– Word document using a minimum of five evidence-based resource articles, not older than three years, and the course textbook.
M. W. is a 70-year-old Caucasian with a medical history of hypertension, osteoarthritis, atrial fibrillation, and total hysterectomy who lives by herself in a two-story row home. She visits the primary care clinic with her daughter, who is concerned because M. W. has bounced a few checks and can no longer pay her bills without assistance. M. W. admits that she has been forgetful and appears anxious as she describes an incident in which she went shopping and could not remember where she parked her car. Her daughter states that her mother’s memory has progressively worsened over the past year.
Fosinopril 20 mg PO daily
Metoprolol Succinate ER 50 mg PO daily
Warfarin 5 mg PO daily
Vitamin D 1,000 IU PO daily
Acetaminophen 325 mg 2 tablets (650 mg) PO tid
A careful evaluation and workup was ordered.
Diagnosis: Mild AD with an MMSE score of 22
List specific goals of treatment for M. W.
What drug therapy would you prescribe for M. W.? Why?
What are the parameters for monitoring success of therapy?
Discuss specific patient education based on the prescribed therapy.
List one or two adverse reactions for the selected agent that would cause you to change therapy.
Would there be any over-the-counter and/or alternative agents appropriate for M. W.?
What lifestyle changes would you recommend to M. W.?
Describe one or two drug-drug or drug-food interactions for the selected agent.
Craft a Therapeutic Plan.
Using Beers Criteria and rational drug prescribing, review the medications and diagnoses listed for M. W. What three prioritized changes would you make to the medication regimen? Include a detailed and evidence-based rationale for all changes, including, but not limited to, monitoring, drug-drug interactions, drug-disease interactions, pharmacokinetics/pharmacodynamics, age, gender, and culture.
What would be your pharmacological-related patient education?
Would you order any laboratory testing? Provide rationale for all decisions.
Describe a follow-up plan of care with rationale.
Therapeutic Plan for M. W.
Specific Goals of Treatment:
Drug Therapy: For the treatment of Mild AD, I would prescribe donepezil (Aricept) 5 mg PO daily initially, with a gradual titration to 10 mg PO daily. Donepezil is an acetylcholinesterase inhibitor that can help improve cognitive function and slow the progression of AD. It is considered a first-line treatment for Mild AD. The rationale for this choice includes its proven efficacy in improving cognitive function and its relatively favorable side effect profile.
Parameters for Monitoring Success of Therapy:
Adverse Reactions for Donepezil:
Over-the-Counter and/or Alternative Agents: There are various dietary supplements and alternative therapies advertised for cognitive enhancement, but their efficacy is not well-established. It is advisable to discuss any potential supplements with M. W.’s healthcare provider before use.
Drug-Drug or Drug-Food Interactions:
Beers Criteria and Medication Changes: Considering the Beers Criteria and rational drug prescribing:
Pharmacological-Related Patient Education:
Laboratory Testing: Regular monitoring of INR for warfarin therapy management and liver function tests if acetaminophen is continued for pain management.
Follow-up Plan of Care: