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Psychotropics for Alzheimer’s disease
Neurotransmitters


Acetylcholine (ACH) – neurotransmitter of the parasympathetic nervous system, which controls muscles, memory, and coordination;
changes in acetylcholine levels are involved with Alzheimer’s disease (too little acetylcholine)
Glutamate– an excitatory neurotransmitter; relay of sensory information; allows controlled amount of calcium into nerve cells
Psychotropic medications for treating patient with Alzheimer’s disease exert their effects in various ways by
influencing synaptic transmission:

Enzyme inhibitors
Drugs that inhibit catabolic enzymes
promote excess buildup of the neurotransmitter in the synapse.
 Receptor blockade (antagonists)
Some drugs cause receptor blockade, thereby resulting in a reduction in transmission and
decreased
neurotransmitter activity. These drugs are called antagonists.
Neurotransmitter
Acetylcholine (ACH)
Note:
Catabolized by the
enzyme
acetylcholinesterase
Glutamate
Function
memory,
movement, sleep,
arousal
Relay of sensory
information
Excitatory
Neurotransmitter
Possible
Link
↓ levels :
Alzheimer’s disease
Psychotropic
Medications
Acetylcholinesterase
inhibitors –
Inhibit the enzyme
that breaks down
ACH
Examples
No direct link
May prolong life of neurons
NMDA receptor
antagonists act by
blocking NMDA
receptors from
Memantine
(Namenda)
Donepezil
(Aricept)
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Acetylcholinesterase inhibitors
Indications
•
Acetylcholinesterase inhibitors may be used to treat Alzheimer disease to improve cognitive function in the early stages.
Actions
•
Some of the symptoms of AD are thought to be the result of a deficiency of the neurotransmitter acetylcholine (ACH). In
the brain, acetylcholine is inactivated by the enzyme
acetylcholinesterase.
•
Acetylcholinesterase inhibitors slow down the degradation of acetylcholine, thereby increasing concentrations of the
neurotransmitter in the brain.
o
o
o
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
The client with Alzheimer’s disease has decreased acetylcholine.
The enzyme, acetylcholinesterase
is inhibited from destroying acetylcholine.
Nursing Considerations
Most common side effects are diarrhea, dizziness, fatigue, and headache.
•
Donepezil (Aricept): May slow the heart rate by means of its cholinergic effect.
•
Galantamine (Razadyne): Can also cause bronchoconstriction and is used with caution in clients with asthma and COPD.
•
Rivastigmine (Exelon): Used with caution in clients with peptic ulcer disease, bradycardia, sick sinus syndrome, urinary
obstruction, and lung disease, because it enhances cholinergic transmission, thereby intensifying symptoms of these
disorders.
NMDA receptor antagonist

NMDA receptor antagonist is used to slow down the progression of cognitive decline and function. It is used in the later
stage of Alzheimer’s disease.

NMDA receptor antagonists act by blocking NMDA receptors from excessive glutamate, preventing continuous influx of
calcium into nerve cells, and ultimately slowing down neuronal degradation.
Slows down brain cell death.
o
Memantine (Namenda)
Glutamate is an excitatory neurotransmitter and speeds neuron activity.
By blocking receptors from glutamate, the life of neurons may be prolonged.
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Spring 2022_PL