Summary of Major Nursing Implications
Cholinesterase Inhibitors/Anticholinesterase
Drug Applies to all drugs for
Alzheimer’s
Therapeutic goal Are approved for patients with
mild to moderate symptoms.
Improvements are seen in
quality of life and cognitive
function.
Baseline data
Identifying high risk Caution in patients with asthma
patients or COPD.
Administration Dosage should be low initially
Routes and then gradually increased to
Dosage the highest tolerable amount.
Evaluating
therapeutic effects
Patient Education
GI effects- nausea, vomiting,
dyspepsia, diarrhea.
Dizziness & headache are
common.
Cause bronchoconstriction—
especially in asthmatic and
COPD
Donepezil
(Aricept)
Approved for those with severe symptoms.
Elevates Ach concentration in the cerebral cortex by slowing
degrading Ach released by remaining intact neurons.
Anesthesia, sick sinus rhythm, AV block, bradycardia, cardiac
arrhythmias, cardiac disease, hypotension; hyperthyroidism, history
of ulcers, abnormal liver function; patients with asthma or
obstructive pulmonary disease, history of seizures, seizures, urinary
tract obstruction, intestinal obstruction; diarrhea, emesis, GI disease,
renal failure, renal impairment, surgery.
Three oral formulation, standard tablets (5 & 10 mg), disintegrating
tablets (5 & 10 mg) and a solution (1 mg/mL)
Done late in the evening, with/out food.
Increase dosage ONLY after 4-6 week of therapy with a 5 mg dose.
Improvement as noted on the Alzheimer’s Disease Assessment Scale
Monitor patients with asthma, obstructive pulmonary disease.
Fainting episodes related to slowing the heart rate may occur.
Report if any GI ulceration or bleeding (“coffee grounds” emesis,
tarry stools, epigastric pain)
Nausea, diarrhea, headache, fatigue
Do not use if pregnant, lactating, GI bleeding, or jaundice
CNS: Insomnia, dizziness, depression, tremor, irritability, vertigo,
ataxia.
CV: Syncope, hypertension, atrial fibrillation, hot flashes,
hypotension.
GI: Nausea, diarrhea, vomiting, muscle cramps, anorexia, GI
bleeding, bloating, fecal incontinence, epigastric pain.
Respiratory: Dyspnea.
Skin: Pruritus, sweating, urticaria.
Other: Ecchymoses, muscle cramps, dehydration, blurred vision,
urinary incontinence, nocturia.