Scene. No potential clinical advantages other than the extent of releases once a day, but amend X are much much hundreds of dollars generally more expensive than the immediate release which is twice a day. So yeah, I typically recommend only the immediate release. If someone is going to use try one of these medications, simply due to the fact that is just one more pill and many patients, you know, with dementia geriatrics, they're oftentimes taking medications more than once a day. Anyway, so it's typically not going to be that much of an issue when you talk about possibly saving hundreds of dollars per month. So just a little note on a dosage forms their discontinuation. So there isn't a perfect algorithm. There is no perfect. Way to know when to stop these medications, obviously, if you're presented with a patient that has a very very short life expectancy there non responsive, you know, that type of patient where the the dementia medication is really providing no value that all is probably pretty easy and pretty safe to go ahead and maybe taper down and discontinue that medication. But you know, what you really think about each patient clinically individually some things that that I think about patient family preference. Really get them involved in that decision of you know, weaning off medications taking medications off the stage of their disease. You know, how close are they potentially to death, for example? Slowly, tapering off is something. I generally always recommend very seldom is there. A reason just to pull out the rug, and and take it all away. That's kind of a geriatric mantra start logo slow and that applies to reducing doses. As well. I if they've got you don't difficulty, swallowing difficulty taking Orel medications, I mentioned kind of minimum minimal responses. You know, that's probably a patient where the medication really isn't helping to improve them or delay anything if they're already at that kinda end stage type of symptoms. So those are just a few things I think about when considering when to actually discontinue dementia medications, let's take a quick break. From our sponsor met at one one dot com. Great resources for nap plex, if you're a pharmacy student, for example. Be CPS VCA C P NBC GP so geriatrics exams. Ambulatory care. Pharmacotherapy exam. Plenty of study material they're met at one one dot com slash stores where you can find the entire list finishing up on drug interactions here. I knew Amena is I guess what we would consider a pretty clean medication in that. It really doesn't have a ton of drug interactions. So that's always a great thing that we're not complicating things in causing concentrations to go up and down for other medications or amend itself so drug interactions. I typically don't worry about too much. There are a few rare ones. I generally think about drugs that might exacerbate dementia in contribute to the prescribing of dementia medication so Anti-cull Nirj sedatives drugs that can. 'cause memory impairment confusion. I think about those drugs in our dementia patients, and I watch and monitor those very closely to make sure we aren't doing more harm than good with that gonna wrap up today's episode again find that free PDF on real life, pharmacology dot com. Simply I subscribing have enjoyed the podcast think, it's helpful. So appreciative of all the ratings and reviews of you've got comments, certainly reach out to us from the website suggestions about different topics or medication you covered feel free to to shoot us. An Email there at real-life pharmacology dot com that gets sent straight to me. So thanks for listening. Take care of hope you have a great rest your name.