Alzheimer’s
The patient is a 76-year-old Iranian male whose diagnostic imaging test are all normal. However, of interest is his reduced interest in religious activities. Besides, he also finds amusement and ridicule in what he would otherwise have taken seriously. Forgetting things has also been normal for patients over the past two years. Apart from that, he also finds it challenging to get the rights words during a conversation making him shift swiftly to a new line of conversation. To help the patient, three decisions were put in place beginning Aricent 5 mg orally at bedtime, increasing Aricept 10mg orally at bedtime, and continuing Aricept 10 mg orally at night.
To avoid an adverse reaction, the patient is placed under Aricept 5 mg orally at bedtime. For a new drug, slow titration upwards towards therapeutic does reduce the adverse side effects. Though the pathogenesis of Alzheimer’s is not well understood, it mainly relates to the loss of central cholinergic innervations. The agents in Aricept facilitates neurotransmission of acetylcholine which improves the cognitive activities. One of the agents acts as a reversible acetylcholinesterase inhibitor. Such inhibition decreases the side effects of cholinergic. Because of this factor, Aricept and its agent reduce the incidence or manage the symptoms of Alzheimer’s disease in mild, moderate, and severe stages of the disease. The night time does highly recommended as it prevents a patient from experienced effects such as fatigue, anorexia, muscle cramps, insomnia, nausea, diarrheas, and vomiting during the day. Considering that it takes the medication 3 – 4 hours to reach its peak taking it during the day, the client might be negatively impacted while increasing their falls. The dosage used is small, leading to continued confabulations, disinterest in once-loved activities, or no significant change.
In case a viable drug does not show any changes in a patient, an increase in dosage should be considered before any change in pharmacological agents take place. Such a factor led to the increase in the Aricept dosage to 10mg at bedtime. The increase in dosage led to the improvement of the elderly client. The once disinterested client is currently attending religious services with the members of the family. The client is also tolerating the medication well, but according to the family, he is not yet better considering he finds serious things amusing. Considering that the pathogenesis of Alzheimer’s is not well known tolerating medicine and stating to attend religious services is a positive sign of the efficacy of the drug.
Continuing Aricept 10 mg orally at bedtime is opted for as it proves to be a viable drug for the patient. No evidence proves that more than 10mg of Aricept daily have therapeutic evidence. Increasing the dose is not appropriate, but discontinuing the medication is utterly inadvisable. The lack of significant improvements within the first eight weeks is because medication can takes months to stabilize. Considering the patient is currently attending religious services with family, the drug is effectively acting as a reversible acetylcholinesterase inhibitor. Such inhibition decreases the side effects of cholinergic.
Considering no side effects have been noticed, and some improvements are noticeable, the medication is viable. However, the family should undergo counseling because the disinhibition might improve, or it might not improve as well. This depends on the patient. Worth noting is that Alzheimer’s is irreversible; thus, stabilization of symptoms can take some time.