pharm

• degerative disease of the CNS, occurs in cortex of brain
• progressive deterioration
• debilitating symptom of AD is demetia involves decrease in cognative function
• decrease in acetylcholine

• Early phase- mild cognative decline:
• increase forgetfulness
• decrease performance in social setting
• evidance of memory deficit when interviewed
• anxiety

• Early dementia phase- mildly severe cognative decline:
• needs assist w/ ADL
• cant recall important aspects of life
• cant make choices
• able to recall major facts
• needs assistance 4 survival

• late dementia phas- severe cognative decline:
• incontinent
• little verbal ability
• no basic psychmotor skills
• assisstance w/ ADL

action: increase level of Acetylcholin in CNS by inhibiting its breakdown & slowing neural distruction

Uses: tx dementia from AD, not used in late stages of AD

cont: renal & hepatic disease, bladder obstruction, seizures disorders, sick sinus syndrome, GI bleeding, asthma, & hx of ulcer disease b/c bleeding may occur

• Inter:
• anticholinergic (decrease body secretion)- decrease effectiveness of anticholinergic
• NSAID(pain)- increase risk 4 GI bleeding
• Theophyline(breathing problems)- increased risk 4 theophyline toxicity

• Ginseng-improves energy & mental performance
• AR: sleeplessness, nervousness, diarrhea when taken in lrg doses
• shouldnt b taken w/ stimulants
• cont: pt w/ high B/P

• Ginkgo- improves memory & brain function, enhances circulation to heart, brain, limbs, & eyes
• affects not visible till 4-24 wks of tx
• AR: GI disturbance, headache, rash, when lrg doses AR are restlessness, nausea, vomiting, diarrhea
• cont: pt. taking MAOI b/c of toxicity, & pt taking anticoagulants

• Use: mild-moderate dementia due to AD
• AR: headache, nausea, diarrhea, insomnia, muscle cramps, WT loss

med given once @ bed time

• use: mild-moderate dementia of AD & parkinson's disease
• available in transdermal patch, changed daily, b/c of dementia place in area where pt couldnt remove, preferred area is the back, same site shouldnt be used more than once q 2wks, nurse needs to teach pt/family about correct use of patch

AR: lots of nausea, vomiting, diarrhea, dyspepsia, anorexia, insomnia, fatigue, dizziness, headache

• use: mild-moderate AD (dementia)
• give 1hr before or 2hr after meals

• AR: nausea, vomiting, diarrhea, dizziness, headache, elevated liver function, hepatotoxicity
• pt should have bolld drawn
• teaching on signs of liver dysfunction like yellow color to skin & eyes

cont: pt w/ liver dysfunction

• monitor ATL wkly from wk 4- 16, after wk 16 monitor q 3mon.
• if levels high d/c meds, benefit of meds lost w/i 6 wk of d/c

• preadmission:
• cognative & functional ability before & during therapy
• cognative assessed w/ Folstein Mini- Mental exam, assessed on orientation, calculation, recall, & language, scoring done by comparing othe test
• assess 4 aggitation & impulsive behavior & ability of ADL, e. of deviatrions poor eye contact, cant answer ?, monotone, inapprotiate laugh, sadness, crying,
• medical & mental hx, family memeber also able to assisst w/ info, pt hostital records
• pysical assessment: B/P in both arms when sitting, pulse, resp., wt, & functional ability

• keep all appt.
• report unusual changes or physical effect
• take RX as directed
• dont drive or perform hazardous task if drowsiness occurs
• dont take OTC unless RX by DR
• keep track of when drug taken, when early stage marking a calander/pill counter
• notify DR if AR occurs- nausea, vomiting, diarrhea, difficulty sleeping, loss of appetite, dehydration, changes in neurologic function, yellowing of skin & eyes
• notify if Hx of ulcer, feels faint, severe stomach pain, vomitus blood or material that looks like coffee grounds, bloody/black stool

• remember that drugs dont cure but slow mental & physical degeneration, but med must be taking continualy
• tacrinetherapy- ATL levels must b monitered