A Report on the Impact of Pharmacotherapy in Alzheimer's Disease in NZ

This report provides an overview of Alzheimer's disease in New Zealand, focusing on its pathophysiology, etiology, incidence, and the impact of pharmacotherapy. It details the prevalence of the disease, including statistics and the financial burden it places on the country. The report then delves into the various drugs used in the management of Alzheimer's, including cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and NMDA receptor antagonists (memantine), discussing their mechanisms of action, dosages, and brands. It further analyzes the impact of these drugs, including their side effects and the management of behavioral symptoms. The report concludes by highlighting the significance of pharmacotherapy in slowing the progression of the disease and improving the quality of life for individuals affected by Alzheimer's in New Zealand, while also emphasizing the need for cautious and specialized medical guidance.

ALZHEIMER’S DISEASES
1.3 B REPORT
Impact of pharmacotherapy in the management of Alzheimer in NZ
INTRODUCTION
The below report is based upon a common health disorder prevailing in New
Zealand (NZ) where the impact of its entire pharmacotherapy has been specified over here.
It has been done to scrutinize the management of the chosen disorder named Alzheimer
(Begg, 2002). Though, the New Zealanders are known to lead a healthy lifestyle, but it is
not applicable to all age groups. It is mainly due to its ageing population that is rapidly
growing at a higher pace. 88% of health-related issues in NZ are related to the prevalence
of non-communicable diseases resulting into long term physical and mental conditions with
8% due to some sort of injuries, etc.
PATHOPHYSIOLOGY AND ETIOLOGY OF ALZHEIMER
Pathophysiology is a way of determining the mechanism of the disease by referring
to the development of such conditions that lead to the progression of the undertaken health
issue. This section is to discuss upon the pathophysiology of Alzheimer which is referred to
be a very common form of dementia related to neurological issues affecting the brain of an
individual (Rahman and Choudhary, 2014). Alzheimer is stated to account approximately
60-80% of cases related to dementia. Alzheimer directly results in loss of memory that even
gets worse with time and starts impacting upon the routine activities of the person suffering
from it. With a similar context to it, below is the pathophysiology of Alzheimer disease-
 Alzheimer disease is firstly referred to affect the 3 leading procedures that are
responsible for a healthy neuron such as communication, repair and metabolism.
 Due to which, some nerve cells involved in the brain of an individual stops working.
 It happens once after the connection between the nerve cells disconnects and die at
the end.
 Such type of demolition and decease of the nerve cells present in the brain leads to a
failed memory that in turn changes the personality of the individual where they
later face challenges in attempting their routine activities.
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Etiology defines the unknown cause of the disease where it duly states about the risk
factors involved in the occurrence of the disease. Likewise, the etiology of Alzheimer
disease are as referred below-
 Advancing age of an individual
 Any previous history in the family with similar case of Alzheimer disease
 APOE 4 genotype which is genetic in nature
 Obesity
 Resistance to insulin
 Vascular factors
 Hypertension
 Any inflammatory markers
 Down syndrome
 Any traumatic injury in the brain affecting the neural structure
INCIDENCE AND STATISTICS PREVALENT TO ALZHEIMER
This is on considering the prevalence of Alzheimer in NZ where in accordance to the
statistics presented in their governmental record, near about 50, 000 individuals suffer
from Alzheimer every year. This ratio is expected to raise by the end of the year 2050 when
there will be more than 150,000 individuals suffering from dementia (Brahmachari, 2013).
It is referred to be a burdening disease in NZ directly impacting upon their undertaken
budget to manage such concerned health issues. At present, the total fiscal cost of
Alzheimer disease in NZ is estimated to be $712.9 million in the year 2008 where this
indicated the lowest financial support by NZ contributed for the research of Alzheimer
disease by NZ in comparison to all other OECD nations. Also, Alzheimer disease is ranked
at 4th leading position that results into the expiry of the population suffering from it and
involves a majority of individuals ageing 65 years and above.
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ALL KIND OF DRUGS USED IN THE MANAGEMENT OF ALZHEIMER
It is on considering a systematic treatment of Alzheimer’s disease where it is a non
curable disease and hence cannot be healed entirely. Its only treatment is medication to
ease of its deterrent symptoms arises in an individual such as loss of memory, learing
issues, communication problems, etc. However, a proper usage of medicine helps in slowing
down the process of deteriorating this disease for a better and longer functioning of an
individual’s brain suffering from it. Although, there do not exists any such medicinal
treatment that can completely cure Alzheimer disease, medication is a single alternative to
slow down the cause and affect of Alzheimer’s. In context to which, there exists such
therapeutic treatments that can slow down the progression of Alzheimer disease by
temporarily alleviating its associated syndromes (MacLeod, Vella-Brincat and Macleod,
2015). With reference to which, there exists two leading type of medication that are
normally used for the treatment of Alzheimer disease. This involves NMDA receptor
antagonists and acetylcholinesterase inhibitors also termed as cholinesterase inhibitors.
Both of these drugs work in distinct manner and are as delineated below-
 Cholinesterase inhibitors further involves three distinct type of inhibitors known as
donepezil, galantamine and rivastigmine.
 Into which, the first inhibitor namely donepezil was primitively patented as
Aricept as its brand name which is now available as generic donepezil and is
widely known with the aforesaid name. Donepezil is also referred to be a
reversible and specific inhibitor of the drug named acetylcholinesterase
which is a registered medicine in New Zealand used for the treatment of
Alzheimer’s (Alzheimer's disease - causes, symptoms, treatment, prevention,
2013). It is together used for the symptomatic treatment of vascular
dementia. It is also referred to be one of the most effective way for the
treatment of moderate Alzheimer disease. Aricept is available in the form of
tablet and can be easily swallowed as a disintegrating pill. Its initial dosage is
of 5mg once in a day and can be increased to 10mg per day after 4 to 6 weeks
of the first dosage. It however depends upon the tolerability of the patient
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where it can further be increased up to 23mg per day after a minimum
period of 3 months.
 Another one named as rivastigmine with its original brand name of Exelon
can be now availed from other similar brands and is widely known as generic
rivastigmine. Rivastigmine is found to be a very less effective measure in
comparison to donepezil where it is known to target both the inhibitors
namely acetylcholinesterase and butyl-cholinesterase inhibitors. However,
such augmented inhibition is not known to create any distinct impact as that
of donepezil. It is as per the clinical trials done to investigate the use of
rivastigmine, it is found to last only for 24 weeks with an unproven result
where it is hard for the treatment to last for more than 6 months. Herein, its
initial dosage in the form of capsule starts from 3mg per day where it is
consumed twice a day, i.e., 1.5mg each time. Although, this initial dose can be
increased after a break of 2 weeks and where it can be increased up to 6, 9
and 12mg per day and each to be consumed twice a day. In addition to this, it
together exists in the form of patch whose dosage begins from 4.6 mg a day
and can be increased up to 9.5 or 13.3mg a day at a minimum break of 4
weeks.
 Lastly, galantamine with its earlier patent name of Reminyl can be now
availed as generic galantamine with some other popular brands with same
dosage known as Reminyl XL, Galsya XL, Acumor XL and Gatalin XL. It is
a more selective inhibitor in comparison to the previous one where it is also
known to enhance the action of acetylcholine used on the nicotinic receptors
(Drug treatments for Alzheimer's disease, 2017). It is where this receptor is
referred to play an important role in controlling the cognitive functions of an
individual like attention. The intial dosage of this generic drug begins with
8mg per day to be taken up two times a day and each in the quantity of 4mg.
This can be increased up to 16 or 24mg a day at a minimum break of 4
weeks.
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 NMDA receptor as an adversary is also known as memantine and was primitively
patented as Ebixa. However, it can be now availed in the signifier of generic
memantine. This is referred to be a non-competitive receptor antagonist which is
specially used for the treatment of symptomatic Alzehimer (Wolfe, 2016). It is done
by partially blocking the NMDA receptors that in turn assists in certain
symptomatic treatment by improving the cognition of the individual to easily
perform the regular tasks. However, there together exists some adverse symptoms
that involves dizziness, headache, influenza and muscular pain, etc.
It is composed of total two distinct medications namely Namenda with inclusive
memantine in it with an initial dosage of 5mg per day and can be further increased to
10mg a day. Moreover, there together exists another two dose composed of 15 and 20
mg a day, each to be consumed separately in 2 divisions after the interval of a week.
This is for instance to state about the 15mg dosage which can be separately consumed
twice as 5mg and 10mg. Likewise, it can also be taken up as an oral solution with
similar dosage. Also, its extended release capsule begins with an initial dose of 7mg a
day and can be increased up to 14, 21 or 28mg a day as per the tolerance level of the
patient considering analogous interval of time.
Lastly, discoursing upon its another form named Namzaric which is a mix of
extended release memantine and donepezil. It can be taken up in two type of doses as
prescribed by the doctor where the dosage of its capsule includes 28mg extended
release of memantine with 10mg of donepezil a day. Another dosage of this medicine
is specially for those who are suffering from any serious typr of renal damage and are
required to take only 14mg mematine extended release with same dosage of donepezil
a day.
IMPACT OF THE DRUGS IN THE MANAGEMENT OF ALZHEIMER
It is mainly in context of the above specified drugs that are mainly used for the
management of Alzheimer disease where all of these dose impacts in a different manner. It
is where the medication involved in cholinesterase inhibitors are used to treat that
Alzheimer disease which is currently at mild to moderate level. Whereas, another
medicinal drug called mematine under NMDA receptor antagonists are used for the
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treatment of those suffering from moderate to severe level of Alzheimer disease
(Broyles, Reiss, McKenzie, Evans, Pleunik, Page, 2013). Although, both categorized
medicinal drugs are also apparent to create some side effects such as dizziness, agitation,
muscle cramps, insomnia, headache and diarrhoea, etc. Also, the heart patients may suffer
from a slower heart beat in rare cases. These side effects from the dosage of cholinesterase
inhibitors are slightly different from that in the case of mematine that involves
constipation, high blood pressure,shortness of breath, tiredness with rare issues in walking
and an increased level of confusion and seizures (Alzheimers disease, 2017).
All of these symptoms are termed as behavioral issues that are together required to
be managed and involves some different set of medicines such as celexa, zoloft, cymbalta,
remeron, wellbutrin and tofranil, etc. Although, all these medications are used only after
trying other therapeutic remedies to avoid excessive use of drugs where these medicines are
together required to be used with extreme caution that directly assists in managing the
state of wandering, anxiety, sleeplessness, agitation, depression, restlessness and aggression,
etc. This is for instance to discourse upon the medicines used as sleep aids where some
medicines like Ambien, lunesta and sonanta should not be used on regular basis. It is due to
its severe side effects that can make the individual more confused. Similarly, therr together
exists some other medicinal therapies that are required to be consumed in a very cautious
manner and only under the strict direction of a specialist.
CONCLUSION
The above report has discoursed upon the prevalence of Alzheimer in NZ where its
active existence is bringing a disability transition over there. The above report has thereby
demonstrated the pathophysiology and etiology of Alzheimer by together indicating its
total incidence rate and statistics in NZ. Lastly, it has discovered the management of
Alzheimer by distinguishing all sort of drugs used for it by together determining the effect
of each of the identified drugs. On whose basis, some supportive treatments with additive
measures has been recommended over here where the patients can be assisted with the help
of an occupational therapists. Such physiological treatments also result in providing
cognitive stimulation that in turn involves medication and other similar therapies given via
music and art, etc.
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REFERENCES
Books and Journal
Begg, E. J., 2002. Instant Clinical Pharmacology. Wiley.
Brahmachari, G., 2013. Chemistry and Pharmacology of Naturally Occurring Bioactive
Compounds. CRC Press.
Broyles, B. E., Reiss, B. S., McKenzie, G., Evans, M. E., Pleunik, S., Page, R., 2013.
Pharmacology in Nursing: Australia and New Zealand. Cengage Learning.
MacLeod, R., Vella-Brincat, J. and Macleod, S., 2015. The Palliative Care Handbook:
Guidelines for Clinical Management and Sympton Control. HammondCare Media.
Rahman, A. and Choudhary, M, I., 2014. Drug Design and Discovery in Alzheimer’s
Disease. Elsevier.
Wolfe, M, S., 2016. Developing Therapeutics for Alzheimer's Disease: Progress and
Challenges. Academic Press.
Online
Alzheimer's disease - causes, symptoms, treatment, prevention. 2013. [Online]. Available
through: <https://www.southerncross.co.nz/group/medical-library/alzheimers-
disease-causes-symptoms-treatment-prevention>. [Accessed on 28th July 2017].
Alzheimers disease. 2017. [Online]. Available through:
<https://www.healthnavigator.org.nz/health-a-z/a/alzheimers-disease/>. [Accessed
on 28th July 2017].
Drug treatments for Alzheimer's disease. 2017. [Online]. Available through:
<https://www.alzheimers.org.uk/info/20162/drugs/105/drug_treatments_for_alzhei
mers_disease>. [Accessed on 28th July 2017].
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