Pharmacological Management of Dementia and AD - Essay Example

"Pharmacological Management of Dementia and AD" is a great example of a paper on drug therapy. This is a case study of an elderly male, 76 years old of Iranian origin who presents with changes in behavior that were observed to change over some time. The patient experienced changes in things he previously enjoyed and was easily amused by things that were not amusing. The patient presented with some confabulations in memory when the mental test was performed, and there were evident memory deficits.

When the diagnosis was made, the patient was discovered to have a significant neurocognitive disorder as a result of Alzheimer’s disease. The patient is taken through a course of therapy involving three decisions accompanied by medication assessment as needed to address the presenting diagnosis.Decision oneDecision: The patient was started on Aricept (donepezil) 5mg oral dose once daily at bedtime. Reasons for decision one: Aricept is an FDA-approved medication that is used in the management of Alzheimer’s disease.

It is particularly useful for moderate to severe Alzheimer's disease, and patients also benefit from the compensation of the cognitive deficits (Zhang & Gordon, 2018). It works by binding to the acetylcholinesterase and then inhibits hydrolysis of the acetylcholine. In the end, there is an increased concentration of acetylcholine which therefore improves concentration and memory (Kumar & Sharma, 2019).The desire for the intervention: it was desired that from the initiation of therapy, the patient would have control over the cognitive deficits and then resume associating with the rest, being able to carry out activities as he previously did.

Outcome: the client returned to the clinic four weeks later after the initial therapy. The outcome did not go as expected since there was only little improvement, and the patient presented most of the initial symptoms. On a positive note, it was registered that the client had begun attending religious activities with family members, which was encouraging.Decision twoDecision: a decision was made to increase the dose of Aricept to an oral dose of 10mg taken once daily at bedtime. Reason for decision: the initial dose of Aricept had only achieved a slight effect, and therefore, it was probable that the initial dose given was not adequate to reach the required therapeutic concentration.

It was not advisable to add another drug to the Aricept since the drug needed more time to elicit effects. The drug has been shown to take up to 6 weeks to achieve the required effect, and hence the patient ought to have taken it for a slightly extended period (Jelic & Winblad, 2016). The addition of NMDA receptor antagonists to acetylcholinesterase inhibitors is often advocated for due to synergistic effects. Still, it would not be necessary in this case because the progress with Aricept was great (Glynn-Servedio & Ranola, 2017).

What was intended from the decision: it was hoped that an increase in dose would yield the required blood concentration of Aricept to restore the patient to desired cognitive functions. It was also expected that Mr. Akkad would control his amusement over the things that were seen as less amusing. It was also intended to ensure an improvement in the MMSE score from the one taken at 18/30. It was also expected that Mr. Akkad would relate well with members of the family despite the cognitive deficits.

The outcome of the decision: the client returned to the clinic after four weeks, and it was reported that the client was tolerating the medication well. The attendance of the religious activities had improved, and the rest of the family members were impressed with the course of therapy. However, the amusement over things that did not seem funny was still existent, and this fueled the desire by the family members to have more improvement.Decision threeDecision: a decision was reached to maintain the patient on Aricept 10mg oral dose at bedtime till an improvement was noticed.

There was also a need to combine therapy with CBT at this point, and this helped the patient cope with any possible cognitive deficits which may arise over time (Ishida, 2016). CBT is useful since it augments the effect of medication and improves cognitive function.Reason for the third decision: the patient was seemingly able to tolerate the drug, and there was a slow but steady improvement in the symptoms. The dose would not be increased beyond 10mg since there is a lack of evidence of Aricept showing effectiveness doses higher than 10mg.

Increasing the dose of the drug to 15 or 20mg would make him more likely to suffer adverse effects, which would then impair patient compliance and hence the resolution of the presenting symptoms.What was intended from the decision: Significant improvements were expected at this point. At this point, it was also expected that the patient would have control over the inappropriate amusements and fully participating in the previously enjoyed activities as expected. The goal of therapy ought to have fully been fulfilled at this point, and the patient goes through improved quality of life and an improved MMSE score.

The outcome of the decision: the patient was experiencing almost a healthy life with appropriate quality. He was able to attend the religious activities with the rest of the family members as expected.