Alzheimer's Disease: A Case Study

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Management of Alzheimer’s Disease
There is no current drug therapy that is curative for Alzheimer’s disease, but there are treatments available that will slow the progression of disease and to control the symptoms. The indirect-acting cholinergic agonists are the group of drugs that are prescribed for the treatment of Alzheimer’s disease. They work by reversibly blocking acetylcholinesterase at the synaptic cleft. This blocking allows the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh receptor sites in all of the postsynaptic cholinergic sites (Karch, 2013). These indirect-acting cholinergic agonists cross the blood-brain barrier and mostly affect the cells in the cortex to increase …show more content…
The GI effects can include nausea, vomiting, cramps, diarrhea, increased salivation, and involuntary defecation related to the increase in GI secretions and activity due to parasympathetic nervous stimulation (Karch, 2013). The cardiovascular effects of the medications used for the treatment of Alzheimer’s disease include bradycardia, heart block, hypotension, and even cardiac arrest, due to the cardiac suppressing effects of the parasympathetic nervous system (Karch, 2013). These drugs can stimulate the bladder muscles, causing sphincter relaxation and can lead to urinary urgency. The CNS cholinergic effects include miosis and blurred vision, headache, dizziness, and drowsiness. The most important drug-drug interaction occurs, when these indirect acting cholinergic agonists were administered along with non-steroidal anti-inflammatory drugs (NSAIDS), because the combination of increased GI secretions and the GI mucosal erosion can result in GI bleeding (Karch, 2013). The patients using these drugs in combination should be closely monitored for signs and symptoms of GI bleeding. The effects of anticholinesterase drugs are decreased when it is administered with any cholinergic drugs, as they both act in opposition to each other (Karch, 2013). When the medication, tacrine is administered with theophylline, it can alter the blood theophylline level, so the dose of theophylline should be adjusted accordingly and patients should be closely monitored. The drugs used for the treatment of Alzheimer’s disease are metabolized in the liver and are excreted in the urine, so these drugs should be administered with caution in the presence of renal or hepatic dysfunction. The patient A.U. was prescribed with donepezil as the primary drug and the caregiver, Mrs. A.U. should be advised to closely monitor for the
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