Introduction . Although not definite, studies are finding Alzheimer's disease may be related to loss of cholinergic innervation. In order to impact this loss of function, therapeutic agents have been developed to reduce the breakdown of acetylcholine, a neurotransmitter vital in cognitive processes. Donepezil has been used in Alzheimer's disease for improving cognition. Although the package insert suggests nighttime administration to reduce the instance of daytime side effects, some patients report sleep disturbances. Methods . Patient charts at the Tallahassee Memorial Healthcare Neuroscience Center (TMH-NSC) were reviewed. Charts of those patients who met the inclusion criteria were used to determine the correlation between night time administration of donepezil and sleep disturbances. Results . A total of 186 patient charts were analyzed. Of those 186, 103 of the patients were taking donepezil as directed in the package labeling, at night time. Nearly half (47.6%) of the patients taking donepezil at night reported night time disturbances (NTD) and only 21 of the 83 patients taking donepezil in the morning reported NTD. Conclusion . This retrospective study showed that taking donepezil at night may be associated with sleep disturbances. Although labeling suggests administration in the evening, should NTDs occur, changing the medication administration to the morning should be explored before switching therapeutic agents.
Pharmacists have valuable skills to assist in the management of diagnosis and management of dementia.
Atopic dermatitis (AD) is a common inflammatory skin disease with recurring episodes of itching and a chronic relapsing course. The prevalence of AD has increased exponentially over the years, along with information on how it may occur. Diagnosis of AD is typically based on physical examination and history and may be confirmed based on chronicity of symptoms, itching, and age-specific morphology. Nonpharmacological approaches include psychological interventions such as behavior modification, stress reduction techniques, and group psychotherapeutic treatments or may also include dietary restrictions, ultraviolet (UV) phototherapy, house dust mite reduction, and avoidance of enzyme-enriched detergents. Herbal therapy has also showed some promise particularly Zemaphyte®, Kamillosan®, and Shiunko®. Pharmacological agents that show great efficacy include emollients, topical corticosteroids, and topical calcineurin inhibitors.
Approximately 65%–75% of patients with major depression will respond to drug therapy. However, conventional antidepressants may be costly and have side effects and drug interactions that may inconvenience the patient, limit the use of the particular drug, or require the discontinuation of a particular therapy. In this past decade, there has been a renewed interest in alternative medicines, especially for depression, that are available without a prescription. The ability of patients to self-medicate depression presents a risk of inappropriate treatment, thereby increasing the morbidity and mortality rates associated with this sometimes fatal disease. In addition, herbal products are not regulated by the government, leading to problems with batch-to-batch consistency and adulteration, even for products that have evidence of efficacy in depression. The potential for herbal-pharmaceutical grade drug interactions increases the need for input and follow-up from health care practitioners. There is limited quality evidence describing the efficacy and optimal dosing for these products. Clinicians must acknowledge that patients are using herbal products and educate on their use to avoid negative outcomes in patients with depressive disorders.
Multiple sclerosis, an autoimmune disorder causing the destruction of the impulse carrying myelin sheath of neurons, can be a debilitating and disabling disease. Symptomatic treatment has provided patients with relief through the use of antispasmodics, anticholinergics, and antidepressants, just to name a few, as well as disease treatment by decreasing progression of the illness by treating acute episodes through the use of corticosteroids, interferons, plasmapheresis, and other immunomodulators like glatiramer, mitoxantrone, and natalizumab. With medical advancements and the development of new treatments such as laquinimod, fampridine-SR, and several others, the future looks promising for those living with this illness.
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