Case study: An elderly Iranian man with Alzheimer’s disease

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Case study: An elderly Iranian man with Alzheimer’s disease

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment.

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Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

Case study: An elderly Iranian man with Alzheimer’s disease Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia

  • donepezil
  • galantamine
  • memantine
  • rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Case study: An elderly Iranian man with Alzheimer’s disease Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD:

Case study An elderly Iranian man with Alzheimer’s disease

Case study An elderly Iranian man with Alzheimer’s disease

Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

At each decision point stop to complete the following:

Decision #1

  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision Point One

Selected Decision

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.

Expected Results

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 #2

  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Week 6 Midterm

Question 1

A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Question 2

Which statement about neurotransmitters and medications is true?

Question 3

When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:

Question 4

During gene expression, what must occur prior to a gene being expressed?

Question 5

While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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