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.
Mild dementia refers to a stage of cognitive decline that is characterized by noticeable but subtle changes in memory, thinking, and behavior. It is often an early stage of dementia and may be associated with conditions such as Alzheimer’s disease. Individuals with mild dementia may have trouble remembering recent events or retaining new information, but they can often recall older memories relatively well and can lead to difficulties with problem-solving, decision-making, and multitasking. Individuals may also experience challenges with language, such as trouble finding the right words or following a conversation (Huang et al., 2020). Some individuals with mild dementia may exhibit changes in mood and behavior, such as increased anxiety, irritability, or social withdrawal. While individuals with mild dementia can often continue to perform activities of daily living independently, they may begin to struggle with more complex tasks and require additional support (Huang et al., 2020).
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. (Trade and generic names).
Cholinesterase Inhibitors: (Drugs 2024)
– Drug: Aricept (donepezil)
Adverse effects: Nausea, vomiting, diarrhea, insomnia, muscle cramps.
NMDA Receptor Antagonist: (Drugs 2024)
– Drug: Namenda (memantine)
Adverse effects: Dizziness, headache, constipation, confusion.
Q2. Mrs. William’s daughter is concerned about the behavioral disturbances that can be associated with progressive dementia. Discuss at least two disturbances associated with progressive dementia and their treatment recommendations. Please provide one medication, trade, and generic name for each of the behavioral disturbances you list.
Agitation: (Drugs 2024)
– Drug: Seroquel (quetiapine)
Adverse effects: Drowsiness, dizziness, weight gain, and increased risk of metabolic problems.
Anxiety: (Drugs 2024)
– Drug: Ativan (lorazepam)
Adverse effects: Drowsiness, dizziness, weakness, and unsteadiness.
It is important to note that the progression of mild dementia can vary from person to person, and early diagnosis and intervention are crucial for managing symptoms and planning for the future (Huang et al., 2020). Healthcare providers often recommend a combination of pharmacological and non-pharmacological interventions to support individuals with mild dementia and their families. These interventions may include medication, cognitive stimulation, lifestyle modifications, and support services aimed at optimizing quality of life and maintaining independence for as long as possible (Huang et al., 2020).
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.
Yes, levodopa is a common and effective medication used in the treatment of Parkinson’s disease (PD), particularly as the disease progresses. Levodopa is a precursor to dopamine, a neurotransmitter that is deficient in individuals with PD (Weintraub et al., 2022). By converting to dopamine in the brain, levodopa helps to alleviate some of the motor symptoms associated with PD, such as tremors, stiffness, and slowness of movement (Weintraub et al., 2022).
As with any medication, there are potential side effects and considerations that should be discussed with Mr. Lacy and his healthcare provider. Some common side effects of levodopa can include nausea, vomiting, low blood pressure, and involuntary movements called dyskinesias (Weintraub et al., 2022). Additionally, long-term use of levodopa can lead to fluctuations in motor response and dyskinesias, which may require adjustments to the treatment regimen over time. It is important for Mr. Lacy to have regular follow-up appointments with his healthcare provider to monitor his response to levodopa and make any necessary adjustments to his treatment plan (Weintraub et al., 2022).
Additionally, his healthcare provider may recommend combining levodopa with other medications, such as carbidopa, to enhance its effectiveness and minimize side effects (Weintraub et al., 2022). The choice of medication and treatment approach for Parkinson’s disease is highly individualized and depends on factors such as the patient’s symptoms, disease stage, age, overall health, and medication tolerance. Patients with Parkinson’s disease should work closely with their healthcare providers to develop a comprehensive treatment plan that addresses their specific needs and goals (Weintraub et al., 2022).
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?
Levodopa is a medication that is used to manage the symptoms of Parkinson’s disease. It is a precursor to dopamine, a neurotransmitter that is deficient in individuals with PD. When levodopa crosses the blood-brain barrier, it is converted to dopamine in the brain, helping to alleviate motor symptoms such as tremors, stiffness, and slowness of movement (Weintraub et al., 2022).
Adverse effects of levodopa in this patient might include: (Drug 2024)
– Nausea and vomiting
– Low blood pressure, especially upon standing
– Hallucinations or confusion, particularly in older patients
– Dyskinesias (involuntary movements) as the disease progresses
Q4. What drug is most combined with levodopa and why?
Carbidopa is the drug most combined with levodopa. The combination of levodopa and carbidopa is known as carbidopa/levodopa. Carbidopa enhances the effectiveness of levodopa by preventing its breakdown in the bloodstream before it reaches the brain. This allows for lower doses of levodopa to be used, which can reduce the risk of side effects such as nausea and vomiting (Weintraub et al., 2022).
