Introduction
The client, Mr. Akkad is a 76 year old Iranian. Mr. Akkad’s diagnosis is major neurocognitive disorder due to Alzheimer’s disease (presumptive). For the MMSE, the client scores 18 out of 30 which indicate moderate dementia. The purpose of this paper is to present three decisions regarding the client’s medications. The paper will also discuss factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Finally, ethical considerations might impact treatment plan and communication with clients will be taken into account. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Discussions and Assignments.
Decision Point 1
The first decision is that the client start taking Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks.
ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE
Rationale of selecting the Decision
This decision was selected because evidence supports effectiveness of Exelon (rivastigmine) for treatment of Alzheimer’s disease and dementia as well (Su et al, 2015). Pathological changes present in Dementia of the Alzheimer type involve cholinergic neuronal pathways. Therefore, exelon (rivastigmine) exercises its therapeutic effect by improving cholinergic function (Kandiah et al, 2017). The medication stops breakdown of acetylcholine and hence improves synaptic transmissions in the brain, which are related to memory and other cognitive functions. The client has Alzheimer’s and hence has low levels of the acetylcholine chemical within the brain. In addition, the client has moderate dementia. FDA guidelines and evidence recommend first dosage to be 1.5 mg BID and if the patient tolerates the dose after treatment of at least 2 weeks, it is appropriate to increase the dosage to 3 mg BID (Birks et al, 2015).
Expected Outcome
With this decision, it was hoped that the client will the client’s cognitive performance would improve. It was also hoped that the client’s behavior, functioning, and he would be able to carry out some activities of daily living. This is because Exelon (rivastigmine) has been shown to be effective in improving symptoms associated with Alzheimer’s disease (Birks et al, 2015). NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Discussions and Assignments
Differences with the Decision Outcome
However, the client’s condition did not improve as indicated by the son’s report and his MMSE, score of 18 out of 30 with major deficits in orientation, attention and memory. The difference with what was hoped to be achieved and the results of the selected decision can be attributed to the low dosage administered to the patient because higher doses of Exelon have been shown to be more effective (Farlow et al, 2013). For the MMSE, absence of change is not a source of concern because MMSE should be evaluated after months, and not weeks.
Decision Point 2
The second decision is to increase rivastigmine dosage to 4.5 mg orally BID.
Rationale of selecting the Decision
The rationale behind this decision is that evidence shows that higher-dose of Exelon is more effective for individuals with Alzheimer’s disease (Farlow et al, 2013 & Stahl, 2008). Rivastigmine indicates dose-dependent efficacy on cognitive functions, activities of daily living, as well as global functioning and hence it was hoped higher dose would be more effective (Su et al, 2015).
Expected Outcome
With this decision, it was hoped that that the client’s cognitive performance would improve and that the increased dosage would have minimal side effects on the client. As aforementioned, higher dosage of Rivastigmine has been associated improved cognitive function as well as better ability to carry out activities of daily living (Birks et al, 2016). Some of side effects of Rivastigmine encompass nausea, diarrhea, vomiting, constipation, abdominal pain, lack of appetite, as well as reduced weight (Mahoney et al, 2014).
Differences with the Decision Outcome
The result of the selected decision is that there was slight improvement as indicated by the client attending religious service with the family. This indicates that the increased medication dosage is improving patient’s symptoms. The client is also tolerating the medication well. There is no statistical difference with the projected results and the actual results of the decision.
Decision Point 3
The third decision is to increase Rivastigmine dosage to 6 mg orally BID.
Rationale of selecting the Decision
Order this paper