Examine Case Study: An Elderly Iranian Man With Alzheimer’s

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease

The assignment involves making three clinical decisions regarding medication prescriptions for an elderly Iranian man diagnosed with Alzheimer’s disease. Each decision must consider factors that might influence the patient's pharmacokinetic and pharmacodynamic responses. For each decision point, the task includes selecting a medication or intervention, justifying the choice with evidence from learning resources, explaining the expected outcomes, and analyzing any differences between anticipated and actual results. Additionally, ethical considerations in treatment planning and communication with the patient and family must be addressed, including rationale for choosing certain medications over alternatives.

Paper For Above instruction

Alzheimer’s disease (AD) presents a complex challenge in geriatric pharmacology, especially considering ethnic and cultural factors that influence drug response and treatment adherence. In managing an elderly Iranian man with AD, clinicians must balance therapeutic efficacy with safety, taking into account age-related pharmacokinetic and pharmacodynamic changes, comorbidities, and cultural considerations. The following discussion depicts three critical decision points in prescribing medication, supported by current evidence, and highlights the significance of ethical practices in healthcare communication and decision-making.

Decision 1: Initiation of Cholinesterase Inhibitor Therapy

The first decision involved choosing whether to initiate cholinesterase inhibitor therapy, such as donepezil, rivastigmine, or galantamine. I selected donepezil as the initial medication because it has a well-established safety profile, once-daily dosing, and proven efficacy in mild to moderate AD (Birks, 2006). Additionally, donepezil’s pharmacokinetics demonstrate favorable absorption with minimal hepatic metabolism interaction, which is beneficial in elderly patients who often have multiple comorbidities and polypharmacy concerns (Birks, 2006).

My goal was to improve cognitive function and delay disease progression, thereby enhancing the patient's quality of life. The literature indicates that cholinesterase inhibitors offer modest benefits in cognition and daily functioning (Cholerton et al., 2011). Ensuring patient safety and minimizing adverse effects—such as gastrointestinal symptoms and bradycardia—were also primary objectives.

Initially, I expected that donepezil would stabilize or mildly improve cognitive symptoms. However, the results showed only slight improvements, and some adverse effects, such as nausea and sleep disturbances, occurred. This divergence highlighted the variability in drug response among elderly patients and the influence of factors like age-related pharmacokinetic changes—slower metabolism and increased drug sensitivity—that can amplify side effects (Birks, 2006). This experience underscored the importance of close monitoring and patient-specific adjustments in therapy.

Decision 2: Addressing Behavioral and Psychological Symptoms

Upon observing persistent behavioral symptoms, including agitation and sleep disturbances, I opted to add non-pharmacological interventions first, but also considered pharmacologic options if necessary. The second decision involved initiating a low dose of memantine if behavioral symptoms worsened. I selected memantine as an adjunct therapy because it offers neuroprotective benefits by modulating glutamate activity, which may help with behavioral symptoms and cognitive decline later in AD progression (Reisberg et al., 2003).

The intention was to improve behavioral symptoms without excessive sedation or anticholinergic burden, which are common concerns in elderly patients. Evidence suggests that memantine is generally well-tolerated and can slow functional decline (Reisberg et al., 2003).

Expectations were that memantine would contribute to behavioral stabilization and cognitive support. In practice, the patient exhibited mild improvement in agitation but experienced dizziness initially, which was managed through dose titration. The different responses highlighted the pharmacodynamic variability in NMDA receptor modulation, especially considering age-related brain changes and comorbid vascular conditions affecting drug efficacy and tolerability (Reisberg et al., 2003). Ethical considerations involved ensuring the patient's autonomy, obtaining informed consent, and communicating potential benefits and risks transparently.

Decision 3: Incorporating Cultural and Ethical Considerations in Pharmacotherapy

The third decision prioritized culturally sensitive communication and involving family members in the treatment plan. Recognizing the patient's Iranian background, language preferences, and family roles, I opted to collaborate closely with family members when discussing ongoing treatment options, medication adherence challenges, and ethical dilemmas, such as balancing quality of life versus medication side effects.

The pharmacological choice prioritized medications with minimal side effects, ease of administration, and cultural relevance. I preferred continuing with donepezil if benefits persisted, but remained open to switching or discontinuing based on new symptoms or side effects, respecting the patient's dignity, cultural values, and autonomy. Ethical principles, including beneficence, non-maleficence, and respect for autonomy, guided decisions. Transparent communication was crucial in building trust and ensuring adherence (American Psychological Association, 2010).

This comprehensive, culturally aware approach aimed to optimize clinical outcomes while honoring the patient's personal and cultural identity. It also involved balancing medication benefits with potential ethical issues like overmedication or neglecting non-pharmacological interventions.

Conclusion

Managing Alzheimer’s disease in elderly patients necessitates a multidimensional approach that incorporates pharmacological evidence, patient-specific factors, and ethical principles. The decisions to initiate cholinesterase inhibitors, add memantine, and engage culturally sensitive communication pathways reflect best practices aligned with current literature (Birks, 2006; Reisberg et al., 2003; Cholerton et al., 2011). Understanding pharmacokinetics and pharmacodynamics in the elderly, respecting cultural contexts, and emphasizing transparent communication enhance the quality of care and patient trust. Addressing potential discrepancies between expected and actual outcomes underscores the importance of ongoing assessment, personalized adjustments, and ethical responsibility in mental health care.

References

  • Birks, J. (2006). Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database of Systematic Reviews, (1), CD005593.
  • Cholerton, B., Jacobson, E., & O'Brien, J. (2011). Pharmacological management of Alzheimer's disease. British Medical Bulletin, 97(1), 159-176.
  • Reisberg, B., Doody, R., Stoffler, A., Schmitt, F., & Lanctôt, K. (2003). Memantine in moderate-to-severe Alzheimer's disease. The New England Journal of Medicine, 348(14), 1333-1341.
  • American Psychological Association. (2010). Ethical Principles of Psychologists and Code of Conduct. Retrieved from https://www.apa.org/ethics/code
  • Alzheimer's Association. (2021). 2021 Alzheimer's Disease Facts and Figures. Alzheimer's & Dementia, 17(3), 327-406.
  • Lopez, O. L., et al. (2019). Pharmacological management of Alzheimer’s disease. Journal of the American Geriatrics Society, 67(9), 1827-1835.
  • Katzman, R. (2017). The evolving management of Alzheimer’s disease: New pharmacologic and nonpharmacologic options. The American Journal of Geriatric Psychiatry, 25(3), 246-266.
  • Kuhn, D., & Sultana, L. (2020). Cultural competence and dementia care. Journal of Geriatric Mental Health, 7(1), 17-25.
  • Centers for Disease Control and Prevention. (2022). Dementia and Alzheimer’s disease: Data and statistics. CDC Reports. https://www.cdc.gov/aging/dementia/data.html
  • Smith, L., & Roberts, S. (2018). Ethical considerations in dementia treatment. Ethics & Medicine, 34(2), 101-110.

Related Assignments