Q5. What other drugs can be used for the treatment of PD?
Apart from levodopa and carbidopa/levodopa, other medications and treatments used in the management of Parkinson’s disease include dopamine agonists, these medications mimic the effects of dopamine in the brain and are often used in early stages of PD or in combination with levodopa. MAO-B inhibitors help prevent the breakdown of dopamine in the brain, thereby increasing dopamine levels and reducing symptoms. COMT inhibitor medications prolong the effects of levodopa by inhibiting the breakdown of dopamine in the bloodstream (Weintraub et al., 2022). Anticholinergics drugs can help control tremors and muscle stiffness, but they are used with caution due to potential side effects, especially in older patients. Deep brain stimulation is a surgical treatment that involves implanting electrodes in specific areas of the brain to help regulate abnormal brain activity and reduce PD symptoms (Weintraub et al., 2022).
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.
It is important to note that the treatment of depression, especially in the context of bereavement, requires a compassionate and comprehensive approach. While medication such as venlafaxine (Effexor XR) can be beneficial, it should ideally be combined with supportive therapy and counseling to address the emotional and psychological impact of the patient’s loss (Li et al., 2021).
Venlafaxine is an antidepressant medication that belongs to the class of serotonin-norepinephrine reuptake inhibitors (SNRIs). It works by increasing the levels of serotonin and norepinephrine in the brain, which can help improve mood and alleviate symptoms of depression (Li et al., 2021). The typical starting dose of venlafaxine for the treatment of depression is 75 mg once daily, with the possibility of dose adjustments based on the individual’s response and tolerability (Drugs 2024). It is important for the patient to follow the prescribed dosage and to attend regular follow-up appointments with their healthcare provider to monitor their response to the medication. In addition to medication, it is advisable for the patient to engage in supportive therapy to address the complex emotional and psychological aspects of grief and depression (Li et al., 2021). Supportive therapy can provide the patient with coping strategies, emotional support, and an opportunity to process their feelings and experiences in a safe and supportive environment. It is crucial for the patient to have a strong support network, which may include family, friends, and mental health professionals. The healthcare provider should closely monitor the patient’s progress and be attentive to any signs of suicidal ideation or worsening symptoms (Li et al., 2021).
Q6. How does venlafaxine differ from tricyclic antidepressants (TCAs)? What adverse effects might this patient expect with venlafaxine?
Venlafaxine differs from tricyclic antidepressants (TCAs) in several ways:
1. Mechanism of Action: (Drugs 2024)
– Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI), which works by increasing the levels of serotonin and norepinephrine in the brain.
– Tricyclic antidepressants (TCAs) primarily work by blocking the reuptake of serotonin and norepinephrine, like SNRIs, but they also have significant anticholinergic and antihistaminic effects.
2. Side Effect Profile: (Drugs 2024)
– Venlafaxine tends to have a more favorable side effect profile compared to TCAs due to its selective action on serotonin and norepinephrine reuptake.
– TCAs are associated with a higher risk of anticholinergic side effects such as dry mouth, constipation, blurred vision, and urinary retention, as well as sedation and potential cardiac effects.
Adverse effects the patient might expect with venlafaxine (Effexor XR) may include: (Drugs 2024)
– Nausea and vomiting
– Headache
– Insomnia or drowsiness
– Sexual dysfunction (e.g., decreased libido, erectile dysfunction)
– Increased blood pressure (especially at higher doses)
– Withdrawal symptoms if the medication is discontinued abruptly (dizziness, headache, nausea)
It is important for the patient to be aware of potential side effects and to report any concerning symptoms to their healthcare provider. Additionally, close monitoring is essential during the initial stages of treatment with venlafaxine to ensure its effectiveness and to manage any adverse effects that may arise (Li et al., 2021).
Reference
Drugs.com. (n.d.). Prescription drug information. Drugs.com. https://www.drugs.com/
Huang HL, Lu WR, Liu CL, Chang HJ. Advance care planning information intervention for persons with mild dementia and their family caregivers: Impact on end-of-life care decision conflicts. PLoS One. 2020 Oct 14;15(10):e0240684.
Li Z, Ruan M, Chen J, Fang Y. Major Depressive Disorder: Advances in neuroscience research and translational applications. Neurosci Bull. 2021 Jun;37(6):863-880.
Weintraub D, Aarsland D, Chaudhuri KR, Dobkin RD, Leentjens AF, Rodriguez-Violante M, Schrag A. The neuropsychiatry of Parkinson’s disease: advances and challenges. Lancet Neurol. 2022 Jan;21(1):89-102.
