Donepezil for Dementia Discussion Essay
Donepezil for Dementia Discussion Essay
Mental disorders cause mild, moderate or severe impacts on individuals. For instance, dementia disrupts one’s daily activities due to declined mental capabilities. It is characterized by communication problems, memory impairment and other cognition problems. Several factors affect the treatment of dementia including family factors, healthcare settings and the stage of the illness (Stahl, 2013). Therefore, healthcare providers should have expansive knowledge on the management of these mental disorders to facilitate effective management. This paper seeks to examine the case study of an elderly Iranian man with Alzheimer’s disease through making of three decisions regarding the medical prescription, factors affecting the pharmacodynamics and pharmacokinetic processes of the client as well as the ethical considerations impacting communication and treatment plan. Donepezil for Dementia Discussion Essay
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Decision #1
Begin Aricept (donepezil) 5 mg Orally at Bedtime
Among the three decisions provided, prescription of Aricept (donepezil) 5 mg orally at bedtime was the most appropriate. This is because; it Aricept (donepezil) is effective for treatment of Alzheimer’s disorder in virtually all stages. It is approved by the Food and Drug Administration for mild to moderate cases and hence recommended for this patient’s case. This medication prevents the worsening of symptoms, is well tolerated and inhibits the breakdown of acetylcholine. Even though Exelon and razadyne have the similar effects, they are only used for treatment of mild to moderate Alzheimer’s only. Moreover, Razadyne 24 mg is not a starting dose but a target dose for Alzheimer’s patients and therefore is not appropriate for application (Bui, 2012). It also causes dizziness and gastrointestinal side effects as well as seizures on rare cases.
The anticipated results include improvement of the patient’s memory, functional capabilities and awareness. This occurs through the balancing effect of Aricept which results from the blockage of enzymes (Birks & Harvey, 2018). The treatment was focused on receiving positive results. However, after four weeks, the client does not demonstrate any signs of improvement from the medication as reported by the son. The patient shown disinterest tin social activities and confabulation was still noted. The patient also scored the same results for MMSE as the initial score. The difference in results was due to the increasing ineffectiveness of medications used in the treatment of Alzheimer’s disease. As such, there exists a chance for little or no change during the treatment as demonstrated in this case.
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Decision #2
Increase Aricept to 10 mg Orally at Bedtime
Aricept does not often produce instant results. As such, it is important to continue the medication for a couple of months before discontinuing. This prevents the occurrence of withdrawal side effects. Therefore, increasing the dosage of this drug was the appropriate decision for this client. The drug was increased in a small dosage to prevent severe effects caused by lack of tolerance by the patient as we sought to get the optimum concentration that was tolerable and yet effective for the symptoms (Stahl, 2014).
The increase of the dosage anticipated to identify the best possible tolerable and effective concentration. In addition, improvement of outcome was expected. These included improvement in memory, social engagement and participation in religious activities. Decision two results confirmed the improvement of the symptoms whereby the patient started attending religious services as expected. However, the memory improvements have not been noted yet. The patient’s son reports that the client was still getting amusements from things that he once found serious. This difference occurred because of the slow effects of Aricept and thus more time is required for more results to be evident. Donepezil for Dementia Discussion Essay
Decision #3
Continue Aricept 10 mg orally at Bedtime
To maximize the impacts of Aricept on the patient, the 10mg dosage was maintained for a longer duration. This decision was taken considering that the drug can take a few months to demonstrate any positive effects on the patient. The fact that the patient had shown some improvements as well as tolerates this dosage indicates the potential positive outcomes of Aricept 0mg on long-term use. On the other hand, the dosage was not improved further since increased concentration on Alzheimer’s patients has not provided evidence of improved outcomes. Instead, severe adverse effects are possible at 15 and 20mg (Stahl, 2014). Therefore, it was appropriate to maintain the dosage at 10mg.
This decision sought to improve the memory of the client and prevent amusements that he experienced for normal events. It also intended to improve attendance to religious events and improve his overall wellbeing and quality of life.
Legal and Ethical Considerations
Ethical and legal considerations involved in the treatment of Alzheimer’s include consent and confidentiality. The client should be given relevant information concerning the illness and advice on the treatment options available as well as their consequences. More so, the patient’s information should be maintained in confidentiality unless authorized (Mintzer, 2018). Informed consent could result in the decline of medication by the client especially for the drugs whose effectiveness is influenced by trial and error and do not guarantee improvement of symptoms. Consequently, confidentiality limits sharing of information of the patient with the family members which affects the treatment process particularly when the client considers himself healthy. Donepezil for Dementia Discussion Essay
Conclusion
Alzheimer’s affects the normal functionality of the patient. Several treatment options are available for the disease. However, their use is limited by patient factors such as tolerance and their ability to provide results at specific concentrations as well as the stages of the illness. Trial and error method is used to determine the optimum dosage that is tolerated by the patient. Aricept is effective in treatment of Alzheimer’s at all stages contrary to Exelon and Razadyne.
References
Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer’s disease. Cochrane Database of systematic reviews, (6).
Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22.
Mintzer, J. (2018). Perspective from Clinical Research: Ethical Issues in Alzheimer’s Disease Research. The Journal of Law, Medicine & Ethics, 46(3), 699-703.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Donepezil for Dementia Discussion Essay
