PHAR3822 – Case 3Alzheimer’s Disease

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Case 3 – Alzheimer’s Disease

› Dr Abercrombie contacts you to prepare a home medication review for Mr Vergessen. He is introducing an acetylcholinesterase inhibitor to treat Mr Vergessens Alzheimer's symptoms. Exelon 1.5 mg ~ 1 bd

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Background and Context

 

› Mr Vergessen (67 y.o.) has been a regular visitor of your pharmacy for over 10 years. You know that he is current regimen includes medication for his COPD, hypertension and osteoarthritis. He loves playing snooker at the local RSL where he enjoys a beer or two. He retired two years ago after a long career as automotive engineer and he still tinkers with cars in his garage. He has been trying to give up smoking for the past two years but hasn't succeeded yet.

› You review his medication from your computer before you visit Mr Vergessen.

› Serevent Accuhaler 50 ug ~ 1 bd

› Panamax 500 mg ~ 1-2 q6h prn

› Dolobid 500 mg ~ 1 prn

› Isoptin SR 240 mg ~ 1 m & 1/2 n

› Champix ~ mdu

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Pre-work for Session 1

› You should prepare a list of appropriate questions to ask Mr Vergessen.

› Read the information on Home Medication Review (HMR) on the Pharmacy Guild and Medicare websites.

- http://www.guild.org.au/mmr/content.asp?id=53

- http://www.medicareaustralia.gov.au/provider/pbs/fourth-agreement/hmr.jsp

› Read the following analysis on dementia medication

- Kurz & Baleen (2004) Gingko biloba Compared with Cholinesterase inhibitors in the treatment of Dementia: a review based on meta-analyses by the Cochrane collaboration. Dementia and Geriatric Cognitive Disorders 18(2): 217 - 226

- impact factor: 2.6; 5 year impact (2.9)

› You should prepare a draft HMR

› Review the pharmacology, pharmacokinetics and chemistry of acetylcholinesterase inhibitors.

Before your tutorial:

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Information gathering

› What questions would you ask to get the information you need from Mr Vergessen?

› Following discussion on above points, students should identify and discuss ..

›  

› General Medication Issues

- Have they determined all Mr Field's medication and how he is taking them?

- Is Mr Field experiencing any adverse reactions to the medication?

- Does Mr Field know why he is taking his medication?

- Does he know if the medication is working?

- Does the addition of complementary medication generate any problems with his prescription medication?

- Does smoking affect any of his medication?

- Could the storage of his medication affect their efficacy?

- Could you suggest a more strategic and safer place to store his medication?

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Identify and discuss ..

› Compliance

- Is Mr Field having trouble remembering to take his medication?

- How could you improve Mr Vergessen's compliance?

- Would a dose administration aid help?

› Acetylcholinesterase inhibitors

- What acetylcholinesterase inhibitors are available?

- Which inhibitors are indicated for Alzheimer's disease?

- Why aren't neostigmine and physostigmine used for Alzheimer's disease?

- Why are organophosphates avoided in the treatment of Alzheimer's disease?

- Although Tacrine was first on the market why isn't it recommended anymore?

- Do any of the acetylcholinesterase inhibitors interact with Mr Vergessen's current medication?

- Are acetylcholinesterase inhibitors contraindicated for Mr Vergessen?

- Should acetylcholinesterase inhibitors be used with caution in Mr Vergessen's case?

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Scenario 2…..

Consider the following scenario with Mr Vergessen…

A month later Mr Vergessen comes down to your pharmacy with a script for Exolon patches 1 d. He wonders if you could explain how this medication works to help his memory.

 

what questions would you ask Mr Vergessen.

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Information processing and delivery

› Are there any differences between nicotine patches and Exolon patches?

› How will you explain how this medication works? (Pacman?)

› What side effects and precautions do you need to warn Mr Vergessen about?