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Pharmacological Effects and Nursing Implications

Alzheimer’s disease is a destructive disorder that touches a dramatic number of people all over the world. According to the statistics, about thirty-six million of the world population suffers from Alzheimer’s disease. Moreover, experts predict that the number of sick people with dementia will have increased to 115 million by the second half of the twenty-first century. In fact, being deprived of full-fledged physical and social activities, Alzheimer’s patients cause suffering to their relatives and society at large. Therefore, the issue of Alzheimer’s patients’ treatment is extremely topical nowadays. During the last decade, memantine has attracted the health experts’ attention, being one of the two types of medications that have passed the clinical tests. This medicine has been successfully prescribed to Alzheimer’s patients along with the cholinesterase inhibitors. There has been a heated discussion on the issue of pharmacological effects and nursing implications of memantine in Alzheimer’s patients. Some scientists claim that memantine is just a symptomatic medicine that cannot alter the cause of the illness. Their opponents argue that it is the most successful current remedy from the disease, being constantly improved and developed as for its nursing implications.

Pharmacological Effects of Memantine in Alzheimer’s Patients

Definitions of the Major Notions of the Paper

Being the key areas of the paper exploration, the notions of pharmacological effect, Alzheimer’s disease, and memantine as the medicine need their definitions and the characteristics of their main features.

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Pharmacological effect. The pharmacological effect can be referred to as “the physiological and biochemical changes in the body produced by a drug in therapeutic concentration” (“Pharmacological effects, prodrugs (definitions, examples) and sources of drug information”, n.d.). Pharmacological effects are divided into two groups: desired (positive) and undesired (negative). In fact, the same medicines may have diverse pharmacological effects. Undesired effects can be classified into harmless and harmful (“Pharmacological effects, prodrugs (definitions, examples) and sources of drug information”, n.d.).

Alzheimer’s disease. Alzheimer’s disease means a progressive disease that destroys memory and other important mental functions. It is the most typical kind of dementia in old people. In fact, the most notable feature of Alzheimer’s disease includes difficulties with memory, developing into problems with the cognition and executive functions, worsening of the capacity to participate in daily activities.

Approximately four million individuals in the United States and about one million Americans aged sixty-five and older suffer from Alzheimer’s disease. According to the statistics of mortality reasons, in 2006, Alzheimer’s disease was considered to be the seventh major cause of death in the United States. Experts claim that mortality rates are higher in patients with dementia compared with age- and sex-matched controls without dementia.

Memantine as a treatment. The Food and Drug Administration accepted memantine as a medical care for Alzheimer’s disease in the autumn of 2003. Forest Laboratories Inc. developed memantine and sold the medicine under the trademark Namenda. According to its features, the medicine is categorized as an N-methyl-D-aspartate, or NMDA, a receptor antagonist. Designed to block pathological levels of glutamate activity, memantine prevents damage caused by excitotoxicity but also permits the maintenance of physiological glutamate activity when given in lower doses. This medicine is accepted for use in the European Union and Australia. Experts argue that memantine, apart from cholinesterase inhibitors, is the only medication allowed for the medical care of Alzheimer’s disease.

The Peculiarities of Pharmacological Effects of Memantine

Memantine neither heals Alzheimer’s disease nor stops its development. Nevertheless, medicine influences some of the illness’s symptoms. Memantine is considered to be a successful treatment producing strong positive effects. Nevertheless, this medicine can have negative effects on patients.

Positive effects of memantine. Alzheimer’s patients suffer from the destruction of cells in the brain. This defect causes memory loss and makes a negative influence on the patients’ mode of life. Blocking the NMDA receptors in the patient’s brain, Memantine stops reactions causing cell death. This action is beneficial as a prophylactic measure preventing the development of Alzheimer’s disease. Experts note that memantine stops undesirable symptoms in patients’ behavior, such as agitation, aggression, delusions, and disinhibition.

The second advantage of memantine is the possibility to take medicine both with and without food. The third positive feature of memantine is the absence of notable drug interactions.

Memantine has demonstrated its advantages in the treatment of patients with moderate to severe Alzheimer’s disease. According to numerous trials, where 2,297 patients took part in 27 clinical trials, memantine has proved to be an effective and successful treatment. During three months, researchers have been prescribing their Alzheimer’s patients a target dose of memantine of 10 mg twice a day. Twenty-four patients took part in the trial. It is notable that a dramatic decrease in agitation and aggression was observed after the patients’ use of memantine. In fact, F-test demonstrated 3 and 90 degrees of freedom. Approximately, 50 percent of the patients were improving on the CGI-C scale. Fourteen patients demonstrated adverse effects during medical care. The major typical adverse connected with memantine appeared to be somnolence (n=5). Nevertheless, this negative effect may be considered harmless. Therefore, the outcomes of the above-mentioned trials demonstrate the fact that medical care with memantine is characterized by improvements in Alzheimer’s patients’ state of health. Examined patients with moderate to severe Alzheimer’s disease showed a decrease in aggressiveness and agitation in their behavior.

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Despite numerous positive effects, some researches focus the public’s attention on the symptomatic feature of the medicine. Firstly, memantine does not reverse the detrimental processes of Alzheimer’s disease. Secondly, the remedy does not restore patients’ memory and functions. Thirdly, memantine does not extend patients’ life. Moreover, some researchers argue that its negative effects may outweigh the benefits. They highlight that Alzheimer’s patients often forget to take memantine regularly. Last, dementia may develop to a stage when the treatment is useless.

Negative effects of memantine. Health experts state that memantine is normally well transferable. Being harmless in their majority, undesired effects reduce after a few weeks. Such symptoms as dizziness, headache, anxiety, and back pain belong to this category. Nevertheless, Alzheimer’s patients may experience such harmful adverse events as confusion, high blood pressure, diarrhea, constipation, hypertension, shortness of breath, and influenza after the use of medicine. In these cases, Alzheimer’s patients should consult a doctor.

Some experts stress the harmful effects of memantine and forbid the medicine in cases of breastfeeding, the patient’s suffering from severely decreased kidney function, fructose, and galactose intolerance. They caution from taking the medicine in cases of allergy and insist on consulting the doctor.

Warning. Some researchers state that memantine may affect an individual’s reactivity. Taking into account this fact and the typical features of Alzheimer’s disease, patients should not drive and operate machinery. Secondly, some experts state that significant changes to Alzheimer’s patients should be refrained from. To illustrate, in case of a patient’s keeping to a meat-eating diet, he or she should avoid a severe vegetarian selection of food, and conversely. Thirdly, the reliability of memantine in pregnant women, children, and adolescents under eighteen years old has not been proved. Fourthly, memantine should be used with caution in cases of “epilepsy, … convulsions, … , decreased kidney functions … severe infections of the urinary tract with Proteus bacteria, heart failure, and … hypertension” (“Ebixa (Memantine)”, 2013).

The Peculiarities of Nursing Implications of Memantine in Alzheimer’s Patients

According to a dictionary, the nursing implication can be referred to as the responsibilities that a medical professional in a specific position must follow. The treatment with memantine must be prescribed only by a health expert, in accordance with the guidelines.

As described above, medical professionals prescribe memantine to patients with moderate to severe Alzheimer’s disease. Moreover, the medicine may have beneficial effects in delaying clinical worsening and in case of strong necessity, reducing the behavioral symptoms, such as agitation and aggression.

Being soluble in water, memantine is a powder of white color. Since 2002, the medicine is made as to the tablets of 5 mg and 10 mg. Patients take memantine orally.

Health experts prescribe memantine both as monotherapy and in combinations with cholinesterase inhibitors, such as rivastigmine, donepezil, and galantamine. Although the advisable target dose of memantine is 10 mg twice a day, this dose may fluctuate between 5 mg a day and 20 mg a day. Moreover, the US Food and Drug Administration lately accepted an extended-release formulation of the medicine equal to 28 mg. The extended-release memantine is produced in capsules of four types: 7 mg, 14 mg, 21 mg, and 28 mg. The recommended dose starts with 7 mg a day, growing every week by 7 mg until attaining the ultimate dose of 28 mg a day. In cases when a patient takes conventional memantine in the dose of10 mg twice a day, he or she may change the medicine to the extended-release formulation in the dose of 28 mg immediately. It is notable that memantine may be consumed without regard to food. Pills should be swallowed. In cases of problems with swallowing, they may be opened to take the substance in applesauce. Experts note that patients with hepatic impairment use a typical dose of medicine. Nevertheless, typical caution exists for patients with severe hepatic impairment, taking into account the lack of clinical researches in this patient category. Alzheimer’s patients suffering from mild or moderate renal impairment may take the advisable target dose of 28 mg. Nevertheless, sick people with severe renal impairment must reduce the dose to 14 mg a day.

In fact, memantine may be prescribed in numerous combinations with cholinesterase inhibitors, saving beneficial safety profile. Taking into account combined efficacy, memantine may be prescribed with acetylcholinesterase inhibitors. Clinical researches demonstrate that memantine does not reduce AChEls blockade. Therefore, these medicines combination may be widely used.

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Being the most typical kind of dementia in the elderly, Alzheimer’s disease is referred to as a progressive disease that destroys memory and other important mental functions of a person. Depriving individuals of full-fledged physical and social activities, Alzheimer’s disease is a challenge for about thirty-six million people all over the world. Therefore, the issue of Alzheimer’s patients’ treatment is extremely important nowadays. During the last decade, memantine has been attracting researchers’ attention, being one of the two types of medications that passed the clinical trials. There has been a brisk discussion on the issue of pharmacological effects and nursing implications of memantine in Alzheimer’s patients. Some scientists claim that memantine is just a symptomatic medicine that cannot actually cure the illness. Their opponents argue that it is the most successful current remedy that is constantly improved and developed.

Numerous researchers have been exploring the pharmacological effects of memantine. Pharmacological effects are used in the meaning of the physiological and biochemical changes in a patient’s body produced by the above-mentioned drug in therapeutic concentration. Being divided into two groups, the pharmacological effects of memantine can be discussed as desirable (positive) and undesirable (negative) ones.

In fact, memantine is considered to be a successful treatment producing strong positive effects. The medicine stops reactions causing cell death in a patient’s brain. This feature is beneficial as a prophylactic measure preventing the development of Alzheimer’s disease. Experts note that memantine stops undesirable symptoms in patients’ behavior, such as agitation, aggression, delusions, and disinhibition. Despite numerous positive effects, some researches indicate a purely symptomatic feature of the medicine.

Nevertheless, this medicine may have negative effects on the patients. Firstly, memantine does not reverse the detrimental processes of Alzheimer’s disease. Secondly, the remedy does not restore patients’ memory and functions. Thirdly, memantine does not extend patients’ life. Moreover, some researchers argue that negative effects may outweigh the benefits.

Health experts state that memantine is normally well transferred. Nevertheless, it may cause certain negative effects. Dizziness, headache, anxiety, and back pain may belong to harmless drawbacks of the remedy. Alzheimer’s patients may experience such harmful adverse effects as confusion, high blood pressure, diarrhea, constipation, hypertension, shortness of breath, and influenza after the use of medicine. Some experts make a stress on the harmful effects of memantine and forbid the medicine in cases of breastfeeding, a patient’s suffering from severely decreased kidney function, fructose, and galactose intolerance. Researchers state that memantine may affect an individual’s reactivity. The reliability of memantine for pregnant women, children, and adolescents under eighteen years old have not been proved. Memantine should be used with caution in cases of epilepsy, convulsions, decreased kidney functions, severe infections of the urinary tract with Proteus bacteria, heart failure, and hypertension.

Health experts prescribe memantine both as monotherapy and in combinations with cholinesterase inhibitors, such as rivastigmine, donepezil, and galantamine. Although the advisable target dose of memantine is 10 mg twice a day, this dose may fluctuate between 5 mg and 20 mg a day. The recommended dose starts with 7 mg a day, growing every week by 7 mg until attaining the ultimate dose of 28 mg a day. In cases when a patient takes conventional memantine in the dose of 10 mg twice a day, he or she may change the medicine to the extended-release formulation in the dose of 28 mg immediately.

To sum up, there are different viewpoints on the pharmacological effects and nursing implications of memantine in Alzheimer’s patients. Nevertheless, one key strategy should be followed: nursing implication must be carried according to a strict guideline, paying great attention to a patient’s condition.

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