75 year old man with a history of diabetes, coronary artery disease, and COPD requiring nasal oxygen is brought to the clinic by his daughter. She reports that the patient has poor memory and has been getting worse over the past 2 years. She states that after he makes a statement or asks a question, he will repeat the statement or question again 15 or 20 minutes later. He can no longer manage his personal finances. The patient reports that his mood is good, and that he gets up occasionally to urinate throughout the night, but is able to get back to sleep quickly once he is done.. On office screening, he scores 18/30 on a mini-mental status test. On physical examination, he has bilateral crackles on lung auscultation and an accentuated …show more content…
S2 heart sound. Strength, sensory testing and deep tendon reflexes were normal. Snout and grasp reflexes were not elicitable. On formal neuropsychological testing, the patient is found to have poor episodic memory and poor visuospatial function. His overall fund of knowledge, language and frontal lobe functions, and depression inventory were normal. MRI of brain was normal other than showing hippocampal atrophy. Laboratory testing results are shown below: Lab: Patient: Reference range: Sodium 140 136-145 mEq/L Potassium 3.9 3.5-5.1 mEq/L Bicarbonate 27 23-29 mEq/L Chloride 100 98-107 mEq/L Glucose 84 70-99 mg/dL Creatinine 0.9 0.6-1.1 mg/dL BUN 12 6-20 mg/dL Calcium 9.8 8.6-10.2 mg/dL Total protein 6.6 6.0-7.8 mg/dL Albumin 4.3 3.5-5.5 mg/dL Total Bilirubin 1.0 0.1-1.1 mg/dL ALT 33 10-40 U/L AST 34 10-40 U/L Alkaline Phosphatase 68 20-70 U/L Vitamin B12 450 220-1000 pg/mL TSH 2.35 0.5-4.0 mIU/L RPR Nonreactive 20-70 U/L What is the correct treatment for his disorder? A. Donepezil B. Galantamine C. Levodopa D. Memantine E. Rivastigmine Answer Choice "D" is the best answer.
This patient has Alzheimer disease. The diagnosis is based on 1) the history describing progressive episodic memory loss, 2) hippocampal atrophy on brain MRI, 3) functional impairment in cognition (patient is no longer able to handle his personal finances) and 4) absence of other reversible pathologies (normal TSH, vitamin B12 and RPR tests). This is not likely to be a depression causing memory loss (a.k.a. “pseudodementia”) since he does not report depressive symptoms, does not have neurovegetative signs, and does not have a positive testing on a depression inventory. The first-line therapy for this disorder is an acetylcholinesterase inhibitor, such as donepezil, galantamine or rivastigmine. These drugs block the breakdown of acetylcholine, which then leads to an increase in acetylcholine in the brain. Side effects of the drug are primarily related to the increase in acetylcholine that are found outside of the brain. Common side effects are related to hyperactivity of the parasympathetic system (nausea, diarrhea, syncope, bronchospasm), neuromuscular transmission (muscle cramps) or other CNS complications (vivid dreams). Because this patient has severe COPD (evidenced by the oxygen requirement, abnormal breath and heart sounds), cholinesterase inhibitors are contraindicated. Therefore the second line agent, memantine, should be used. Memantine works, in part, by blocking NMDA receptors. The side effects of this drug are primarily …show more content…
CNS-related, such as drowsiness, and are rare. Choice "A" is not the best answer.
Donepezil is a cholinesterase inhibitor, and therefore may potentiate the effects of the parasympathetic nervous system. Bronchospasm is a potential complication, and therefore this drug is contraindicated in patients with COPD. Choice "B" is not the best answer. Galantamine is a cholinesterase inhibitor, and therefore may potentiate the effects of the parasympathetic nervous system. Bronchospasm is a potential complication, and therefore this drug is contraindicated in patients with COPD. Choice "C" is not the best answer. Levodopa is the first line agent (along with carbidopa) for Parkinson disease, not Alzheimer disease. Choice "E" is not the best answer. Rivastigmine is a cholinesterase inhibitor, and therefore may potentiate the effects of the parasympathetic nervous system. Bronchospasm is a potential complication, and therefore this drug is contraindicated in patients with COPD. Note that rivastigmine has been formulated into a patch. The patch form has very stable pharmacokinetics, limiting peak-dose effects, and therefore may be useful for patients with gastrointestinal upset (which is related to peak drug levels) on other cholinesterase
inhibitors.
R.S. has been using the recommended treatment for his condition, which inlcude inhaled short-acting Beta-2 agonist and Theophylline, a bronchodilator, to control his respiratory disease.
Asthma is a chronic inflammatory disease of the airways. It is a reversible airway obstruction, occurring 8 to 10% of the population worldwide. According to a study in 2005, asthma affects over 15 million Americans, with more than 2 million annual emergency room visits. Asthma patients have a hyper-responsiveness in their airways and generally and increase in their airway smooth muscle cell mass. This hyperplasia is due to the normal response to the injury and repair to the airway caused by exacerbations. The main choice of therapy for asthma patients is β2- adrenergic agonists. Racemic albuterol has been the drug of choice for a short acting bronchodilator for a long time, but since the development of levalbuterol, there is the question of which drug is a better choice for therapy. Efficacy and cost of treatment must both be taken into consideration in each study of these therapies to determine which is best for the treatment of asthma.
They are both used because they do the same thing in different ways and using two of them will make the treatment more effective since they are not acting on the same way. Theophylline will block the receptors on lung tissue that receive signals from things that increase heart rate or cause vasoconstriction. ß2 agonists will help the beta receptors to bronchodilate.
For Ventolin to work optimally, situations that may trigger an asthma attack must be avoided. These situations include exercising in cold, dry air; smoking; breathing in dust; and exposure to allergens such as pet fur or pollens. Relating to the case study, a few of these may apply to the patient, such as exercising in the cold morning air and perhaps breathing in dust and allergens such as pollens or maybe from the eucalyptus in the Blue Mountains might have had an effect on his condition.
Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).
Eye witness testimony can be a very important piece of evidence surrounding criminal cases but not always the most reliable. As discussed in the textbook Criminal Evidence: Principles and Cases, jurors often rely very heavily on eyewitness interpretations of an incident to determine whether or not a defendant is guilty. Since an adult is presumed to be competent, a juror will often make the assumption that the testimony provided is an accurate account of the events that took place. Amongst other factors, the amount of stress the witness is under at the time of the crime, the presence of a weapon, lighting and the lack of any distinguishable characteristics can play a role in creating a false memory. Under that extreme pressure, a witness is more likely not to recall certain aspects of an incident. Their attention may have been drawn elsewhere and they never noticed the suspect’s beard, tattoos or facial features which can be crucial identifiers. The consequences of falsely identifying a suspect due to false memories can ruin an innocent person’s life, have them convicted and cause them to be punished for a crime that they did not commit.
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
Varanese, S., Birnbaum, Z., Rossi, R., & Di Rocco, A. (2010). Treatment of Advanced Parkinson's Disease. Parkinson's Disease.
...a are bronchodilators like anticholinergic, beta agonists, theophylline and oxygen, which are for the advance cases of the disease. In addition, the best treatment for people whom have emphysema is for them to stop smoking.
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
...pecific leukotriene receptors on bronchial tissues, therefore preventing bronchoconstriction, mucus secretion, and oedema. These treatments also reduce the influx of eosinophils, which results the ability to limit inflammatory damage being caused in the airway. These oral, non-steroidal, anti-inflammatory drugs reduce the incidence of acute asthma attacks when taken on a regularly basis. Although in cases of acute asthmatic attacks medical intervention and treatment is required. The type of intervention depends on the severity of the attack itself.
Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992). The diagnosis of COPD is predominantly based on the results of a lung function assessment (Larsson, 2007). Chronic bronchitis is differentiated from emphysema by it's presentation of a productive cough present for a minimum of three months in two consecutive years that cannot be attributed to other pulmonary or cardiac causes (Marx, Hockberger & Walls, 2014) (Viegi et al., 2007). Whereas emphysema is defined pathologically as as the irreversible destruction without obvious fibrosis of the lung alveoli (Marx, Hockberger & Walls, 2014) (Veigi et al., 2007).It is common for emphysema and chronic bronchitis to be diagnosed concurrently owing to the similarities between the diseases (Marx, Hockberger & Walls, 2014).
Lack of acetylcholine is the main cause for loss of memory. In most people throughout the aging process, acetylcholine degenerates over time at a normal rate. In people affected by Alzheimer’s, acetylcholine degenerates at more than double the rate of people unaffected with this disease. Acetylcholine is a major neurotransmitter in the brain that allows communication of information from one nerve cell to an...
Li, James T., ed. Pharmacotherapy of Asthma. Vol. 212. New York: Taylor and Francis, 2006. Print.
One of the common diseases in the respiratory system that many people around the world face is emphysema or also known as chronic obstructive pulmonary disease (COPD). It is a chronic lung condition where the alveoli or air sacs may be damaged or enlarged resulting in short of breath (Mayo Clinic, 2011). If emphysema is left untreated, it will worsen causing the sphere shaped air sacs to come together making holes and reduce the surface area of the lungs and the amount of oxygen that travels through the bloodstream, blocking the airways of the lungs (Karriem- Norwood, 2012). The most common ways a patient can get emphysema are by cigarette smoking or being exposed to chemicals, dust or air pollutants for a long period of time. Common physical exams reveal a temperature of 100.8 Fahrenheit, 104 beats per minute, a blood pressure of 146/92, and a respiratory rate of 36 breaths per min (Karriem- Norwood, 2012). (see appendix A.1,A.2, A.3, A.4 for complete proof.)