Page 2368 - Saunders Comprehensive Review For NCLEX-RN

continued need for the medication, and temporarily
remove side effects of the medication, which
commonly include sleep delay, appetite suppression,
and tolerance to treatment.

X. Medications to Treat Alzheimer’s Disease (Box 68-11)

A. Acetylcholinesterase inhibitors may be used in clients with
Alzheimer’s disease to improve cognitive functions in the early
stages.
B. Donepezil
1. An inhibitor of acetylcholinesterase used to treat mild
to moderate dementia of Alzheimer’s disease
2. Side and adverse effects include nausea and diarrhea.
3. Donepezil can slow the heart rate through its
vagotonic effect.
C. Galantamine
1. An inhibitor of cholinesterase used to treat mild to
moderate dementia of Alzheimer’s disease
2. Side and adverse effects include nausea, vomiting,
diarrhea, anorexia, and weight loss.
3. Galantamine can cause bronchoconstriction; it should
be used with caution in clients with asthma and
chronic obstructive pulmonary disease.
D. Memantine
1. N-Methyl-d-aspartate (NMDA) receptor antagonist
indicated for treatment of moderate to severe
dementia of Alzheimer’s disease
2. Side and adverse effects include dizziness, headache,
confusion, and constipation.
3. Memantine should not be used in combination with
other NMDA receptor antagonists such as
amantadine or ketamine; such combinations produce
undesirable additive effects.
4. Sodium bicarbonate and other medications that
alkalinize the urine can decrease renal excretion of
memantine; accumulation to toxic levels can result.
5. Clearance is reduced with renal impairment; therefore,
use with caution.
E. Rivastigmine
1. Cholinesterase inhibitor used to treat mild to moderate
dementia of Alzheimer’s disease
2. Side and adverse effects include nausea, vomiting,
diarrhea, anorexia, and weight loss.
3. Should be taken with food to reduce gastrointestinal
side effects.
4. Rivastigmine should be used with caution in clients
with peptic ulcer disease, bradycardia, sick sinus
syndrome, urinary obstruction, and lung disease

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