Week 6: Discussion Question

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).

According to the World Health Organization, there are more than 55 million dementia

sufferers worldwide. Not a disease, dementia is a syndrome. A combination of symptoms

without a clear diagnosis is referred to as a syndrome. Mental cognitive functions like memory

and reasoning are impacted by dementia. It can be brought on by a number of illnesses,

Alzheimer’s disease being the most prevalent. There are various dementias that people can get.

Mixed dementia is the term for this. People who have mixed dementia exhibit signs of two or

more dementia types. Only an autopsy can provide definitive proof of a mixed dementia

diagnosis. Dementia can significantly affect a person’s capacity for independent functioning as it

advances. It is a significant contributor to older individuals’ disabilities and puts a strain on

families and carers both emotionally and financially. The prevalence of dementia is anticipated

to increase thrice over the next 30 years, making it the fifth greatest cause of mortality in the

world (Yetman, 2021).

 Acetylcholinesterase inhibitors: Acetylcholinesterase inhibitors (AChEIs), sometimes

known as “anti-dementia drugs,” were created to slow the deterioration of neurocognitive

diseases and to cut down on medical expenses. In clinical practice, AChEIs are frequently

recommended to treat Alzheimer’s disease, which accounts for 70% of dementia cases.

- Generic Name = Trade Name:

 Donepezil = Aricept, Aricept ODT, Namzaric, Adlarity Pro

 Galantamine = Razadyne ER, Reminyl, Razadyne Pro

 Rivastigmine = Exelon Pro

- Adverse Effects: Due to overstimulation of peripheral cholinergic activity and

activation of muscarinic receptors, the increasing usage of AChEIs increases

adverse drug reactions (ADRs), which include deleterious effects on the heart and

gastrointestinal system

(Ruangritchankul et al., 2020)

 NMDA receptor antagonists: It’s utilized to lessen the neurotoxicity that’s suspected to

contribute to conditions like Alzheimer’s and other neurodegenerative disorders. It

inhibits the over-activation of glutamine receptors while permitting normal action by

blocking the NMDA-receptor subtype of glutamate receptors. Its blocking properties

counteract the neurotoxicity seen in Alzheimer disease, which is considered to be caused

by an overactive glutaminergic pathway in the central nervous system (CNS).

- Generic Name= Trade Name:

 Memantine = Namenda, Namenda XR

- Adverse Effects: The most frequent side effects in clinical trials were headaches,

disorientation, dizziness, diarrhea, and constipation. In contrast, some people

experience weariness, discomfort, hypertension, weight gain, hallucinations,

confusion, aggressive behavior, vomiting, abdominal pain, and urine

incontinence.

(Kuns et al., 2022)

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.

Psychosis- A person’s thoughts and perceptions are impacted by psychosis. It changes the way

individuals process information, making it challenging to distinguish between what is true and

what is false. Psychotic patients may experience unreal sounds, sights, smells, tastes, or

sensations. They may also have irrational thoughts or notions, such as the notion that someone is

trying to harm them or keeping an eye on their activities when in reality, these things are not the

case.

 Antipsychotic drugs – lessen the symptoms of psychosis in those with psychiatric

diseases like schizophrenia. They don’t, however, address or resolve the underlying

problem.

- Generic Name = Trade Name:

 Aripiprazole = Abilify

 Clozapine = Clozaril

 Haloperidol = Haldol

 Olanzapine = Zyprexa

 Quetiapine = Seroquel

 Risperidone = Risperdal

 Ziprasidone = Geodon

(MacGill & Tee-Melegrito, 2023)

Anxiety- Most people encounter stress at various times throughout their lives. However, stress is

a physiological reaction to a perceived threat or biological injury, and it usually lasts just a short
time. On the other side, anxiety is the concern and stress brought on by the anticipation of a

perceived threat.

 Antidepressants drugs- for irritation and a bad mood.

- Generic Name= Trade Name:

 Citalopram = Celexa

 Fluoxetine = Prozac

 PParoxeine = Paxil

 Sertraline = Zoloft

 Trazodone = Desyrel

(Felman, 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?

Parkinson’s is neither slowed down nor reversed by levodopa. However, it can aid in the

management of symptoms that make it difficult to move, such as bradykinesia, or sluggish

movement. The body thus slows down considerably. Walking, getting dressed, and even raising

the arm higher now take longer than they used to. There are moments when things slow down so

significantly that briefly “freeze.” The feet feel as though they are anchored to the ground but

want to move. Also rigidity, a term for stiff muscles. The ability to swing the arms while walking

might not be available. Furthermore, can find it difficult to write, button the shirt, move out of a

chair, or turn over in bed. And lastly, tremor. Wherein can’t control the slight trembling that is

occurring. In one hand, when calm and still, it typically begins. The foot or leg on the same side

may also be affected, as well as the arm or upper body. Tremor is not an issue for everyone with
Parkinson’s, and it is not for everyone. Over time, though, it can get worse. The most frequent

side effects of levodopa therapy include nausea, vertigo, headaches, and sleepiness (Rath, 2022).

