NURS 6630 – Psychopharmacologic
Approaches to Treatment of
Psychopathology Discussions and
Assignments
Case Study: An Elderly Iranian Man with Alzheimer’s Disease
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.
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
Approaches to Treatment of
Psychopathology Discussions and
Assignments
Case Study: An Elderly Iranian Man with Alzheimer’s Disease
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.
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
