scholarly journals Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review

2021 ◽  
Vol Volume 17 ◽  
pp. 927-949
Author(s):  
Sirasa Ruangritchankul ◽  
Prawat Chantharit ◽  
Sahaphume Srisuma ◽  
Leonard C Gray
Keyword(s):  
Literature Review ◽  
Older People ◽  
Adverse Drug Reactions ◽  
Acetylcholinesterase Inhibitors ◽  
Drug Reactions ◽  
Comprehensive Literature Review

scholarly journals Safety of Cholinesterase Inhibitors and NMDA Receptors Antagonists for the Treatment of Patients with Dementia

2019 ◽  
Vol 7 (4) ◽  
pp. 190-199
Author(s):  
A. P. Pereverzev ◽  
O. D. Ostroumova ◽  
O. N. Tkacheva ◽  
Y. V. Kotovskaya
Keyword(s):  
Nmda Receptor ◽  
Nmda Receptors ◽  
Adverse Drug Reactions ◽  
Cholinesterase Inhibitors ◽  
Acetylcholinesterase Inhibitors ◽  
Competitive Inhibitor ◽  
Nmda Receptor Antagonists ◽  
Drug Reactions ◽  
Receptor Antagonists ◽  
Increased Risk

For the treatment of dementia and Alzheimer’s disease, acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and/or the non-competitive inhibitor of N-methyl-D-aspartate receptors (NMDA receptors) memantine are currently used. The administration of these drugs can help temporarily improve or stabilize memory impairments and other cognitive functions, regress behavioral disorders, reduce the patient’s dependence on others, but at the same time can lead to the development of adverse drug reactions. The aim of this study was to analyze the information on the safety of acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the non-competitive inhibitor of NMDA receptors used to treat dementia. It was shown that stimulation of cholinergic receptors can lead to adverse drug reactions as contraction and narrowing of the pupil (miosis), an increase in lens curvature, accommodation spasm (visual impairment and an increased risk of falls), a decrease in heart rate (bradycardia) and inhibition of conduction of impulses through the conducting system heart, increased tone of the bronchi, gastrointestinal tract, gall and bladder, decreased tone of the sphincters of the digestive tract and bladder, increased secretion of exocrine and glands of the stomach, agitation, confusion. Blockade of NMDA receptors due to impairment of glutamate metabolism in the central nervous system may be the cause of neurotoxicity of NMDA receptor antagonists, and also causes dizziness, feeling of tiredness, hallucinations, drowsiness, and confusion. In case of development of adverse reactions, if possible, it is necessary to stop using the drug or reduce its dose, in case of an overdose or other need, prescribe symptomatic therapy. Information on the safety of cholinesterase inhibitors and NMDA receptor antagonists presented in the article is of practical importance for healthcare professionals, as it allows them to assess the possible risks associated with the use of drugs of these groups more accurately. In addition, the information can be used to optimize and individualize the pharmacotherapy regimens for patients with dementia, including the development of domestic protocols for the deprescribing of drugs (evidence-based practice of withdrawal, replacement or gradual dose reduction) in the elderly. 

scholarly journals The phenotype of adverse drug effects: Do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study

2020 ◽  
Vol 86 (11) ◽  
pp. 2144-2154 ◽  
Author(s):  
Katja S. Just ◽  
Harald Dormann ◽  
Marlen Schurig ◽  
Miriam Böhme ◽  
Michael Steffens ◽  
...  
Keyword(s):  
Older People ◽  
Adverse Drug Reactions ◽  
Drug Effects ◽  
Adverse Drug Effects ◽  
Drug Reactions ◽  
Emergency Visits

scholarly journals THESIGNIFICANCE OF PHARMACOGENETIC TESTING FOR BETTER ANAESTHETIC OUTCOME AND LESSSURGICALSTRESS. Literature Review

2020 ◽  
Vol 10 (4) ◽  
pp. 112-117
Author(s):  
Kristina Tatzhikova ◽  
Bela Kantemirova ◽  
Aleksei Zhidovinov ◽  
Irakliy Kitiashvili
Keyword(s):  
Drug Interaction ◽  
Genetic Polymorphism ◽  
Literature Review ◽  
Adverse Drug Reactions ◽  
Genetic Screening ◽  
Web Of Science ◽  
Depth Of Anesthesia ◽  
Drug Reactions ◽  
Promising Tool ◽  
Stress Protection

The review is devoted to the problem of optimizing the anesthetic manual based on pharmacogenetic data in order to achieve an adequate depth of anesthesia and stress protection and reduce the number of adverse drug reactions. We analyzed the data of Pub Med and Web of Science databases to investigate the influence of genetic polymorphism on the body's response to the main groups of drugs used for anesthesia, and changes in the effects of drug interaction. Specifically, we have reported that the use of preoperative genetic screening for a set of markers (polymorphic alleles of a number of cytochromes) is a promising tool in the anesthesiologist's practice.

scholarly journals Methodological framework to identify possible adverse drug reactions using population-based administrative data

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 258
Author(s):  
Brian C. Sauer ◽  
Jonathan Nebeker ◽  
Shuying Shen ◽  
Randall Rupper ◽  
Suzanne West ◽  
...  
Keyword(s):  
Administrative Data ◽  
Adverse Drug Reactions ◽  
Conditional Logistic Regression ◽  
Acetylcholinesterase Inhibitors ◽  
Population Based ◽  
Crossover Design ◽  
Transient Effects ◽  
Drug Reactions ◽  
Medication Therapy ◽  
Respiratory Disturbance

Purpose: We present a framework for detecting possible adverse drug reactions (ADRs) using the Utah Medicaid administrative data. We examined four classes of ADRs associated with treatment of dementia by acetylcholinesterase inhibitors (AChEIs): known reactions (gastrointestinal, psychological disturbances), potential reactions (respiratory disturbance), novel reactions (hepatic, hematological disturbances), and death.Methods: Our cohort design linked drug utilization data to medical claims from Utah Medicaid recipients. We restricted the analysis to 50 years-old and older beneficiaries diagnosed with dementia-related diseases. We compared patients treated with AChEI to patients untreated with anti-dementia medication therapy. We attempted to remove confounding by establishing propensity-score-matched cohorts for each outcome investigated; we then evaluated the effects of drug treatment by conditional multivariable Cox-proportional-hazard regression. Acute and transient effects were evaluated by a crossover design using conditional logistic regression.Results: Propensity-matched analysis of expected reactions revealed that AChEI treatment was associated with gastrointestinal episodes (Hazard Ratio [HR]: 2.02; 95%CI: 1.28-3.2), but not psychological episodes, respiratory disturbance, or death. Among the unexpected reactions, the risk of hematological episodes was higher (HR: 2.32; 95%CI: 1.47-3.6) in patients exposed to AChEI. AChEI exposure was not associated with an increase in hepatic episodes. We also noted a trend, identified in the case-crossover design, toward increase odds of experiencing acute hematological events during AChEI exposure (Odds Ratio: 3.0; 95% CI: 0.97 - 9.3).Conclusions: We observed an expected association between AChEIs treatment and gastrointestinal disturbances and detected a signal of possible hematological ADR after treatment with AChEIs in this pilot study. Using this analytic framework may raise awareness of potential ADEs and generate hypotheses for future investigations. Early findings, or signal detection, are considered hypothesis generating since confirmatory studies must be designed to determine if the signal represents a true drug safety problem.

scholarly journals Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem

2016 ◽  
Vol 8 (1) ◽  
pp. 31-46 ◽  
Author(s):  
Carole Parsons
Keyword(s):  
Older People ◽  
Adverse Drug Reactions ◽  
Inappropriate Prescribing ◽  
Drug Reactions ◽  
Full Spectrum ◽  
People With Dementia ◽  
Increased Risk ◽  
Vulnerable Patient ◽  
The Impact ◽  
Medication Appropriateness

Multimorbidity and polypharmacy are increasingly prevalent across healthcare systems and settings as global demographic trends shift towards increased proportions of older people in populations. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing (PIP), and have reported high prevalence of PIP across settings of care in Europe and North America and, as a consequence, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and PIP in this patient cohort. This narrative review considers the evidence currently available in the area, including studies examining prevalence of PIP in older people with dementia, how appropriateness of prescribing is assessed, the medications most commonly implicated, the clinical consequences, and research priorities to optimize prescribing for this vulnerable patient group. Although there has been a considerable research effort to develop criteria to assess medication appropriateness in older people in recent years, the majority of tools do not focus on people with dementia. Of the limited number of tools available, most focus on the advanced stages of dementia in which life expectancy is limited. The development of tools to assess medication appropriateness in people with mild to moderate dementia or across the full spectrum of disease severity represents an important gap in the research literature and is beginning to attract research interest, with recent studies considering the medication regimen as a whole, or misprescribing, overprescribing or underprescribing of certain medications/medication classes, including anticholinergics, psychotropics, antibiotics and analgesics. Further work is required in development and validation of criteria to assess prescribing appropriateness in this vulnerable patient population, to determine prevalence of PIP in large cohorts of people with the full spectrum of dementia variants and severities, and to examine the impact of PIP on health outcomes.

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