Prescriptive Case Study Two Ben Casey is a 63-year-old man who presents for his annual exam. Mr. Casey often seems confused and does not seem to recall events of the past year during the exam. According to his wife, Ben has difficulty remembering names the names of his 12 grandchildren and seem confused with driving to church or to groceries. Mrs. Casey states that Ben is able to perform his usual activities of daily living, but no longer wants to drive. She also mentions that he seems depressed. His physical exam and lab work are within normal, other than being confused as to the location and time of day. His medical history indicates hypertension, for which he takes Lisinopril 5mg daily without any difficulty. Other than drinking a glass…show more content… Unfortunately, the treatment only benefits 1 in 12 patients and for those who benefit, there are improvements in quality of life due to the increase in cognitive functions. Donepezil reversibly inhibit acetylcholine, but is more selective for acetylcholine found in the brain than that found in the periphery. The oral form of this medication allows for ease of absorption in the body. Its metabolism occurs by the hepatic cytochrome P450 enzymes, and elimination takes place mainly in the urine and partly in the bile. Due to donepezil’s prolonged plasma half-life of about 60 hours, patients can take the drug once daily, making medication regiment compliance more…show more content… This allows for patients to take the medication in disintegrating tablets if swallowing becomes difficult due to disease progression. The tablets come in 5, 10, and 23 mg and oral disintegrating tablets come in 5 and 10 mg and with both formulations, patients may take it with or without food late in the evening. Titrating the dosage slowly minimizes side effects of the drug. The initial dosage is 5 mg once daily and if necessary, increasing the dose to 10 mg daily occurs after 4 to 6 weeks. Dosage increase to 23 mg once daily for patients with moderate or severe AD occurs for those who have taken 10 mg daily for at least 3 months. However, the likelihood of side effects at this dosage increases. As with any cholinesterase inhibitor, by elevating acetylcholine in the periphery, typical cholinergic side effects such as nausea and diarrhea occurs often. If symptomatic bradycardia occurs, leading to fainting, falls, and fall-related fractures, withdrawing the drug is necessary, especially if cognitive benefits are minimal. Avoiding drugs that block cholinergic receptors such as first-generation antihistamines, tricyclic antidepressants, conventional antipsychotics can reduce therapeutic effects. Treatment continues indefinitely, or until the harmful effects of the drug outweighs the
