The Effect of Calcium in Patient with Alzheimer Disease

ALZHEIMER'S DISEASE
PHARMACOTHERAPY AND
CA2+ INVOLVEMENT

Calcium as a regulatory and
signalling ion
 Calcium ions can act as neurotransmitters signals either
directly or indirectly(Popugaeva, Vlasova and Bezprozvanny,
2015) .
 Action potential usually stimulate calcium ions enabling them
to open voltages dependant calcium Channels (Hsu, Lane and
Lin, 2018)
 In neurons, calcium ions acts as transmitters where they can
alter the electrical conductivity by modifying the closing of
sodium and potassium channels in order to stimulate the
release of a neural transmitter substances(Popugaeva,
Pchitskaya and Bezprozvanny, 2017) .
 Calcium can later lead to regulation of metabolic activities,
cell growth, and long term change in synaptic efficiency thus
leading to destruction of neurones (Hsu, Lane and Lin, 2018).

Calcium Ions and Alzheimer's
disease
 The Familial Alzheimer’s disease mutations in the
presenilins are directly linked endoplasmic reticulum
calcium ions leaked function presenilins.
 As a result, calcium ions dysregulation is involved in
Alzheimer's disease(Small, 2009) . Various amyloid
proteins have been proved to be involved in the
induction of calcium ions influx into neurons,
making this calcium reflux alters neurological
excitability (Amidfar, Kim and Wiborg, 2018).
 In that case, therefore, calcium ions might be the key
to the step of studying the pathogenesis of
Alzheimer's disease(Popugaeva, Pchitskaya and
Bezprozvanny, 2017) .

Core pharmacology used in
treatment of Alzheimer's disease
 There are various drugs used in the
treatment of the disease namely
Cholinesterase inhibitors and memantine
(Downey, 2013).
 Cholinesterase inhibitors prevent the break
down of acetylcholine, delay worsening and
are generally tolerated.
 Memantine helps to improve memory,
reasoning, language and increase people
performance of little tasks (Downey, 2013).

Cholinesterase inhibitors
 These class of drugs prevent the break
down of acetylcholine which is usually
crucial in learning and memory (Downey,
2013).
 The drug also slow worsening of the
symptoms and their complications are
well tolerated(Small, 2013) .
 These drugs include Donepezil,
rivastigmine and galatamine.

Donepezil
 This drug is approved to treat all stages
of Alzheimer (Dyer et al., 2017).
mechanism of action
This medication acts as an enzyme blocker
in order to restore the balance of
neurotransmitters. The drug improve
awareness, memory and ability to function
(Downey, 2013)

Pharmacokinetics
 Donepezil is well absorbed in the body with a
bioavailability of 100% where it reached the peak
plasma concentration 3 to 4 hours after intake
(Dyer et al., 2017).
 The drug well distribute with a volume of
distribution of 12l/kg and a protein biding of more
than 96% (Alzheimer's Association, 2018)
 The medication is metabolised in the liver using CYP
450 isoenxymes and undergoes a glucuronidation.
 The drug have a half life of 70 hours and it is
eliminated through the urine (Alzheimer's
Association, 2018).

Side effects and
precautions
 Side effects include nausea, vomiting,
diarrhoea, weight loss, weakness, weight
loss, muscle cramps, tremor and dizziness.
These side effects normally last between 1-
3 weeks then lessen (Alzheimer's
Association, 2018)
 Precautions includes anybody allergic to
the drug, people with breathing problems,
fainting, seizures, stomach ulcers and
bleeding and people who have trouble in
urinating (Alzheimer's Association, 2018).

Rivastigmine
 The drug is approved to treat moderate
and mild Alzheimer
 Mode of action
The medication acts by inhibiting both
acetylcholinesterase and
butyrychonesterase.

Pharmacokinetics
 The extent of absorption of this drug is
not well known but have a distribution
rate of 1.8 to 2.7 l / kg with a protein
biding of 40%
 The drug is metabolized through
cholenesterase mediated hydrolysis with
a half life of i.5 hours.
 The medication is excreted majorly by
renal excretion with less than 1%
excreted in the faeces.

Side effects and
precautions
 Side effects similar to Donepezil which include
nausea, vomiting, diarrhoea, weight loss,
weakness, weight loss, muscle cramps, tremor
and dizziness. These side effects normally last
between 1-3 weeks then lessen (Alzheimer's
Association, 2018)
 Precautions similar to Donepezil which includes
anybody allergic to the drug, people with
breathing problems, fainting, seizures, stomach
ulcers and bleeding and people who have
trouble in urinating (Alzheimer's Association,
2018).

Memantine.
 With a combination od Donepezil, the
medication is used in treatment of severe
Alzheimer disease(Marum, 2014)
 Mode of action
The drug acts to regulate the activity of
glutamate a chemical that is use in
processing, storage and retrieval of
information(Marum, 2014)

Pharmacokinetics
 Well absorbed with a bioavailability of 100%. The drug
reach to a peak plasma concentration in 3-7 hours.
Absorption is not affected by food (Alzheimer's
Association, 2018).
 The volume of distribution ranges between 9-11l/kg with
a protein binding of 45% (Marum, 2014)
 The drug is excreted largely unchanged but about 20-25
% is metabolised in the liver by 1-amino-3-
hydroxymethyl-5-methyl-adamantane and 3-amino-1-
hydroxy-5,7-dimethyl-adamantane (Alzheimer's
Association, 2018)
 The drug have a half life of about 60-100 hours and it is
excreted in the urine where about 48% is excreted
unchanged (Alzheimer's Association, 2018).

Relevance of the Topic
 The topic help nurse to understand the
effect of calcium in patient with
Alzheimer disease and offer a gap for
research.
 Other than that, nurses and patients are
able to understand different types of
drugs available for treatment and their
side effects and precautions.

References
 Alzheimer's Association. (2018). Latest Medication for Memory Loss | Alzheimer's Association.
Available at: https://www.alz.org/alzheimers_disease_standard_prescriptions.asp
 Dyer, S., Harrison, S., Laver, K., Whitehead, C. and Crotty, M. (2017). An overview of
systematic reviews of pharmacological and non-pharmacological interventions for the
treatment of behavioral and psychological symptoms of dementia. International
Psychogeriatrics, 30(03), pp.295-309.
 Downey, D. (2013). Pharmacologic Management of Alzheimer Disease. Journal of Neuroscience
Nursing, 40(1), pp.55-59.
 Hsu, W., Lane, H. and Lin, C. (2018). Medications Used for Cognitive Enhancement in Patients
With Schizophrenia, Bipolar Disorder, Alzheimer’s Disease, and Parkinson’s Disease.Frontiers
in Psychiatry, 9.
 Marum, R. (2014). Update on the use of memantine in Alzheimer’s
disease.Neuropsychiatric Disease and Treatment, p.237.
 Popugaeva, E., Pchitskaya, E. and Bezprozvanny, I. (2017). Dysregulation of neuronal calcium
homeostasis in Alzheimer's disease – A therapeutic opportunity?. Biochemical and Biophysical
Research Communications, 483(4), pp.998-1004.
 Popugaeva, E., Vlasova, O. and Bezprozvanny, I. (2015). Restoring calcium homeostasis to
treat Alzheimer's disease: a future perspective. Neurodegenerative Disease Management,
5(5), pp.395-398.
 Small, D. (2013). Dysregulation of Calcium Homeostasis in Alzheimer’s Disease.Neurochemical
Research, 34(10), pp.1824-1829.