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

The most effective medication combination for the treatment of Parkinson’s disease is

levodopa and carbidopa. Dopamine, a chemical messenger that regulates movement in the brain,

is created from the precursor levodopa. Levodopa is not broken down by the peripheral

decarboxylase inhibitor carbadopa, allowing it to enter the brain and raise dopamine levels

(Mishra, 2021).

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

Levodopa is frequently used with dopamine agonists (Das) or enzyme inhibitors to treat

motor problems, such as Catechol-o-methyl-transferase (COMT) inhibitors and Monoamine

oxidase B (MAO-B) inhibitors. Levodopa degradation is inhibited by commonly used COMT

inhibitors like entacapone and opicapone in the peripheral nervous system, but dopamine

degradation is decreased by blood-brain barrier-crossing MAO-B inhibitors. When used as an

additional therapy in more advanced illness, MAO-B inhibitors have been proven to have

outstanding efficacy and safety throughout the early stages of PD. Clinical investigations have

demonstrated an association between a longer period of MAO-B inhibitor exposure and a

decrease in levodopa use as well as a slower rate of clinical decline (Tan et al., 2021).

Q6. How does venlafaxine differ from tricyclic antidepressants (TCAs)? What adverse effects

might this patient expect with venlafaxine?

Venlafaxine has a minimal affinity for other neurotransmitter receptor sites, in contrast to

clomipramine and other tricyclic antidepressants, hence it lacks sedative and anticholinergic
properties. A selective serotonin and noradrenaline reuptake inhibitor (SNRI) is the classification

given to venlafaxine. Venlafaxine’s typical adverse effects may include headaches, dry mouth,

constipation or diarrhea, sexual dysfunction, sleep troubles, and issues with the appetite.

Perspiration, sickness or vomiting, shivering, changes in weight, disorientation, sleepiness,

indigestion, and strange nightmares (Rangaves, 2023).

Felman, A. (2022, May 5). Anxiety Treatment: Self-management, Therapy, and Medication.

Medical News Today. Retrieved June 4, 2023, from

https://www.medicalnewstoday.com/articles/323494

Kuns, B., Rosani, A., & Varghese, D. (2022, July 11). Memantine. StatPearls – NCBI Bookshelf.

Retrieved June 4, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK500025/

MacGill, M., & Tee-Melegrito, R. A. (2023, February 15). Psychosis: Causes, Symptoms, and

Treatments. Medical News Today. Retrieved June 4, 2023, from

https://www.medicalnewstoday.com/articles/248159

Mishra, S. (2021, September 29). Levodopa + Carbidopa: View Uses, Side Effects and

Medicines | 1mg. TATA 1mg. Retrieved June 4, 2023, from

https://www.1mg.com/generics/levodopa-carbidopa-402115

Rangaves, D. (2023, January 31). Effexor (Venlafaxine) Side Effects: Common, Severe, & Rare.

Choosing Therapy. Retrieved June 4, 2023, from

https://www.choosingtherapy.com/venlafaxine-effexor-side-effects/#side-effects-of-

effexor

Rath, L. (2022, April 15). Dyskinesia in Parkinson’s Disease and Levodopa: Deciding to Take

the Drug. WebMD. Retrieved June 4, 2023, from https://www.webmd.com/parkinsons-

disease/decide-start-levodopa

Ruangritchankul, S., Chantharit, P., Srisuma, S., & Gray, L. C. (2020, November 22). Adverse

Drug Reactions of Acetylcholinesterase Inhibitors in Older Peo | TCRM. Dovepress.

acetylcholinesterase-inhibitors-in-older-peo-peer-reviewed-fulltext-article-TCRM

Tan, Y. Y., Jenner, P., & Chen, S. D. (2021, November 30). Monoamine Oxidase-B Inhibitors

for the Treatment of Parkinson’s Disease: Past, Present, and Future – IOS Press. IOS

Press. Retrieved June 4, 2023, from https://content.iospress.com/articles/journal-of-

parkinsons-disease/jpd212976

Yetman, D. (2021, December 22). What’s the Difference Between Dementia and Alzheimer’s

Disease? Healthline. Retrieved June 4, 2023, from

https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers