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Assignment: Alzheimer\’s Disease 76 year old Iranian Male
Assignment Alzheimer ‘s Disease 76 year old Iranian Male
This is the same one believe you said you already had the information from the Stal web site. Week 10 Assignment Alzheimer\’s Disease 76 year old Iranian Male. Please let me know?
An Elderly Iranian Man with Alzheimer’s
Most elderly people in the United States and across the world suffer from Alzheimer’s condition. According to several studies, Alzheimer’s as a neurodegenerative condition, which starts slowly and then degenerates over a sustained period. Epidemiological data regarding the condition reveals that this disease affects over 70 per cent of elderly people with dementia in the world. The most revealing symptomology of the condition involves the presence of memory lapse concerning latest events in a patient’s life. As the condition advances, additional symptoms including mood swings, behavioral issues, language difficulties, disorientation, and the absence of self-care management begin to manifest. Gradually, the body will lose all of its vital functions, a phenomenon that will eventually culminate into death. Houmani and his colleagues (2018) assert that the lifespan of the disease varies from one patient to another yet the expectancy does not exceed nine years post-diagnosis. More fundamentally, Alzheimer’s condition lacks a cure and the only available respite is to manage it so as to make certain that a patient enjoys an improved quality of life before their eventual demise.
In the present case study, an Iranian man whose son charges that he displays strange behaviors will be examined and pharmacologically treated by the present nurse practitioner. According to the patient interview, Mr. Akan displayed a loss of interest in things that were initially dear to him. Moreover, the patient has become forgetful in the recent past and confabulation was noticeable from his mental health testing procedure. Additional symptoms evident from the diagnostic process include impaired judgment and impulse as well as restricted affect. According to a mini-mental status examination that was conducted, the patient also suffers from a major neurocognitive disorder. The nurse suspected that the condition may have been caused by presumptive Alzheimer. Therefore, the present paper will seek to elucidate the assessment outcomes and create a pharmacological treatment therapy based on informed standard procedures. According to studies, while the condition is essentially untreatable, it can be managed pharmacologically. The pharmacological management is however influenced by factors such as dosage, proper selection of drugs, and time of use and administration route. Importantly, it is important for the nurse practitioner to monitor the responsiveness of a patient to drugs and their dosages and make fundamental adjustments after periodic assessment.
Decision Point One
Decision point one presented the nurse practitioner with three important options. The first option was to start the patient on Razadyne (galantamien) 4 mg daily. The second option would see the nurse prescribe Aricept (donepezil) 5 mg orally during bedtime. Lastly, the nurse can also think of beginning begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks. Out of the three options, the nurse chose to begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks for various pharmacokinetic and pharmacodynamics reasons.
Reasons for Selection
The drug Exelon, which is the trade name of the chemical compound rivastigmine, has proven to be comparatively effective in the management of Alzheimer’s. The mechanism of action of the compound rivastigmine involves inhibition of acetylcholinesterase in the brain (Stahl, 2013). Specifically, its pharmacodynamics advantage over the other listed medications is found in the fact that it inhibits butyrylcholinesterase that is implicated in the progression of the symptoms of Alzheimer’s. Moreover, the oral route of administration ensures that the drug is well-absorbed, with a bioavailability of around 40%. The drug achieves peak plasma concentration within an hour of administration, with its peak cerebrospinal fluid concentrations occurring between 1.4-3.6 hours (Rhoads & Murphy, 2015). Also, the drug crosses the blood-brain barrier with plasm binding protein of about 40% while it undergoes quick urinal elimination at over 97%.
On the other hand, Razadyne acts selectively by inhibiting the enzyme acetylcholinesterase. In addition, it has a plasma protein binding rate of about 18%, which is comparatively low. The drug also has a bioavailability of between 80%-100% and a terminal elimination half-life of seven hours (Cohen, L., Jann, M., & Penzak, 2016). Similar to Exelon, the drug also achieves its peak inhibition effect one hour after administration; however, this occurs at 8 mg of the drug while for Exelon, the effect was achieved at 3 mg. Donepezil is also a selective inhibitor of acetylcholinesterase, which enhances the concentrations of acetylcholine at the cholinergic synapses (Stahl, 2013). Nevertheless, its pharmacodynamics and pharmacokinetics are less superior to the above discussed drugs. Therefore, from the analysis, it was prudent for the nurse to choose Exelon based on its mechanism of action and its superior elimination and quick rate of achieving its inhibitory effect.
Studies concerning the effectiveness of Exelon by Yoon et al. (2017) observed that the symptomatic reversal began at around 2 weeks after administration. However, the observed improvement in the patient’s behavior after the two week period is only supposed to be slight. Additionally, the confabulatory restrictions are expected to start reducing within two weeks. This is in line with the targeted mechanism of action of Exelon’s chemical molecule.
Differences between Expected Results and Actual Results
Upon returning to the clinic after four weeks, the patient still showed disinterest in church activities according to his son. His disinhibited behaviors still continued and his confabulation was still present. When the MMSE score was taken, he scored 18 out of 30. Thus, the only noticeable difference between the expected result and the actual result was the absence of improvement in Mr. Akid’s interest in religious activities. The difference between the expected results and the actual results could be attributable to the administered dosage since the drug is partially effective at this dose in most cases.
Decision Point Two
After a review of the performance of Exelon four weeks after its administration, the nurse practitioner was presented with certain three options. These were: Increase Exelon to 4.5 mg orally BID, increase Exelon to 6 mg orally BID, Maintain current dose of Exelon, and Add Namenda (memantine) 5 mg orally per day. From the three options, the nurse practitioner chose to increase Exelon to 4.5 mg orally BID.
Reason for Selection
When the client was given the previous dose of Exelon, he demonstrated improvement in his Alzheimer’s symptomatology. Specifically, while he has not wholly accepted to attend church activities, he has begun to show a slight interest. The manifestation of the improvement is evident that the drug has some level of effectiveness at this level. Thus, in addition to the fact that the clients has shown remarkable tolerability to the dosage, the logical thing would be to increase it to 4.5 mg. Pharmacologically, the 4.5 mg would be the maintenance dose of the drug, in order to sustain its effectiveness (Stahl, 2013). Whereas the dosage could be increased to 6 mg, it is vital for the increments to be conducted cautiously as tolerability is monitored. Moreover, prescribing Namenda (In Nageshwaran, In Ledingham, In Wilson, & In Dickenson, 2017) at the present point is not logical since the Exelon has not yet reached its maximum therapeutic level. Thus, Yoon et al. (2017) advises that it is paramount for the maximum potential option to be followed before augmentation can be considered. Also, it would be imprudent to maintain the dosage at its initial level since the drug will not produce maximum benefits. These reasons therefore support the decision to increase Exelon’s dosage to 4.5 mg.
Upon increasing the drug’s dosage, the symptoms are expected to improve even further. Specifically, the restricted confabulation is expected to reduce even further due to the drug’s dosage. In addition to confabulation, the patient’s resistance towards church activities is expected to wane during the intervening period after dosage increase and the next assessment.
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When the client came back to the clinic after four weeks had elapsed since the decision to increase Exelon’s dosage was made,
he shows remarkable improvement in certain symptoms of Alzheimer’s. For instance, his son states that Mr. Akid had started to attend church activities more frequently. As expected, some of the symptoms such as amusement towards his erstwhile favorite activities still existed. Chen et al. (2017) argues that the symptomatology of Alzheimer’s ca only be improved and not eliminated. In fact, the drug Exelon can only improve other functions but cognition hence the reason for the persistence of the amusement symptom. Thus, there was no difference between expected results and actual results after the assessment.
Decision Point Three
On the twelfth week of the pharmacotherapy, the client visits the clinic again. After analysis of the progress, the nurse is expected to choose between increasing Exelon’s dosage to 6 mg and maintaining it at 4 mg. Given the prevailing circumstances, the nurse practitioner will choose to increase the dosage to 6 mg.
Reason (s) for Selection
Analysis of literary materials on the dosage and administration of Exelon reveal that the maximum dosage for the drug is 6 mg. However, the decision to prescribe a maximum dose for the drug is contingent upon the tolerability exhibited by the patient as well as safety of the medication (Cohen, L., Jann, M., & Penzak, 2016). The nurse has incrementally improved the dosage of the drug to 4.5 mg yet the client has not reacted negatively to the drug. Up until now, Mr. Akid has not complained of any side-effects or contraindications caused by the drug. Thus, it will only be logical for the nurse to increase the dosage to 6 mg pursuant to the standard procedure followed in the management of Alzheimer’s and other similar conditions. The above explanation automatically excludes maintaining the dosage at 4.5 mg. Moreover, augmenting Exelon with Namenda will not receive recommendation as Exelon is already proving effective. Also, augmenting Exelon with Namenda is a gamble that is too risky to countenance for the nurse.
At 6mg, Exelon is already at its maximum dosage. Given that the drug has already improved certain symptoms, the expectation is that it will continue to improve them even further and even prevent a relapse of the affected symptoms.
Differences between Expected Results and Actual Results
The latest assessment revealed that certain Alzheimer’s symptoms persisted when the client came back to the clinic. Nevertheless, other symptoms had improved remarkable, which was a justification to the decision to increase the dosage (Tasman et al., 2015). The two outcomes were expected as studies reveal that the degenerative feature of Alzheimer’s is not under the purview of cholinesterase inhibitors. Therefore, the nurse practitioner expected the presence of some of the symptoms of Alzheimer’s.
Normally, when patients seek treatment and prescriptions from mental healthcare practitioners, they expect the evident symptoms to undergo remission. However, Alzheimer’s, as already mentioned in the discussion, is a diseases of various pathophysiology and most of the formulated therapies fail to improve cognition. As such, Leuzy and Gauthier (2012) assert that during the creation of the present therapy, the nurse practitioner was supposed to remind the client and his family of the painstaking process that the treatment normally Thus, ethically, the nurse is expected to advise the patient and his family of this fact in a compassionate manner. However, during such conversations, the nurse is similarly expected to stress to the family of the need to continue with the management of the disease.
The management of Alzheimer’s is a complicated and painful affair. Whereas treatment options are available, the condition cannot be completely eliminated. As such, even when a patient seeks treatment with support from their family, they normally do this with the knowledge that they are simply prolonging the inevitable. Having said that, the treatment options that are available improve the quality of life of a patient by improving some of the symptomatology of the disease. To effectively do this, a nurse is required to monitor a patient for tolerability, effectiveness, and safety of administered drugs and make appropriate adjustments. Thus, the management of Alzheimer’s is a dynamic process that requires a nurse’s full attention to details including the ethics of the same.