Primary Care Medication Management

Primary Care Medication Management

Q1. Name a drug for each of the two classes of medication that is currently available for the treatment of dementia and their adverse effects

The two classes of drugs commonly available and approved for the treatment of dementia are cholinesterase inhibitors and glutamate inhibitors. An example of a cholinesterase inhibitor is Donepezil, sold under the brand name Aricept. The common glutamate inhibitor is Memantine, sold under the brand name Namenda. The adverse side effects of using cholinesterase inhibitor donepezil (Aricept) include fading and slowed heartbeats, cases of stomach ulcers and bleeding, seizures, elevated lung issues in case of existing lung problems, and issues with passing urine. Adverse side effects of Memantine (Namenda) include risk for pancreatic, hepatitis, and congestive heart failure. Patients may also experience severe allergic reactions, including hives, swelling lips, and shortness of breath.

Q2. Behavioral disturbances associated with progressive dementia and their recommended treatment

Behavioral disturbances associated with progressive dementia include physical aggressiveness and hypersomnia (Zhong et al., 2021). Physical aggressiveness involves the dementia patient developing a habit of trying to harm those around them through kicking, biting, scratching, or throwing things at them. Hypersomnia is a case whereby the patient expresses a habit of always wanting to sleep. The recommended medication for physical aggressiveness is Risperidone, branded as Risperdal, while the recommended medication for hypersomnia is modafinil, usually branded as Provigil.

Q3. Levodopa in the treatment of Parkinson’s disease and its adverse effects

Levodopa is a medication that is used as an agent to replace dopamine replacement in the treatment of Parkinson’s disease (Gandhi & Saadabadi, 2021). Mr Lacy may normally experience nausea, instances of vomiting, increased appetite, lowered blood pressure, and confusion after taking levodopa. However, in adverse instances, the patient may experience a twitching of muscles, severe allergic reactions leading to breathing difficulties, clogged throat, hives, and swelling on lips and face. The patient may also have issues controlling their body parts, such as hands, risk of seizures, persistent nausea and vomiting, extreme mood swings, cases of depression and suicidal thoughts, and postural hypotension (Gandhi & Saadabadi, 2021).

Q4. What drug is most commonly combined with levodopa and why?

Levodopa is commonly combined with carbidopa. Carbidopa is combined with levodopa as it slows down the peripheral metabolism of levodopa to allow the active drug ingredient to cross the blood-brain barrier in larger quantities to improve its effectiveness in managing Parkinson’s disease.

Q5. Drug options for the treatment of PD

Besides the carbidopa-levodopa combination, other treatment options for PD include the use of dopamine agonists such as pramipexole, ropinirole, and rotigotine, MAO B inhibitors such as selegiline and nd safinamide, Catechol O-methyltransferase (COMT) inhibitors, Anticholinergics, and deep brain surgical procedures (Armstrong & Okun, 2020).

Q6. How does venlafaxine differ from tricyclic antidepressants (TCAs)? What adverse effects might this patient expect with venlafaxine?

Both drugs are antidepressants and bear little pharmacological differences. Both venlafaxine and TCA have similar treatment efficacy; however, venlafaxine belongs to the serotonin-norepinephrine reuptake inhibitor class, while TCAs belong to the Tricyclic class of antidepressants (Clevenger et al., 2021). Venlafaxine’s adverse effects might include seizures, coma, irregular heartbeats, severe allergic reactions, difficulties breathing and swallowing, confusion, and coordination issues.

References

Armstrong, M. J., & Okun, M. S. (2020). Diagnosis and treatment of Parkinson’s disease: a review. Jama, 323(6), 548-560.

Clevenger, S. S., Malhotra, D., Dang, J., Valle, B., & Ishak, W. W. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Therapeutic advances in psychopharmacology, 8(1), 49-58.

Gandhi, K. R., & Saadabadi, A. (2021). Levodopa (l-dopa). In StatPearls [Internet]. StatPearls Publishing.

Zhong, W., Liu, X., Voss, T., Khalilieh, S., Khandker, R. K., Bortnichak, E., & Liaw, K. L. (2021). Medications in Patients with Dementia and Behavioral Disturbance. Journal of Alzheimer’s disease reports, (Preprint), 1-6.

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Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)

Primary Care Medication Management

Mrs. William, a 75-year-old patient, is with her daughter for a follow-up visit. At her previous office visit, her daughter expressed concerns about her mother’s increasing forgetfulness. You send Mrs. William for neuropsychiatric testing. She is diagnosed with mild dementia, and the patient and family would like to discuss treatment options.

Q1. Name a drug for each of the two classes of medication that is currently available for the treatment of dementia and its adverse effects. (Trade and generic names).

Q2. Mrs. William’s daughter is concerned about the behavioral disturbances that can be associated with progressive dementia. Discuss at least two disturbances that are associated with progressive dementia and their treatment recommendations. Please provide one medication, trade, and generic name for each of the behavioral disturbances you list.

Mr. Lacy is a 65-year-old man diagnosed with Parkinson’s disease (PD) five years ago. His disease has progressed over the years, and it is recommended that he be treated with levodopa.

Q3. What is levodopa, and how is it used in the treatment of Parkinson’s disease? What are the adverse effects of levodopa that might be expected in this patient?

Q4. What drug is most commonly combined with levodopa and why?

Q5. What other drugs can be used for the treatment of PD?

A 50-year-old man has developed depression after the death of his wife. He is prescribed venlafaxine (Effexor XR) 75 mg PO once a day.

Q6. How does venlafaxine differ from tricyclic antidepressants (TCAs)? What adverse effects might this patient expect with venlafaxine?