Pharmacology for Dentistry

CNS Stimulants 121

senile dementia, cerebral insufficiency and
behavioural problem in elderly.

The other drugs in this category are
aniracetam, oxiracetam, fosracetam,
nefiracetam, nebracetam and pramiracetam.

DIHYDROERGOTOXINE

It increases cerebral blood flow by
blocking alpha adrenergic receptors.

Adverse effects include nausea, epi-
gastric distress, headache, dizziness,
nasal congestion, skin rash and orthostatic
hypotension.

It is indicated in arteriosclerotic demen-
tia, primary progressive dementia,
Alzheimer’s dementia, multiinfarct demen-
tia and primary progressive dementia.

NICERGOLINE

It is an ergot derivative with activity
similar to that of dihydroergotoxine.

Adverse effects include GI disturbances,
malaise, dizziness, agitation and hot flushes.

It is indicated in cognitive, behavioural
and somatic symptoms associated with
cerebral decay, parkinson’s disease, memory
disorders, apathy, asthenia, anorexia,
dizziness and tinnitus.

PIRIBEDIL

It is a dopaminergic agonist and
improves memory, concentration and
vigilance in older individuals.

NIMODIPINE

It is a calcium channel antagonist. It
enters the brain and acts by blocking the

entry of extracellular calcium in smooth

muscle cells and neurons.

Adverse effects include nausea,

epigastric distress, hypotension and

flushing.

It is indicated in prevention and

treatment of ischaemic neurological deficit

following subarachnoid haemorrhage.

Some of the plant preparations

containing Ginkgo biloba are used in cerebral

impairment due to organic degeneration of

cortex, multiple vascular infarcts, in

psychobehavioural symptoms, certain

syndrome of vertigo, dizziness and tinnitus

etc. Benefit is due to ginkgoflavin glycosides

which has PAF antagonistic action.

DRUGS USED IN ALZHEIMER’S DISEASE

(AD)

It is progressive neurodegenerative disorder

and mainly affects older individuals. It is the

most common cause of dementia which is a

impairment of intellect, memory and

personality in the absence of gross clouding

of motor involvement.

The drugs used in AD are:

• Centrally acting ChE inhibitor:
  Tacrine, donepezil.


• ChE inhibitors: Metrifonate,
  rivastigmine, epastigmine, galantamine.


• Cholinergic agonists: Milameline,
  xanomeline.

TACRINE

It is the first centrally acting anti-ChE

used in mild to moderate cases of AD. Side