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Cholinesterase inhibitors are commonly prescribed for the treatment of dementia symptoms (Mayo Clinic, 2022).


Donepezil (Aricept) is approved to treat all stages of the disease (Mayo Clinic, 2022). It’s taken once a day as a pill. Side effects include atrial fibrillation, hypertension, hypotension, vasodilation, ecchymoses, GI upset, frequent urination, weight loss, arthritis, muscle ramps, headache, drowsiness, fatigue, sedation, and dizziness (Vallerand & Sanoski, 2020).

Galantamine (Razadyne) is approved to treat mild to moderate Alzheimer’s (Mayo Clinic, 2022). Side effects include bradycardia, GI upset, incontinence, extrapyramidal symptoms, and syncope (Vallerand & Sanoski, 2020).


N-methyl-D-aspartate (NMDA) receptor antagonist  


Memantine (Ebixa) is used for moderate to severe dementia (Vallerand & Sanoski, 2020). Side effects include hypertension, rash, weight gain, urinary frequency, anemia, fatigue, and headache (Vallerand & Sanoski, 2020). 


Behavior disturbances associated with progressive dementia include symptoms such as depression, anxiety psychosis, agitation, aggression, disinhibition, and sleep disturbances (Müller-Spahn, 2003). Some evidence shows that symptoms such as depression and anxiety are common in early stages of dementia and aggression, psychosis, and behavioral problems occur in advanced stages (Müller-Spahn, 2003). Treatment of agitation in dementia include non-pharmacologic and pharmacologic interventions including behavioral management, environmental modifications, interventions using sound and light, and social interaction groups and antipsychotics, selective serotonin reuptake inhibitors, beta-blockers, and anticonvulsants (Müller-Spahn, 2003). Research found that citalopram (CeleXA) and perphenazine (Trilafon) were more effective than placebo in the treatment of aggression and psychosis in demented patients (Müller-Spahn, 2003). 


Parkinson’s disease

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?


Mr. Lacy is a 65-year-old man diagnosed with Parkinson’s disease (PD) that has progressed over the years. PD is a progressive condition involving the loss of neurons in the susbtantia nigra and a depletion of the neurotransmitter dopamine in the brain, which results in smooth, coordinated muscle movement impairment (Dlugash & Story, 2021). It is recommended that he be treated with levodopa. Levodopa is the precursor to dopamine, and it is used as a dopamine replacement agent for the treatment of PD (Gandhi & Saadabadi, 2022). Levodopa, unlike dopamine, can pass through the blood-brain barrier (BBB). Both the CNS and the peripheral areas of the body convert levodopa to dopamine, its active form. Levodopa functions as dopamine and aids in reestablishing the proper balance between dopamine and acetylcholine (Rosenthal & Burchum, 2021). Its adverse effects include nausea, vomiting, dyskinesias, postural hypotension, and CNS effects (e.g., anxiety, agitation, and cognitive impairment). 

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

Carbidopa is the most common drug combined with levodopa. It is a dopamine decarboxylase inhibitor, which prevents the conversion of levodopa to dopamine in the peripheral areas, allowing more levodopa to cross the BBB (Gandhi & Saadabadi, 2022). In addition, carbidopa cannot cross the BBB, thus being unable to prevent the conversion of levodopa to dopamine by decarboxylases in the brain (Rosenthal & Burchum, 2021). Carbidopa also promotes a faster response by enabling the use of lower doses of levodopa and reducing levodopa-induced nausea and vomiting. 

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

Dopamine agonists can also be used to treat PD (Rosenthal & Burchum, 2021). Dopamine agonists bind to the dopamine receptors and include ergot alkaloids and non-ergot alkaloids. Nonergot derivatives, which include Mirapex (pramipexole), Requip (ropinirole), Neupro (rotigotine), and Apokyn (apomorphine), are highly selective for dopamine receptors and cause fewer side effects than ergot derivatives. Parlodel (bromocriptine) and Dostinex (cabergoline) are ergot derivatives and are less selective for dopamine receptors.

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