Although it has always been seen as an “old person” disease, Alzheimer’s disease can be diagnosed as early-onset Alzheimer’s. Some of the youngest Alzheimer’s patients have ranged from their late 20’s to early 50’s; while most patients diagnosed with Alzheimer’s are usually age 65 and older. Due to early-onset Alzheimer’s,doctors have had to learn more about the early signs and beginning stages in patients as they appear. The early stages of the disease usually just include some mild memory loss, but once the patient enters into the moderate stage some of the symptoms include:
- Increased memory loss and confusion
- Problems recognizing family and friends
- Continuously repeating stories, favorite wants, or motions
- Difficulty doing things that have multiple steps, like getting dressed
- Lack of concern for hygiene and appearance
As Alzheimer’s disease progresses into the severe stage, the symptoms will continue to worsen:
- Inability to recognize oneself or family
- Inability to communicate
- Lack of control over bowel and bladder
- Groaning, moaning, or grunting
- Needing help with all activities of daily living
According to the Alzheimer’s Association the percentage of adults age 65 and older that develop Alzheimer’s will increase from 12% to 31% by the year 2025 in the state of North Carolina. With over 5.3 million people suffering from Alzheimer’s in the United States, the costs associated with caregiving is overwhelming. In North Carolina alone, the value of unpaid care totals to more than $6.2 billion.
A new drug called Namzaric has just been released to the public for helping treat Alzheimer’s disease. Being the first drug to be approved by the FDA in approximately 14 years, Namzaric combines two medications that help fight the disease and has put them into one capsule. Because of this new advancement in medication, it is a step forward in finding ways to slow down or even prevent Alzheimer’s disease from progressing. According to the website for Namzaric, this new drug will benefit the patient with:
- An improvement in cognition, also known as mental function
- An improvement in overall function
- A slowdown in the worsening of symptoms for a while
Although this is not a cure for Alzheimer’s, it is certainly a step in the right direction.
People respond differently to medications, and and some may even experience different side effects from prescription drugs. In fact, there are over 2 MILLION accounts of adverse drug reactions that occur annually. Although this is a frightening statistic there is an analysis called Pharmacogenetics that can help professionals understand what drugs will cause these reactions based on a person’s individual genes. Pharmacogenetics includes the process of evaluating the genes that form the specific drug targets or enzymes that metabolize a drug or are associated with immune response.
Some variables that contribute to the adverse effects prescription drugs have on a person includes physiological and environmental factors. These factors involve a person’s:
- Pre-existing diseases
- Tobacco use
- Alcohol intake
Geriatric patients are more susceptible to the many adverse effects of prescription drugs due to the fact that:
- They are prone to health problems and therefore are often taking numerous prescription and over-the-counter medications
- The liver is less adequate to metabolize multiple drugs
- The kidneys are less able to remove drugs from the body, increasing the risk of kidney damage
- Undernourishment and dehydration is more common in older people
Once a patient seeks medical help with Pharmacogenetics they will undergo a simple swab to the cheek before it is tested. A doctor analyzes these factors he/she may resolve to increase or decrease the dose or even change to a different drug. The doctor’s conclusion about which medication to advise will also be influenced by any other prescription drugs the patient is taking. This precaution is taken to avoid negative drug interactions between each medication the patient is taking.
Private Insurance covers pharmacogenetics testing in many diagnostic situations including adverse drug reactions or lack of response to medication, pain management, cancer management, and management of many co-morbid conditions. Medicare coverage varies by plan; Medicare Advantage covers in many instances and traditional Medicare covers testing in some select cases.
For further information about pharmacogenetics please contact one of the Holladay pharmacists at 1-800-848-3446.
“It’s estimated that over 6 million people in America use prescription drugs for non-medical purposes.” This transference of a controlled substance from a legal use to a use or channel that is illegal is referred to as diversion. The theft of another’s prescription drugs is an act many would not expect from health care professionals. Unfortunately, this act is common in the healthcare industry, including long-term care facilities. Because of the availability of prescription drugs in long-term care facilities, it’s important that all staff is aware of the hazards and consequences of diverting medication.
The three types of prescription drugs that are most commonly abused are: Opioids, Central Nervous System (CNS) Depressants, and Stimulants. These drugs are most commonly diverted due to the effects they may yield.
- Opioids (Oxycodone, Hydrocodone, etc.): These medications are commonly prescribed to reduce pain and have a high risk for addiction and overdose. Opioid abuse can lead to respiratory distress and even death.
- CNS Depressants (Mephobarbital-“Mebaral”, Diazepam – “Valium”, Alprazolam – “Xanax,” etc.): These are used to treat anxiety and sleep disorders. These addictive substances can lead to overdose, resulting in significant breathing problems or death.
- Stimulants (Dextroamphetamine – “Adderall”, Methylphenidate – “Ritalin,” etc.) – are prescribed to treat sleep disorders and attention deficit hyperactivity disorder (ADHD) and can lead to severely high body temperatures, seizures, and cardiovascular distress. These drugs are less likely to be abused in long-term care facilities due to the fact that residents in long-term care are not often prescribed them.
“The Wisconsin Division of Quality Assurance estimates that oxycodone, morphine, fentanyl and hydrocodone products are the most often diverted medications in long-term care facilities.” Here are a few signs that an individual in your facility may be diverting a resident’s medications for personal use: (keep in mind these signs are just indicators and not absolute proof)
- Unwarranted and abundant absenteeism (especially last minute call-ins)
- Insistence on helping only specific residents who are prescribed controlled substances, (especially tenants with cognitive impairments)
- Disorderly documentation, repeatedly “forgetting” to chart medicine
- Offering to work night shifts or in settings with no (or few) other staff
- A steady decline in personal hygiene
- Temperament changes, behavioral mood swings, depression, lack of impulse control, etc.
As an employer, if you recognize any combination of these signs it is imperative to confront an employee suspected of diverting controlled substances. In some cases, the threat of employment loss can be enough inspiration for an abuser to seek treatment. Encourage your employee to seek assistance and provide them with information on available treatment programs in your area.
Diabetes affects approximately 380 million people world wide and this number is only increasing as the years progress. This metabolic disease causes elevated levels of glucose in the blood that must be regulated through means of insulin. Because those with diabetes do not have the ability to produce enough insulin it is imperative that they be able to self-administer this hormone into their systems through means of injection.
- The Humalog U-200 KwikPen delivers the same dose as Lilly’s Humalog U-100 KwikPen in half the volume, and is the fundamental concentrated mealtime insulin analog to receive FDA approval.
- Another benefit of the U-200 formulation is that in comparison to the 300 units of insulin the U-100 formulation holds, the U-200 KwikPen holds 600 units. This allows diabetics to change their pens less frequently.
- Users that are requiring smaller amounts of insulin to achieve glycemic control will have a larger amount of remaining unused insulin at the expiration date of the new pen. This new U-200 KwikPen continues to have the same storage and expiration dating requirements as the U-100 KwikPen. For these users, the U-200 KwikPen may not be the most cost effective product.
- Like any drug, Humalog U-200 can have possible adverse effects. The adverse event most commonly associated with the use of Humalog is hypoglycemia, (which in severe cases may lead to unconsciousness, seizures, and death).
In late March of 2012, the Centers for Medicare & Medicaid Services (CMS) started the National Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Drug Use in Nursing Homes. This organization has been commonly referred to as the Partnership to Improve Dementia Care in Nursing Homes. Antipsychotic drugs are those used to alleviate the behavioral and psychological symptoms of those with disorders of the mind, namely Alzheimer’s and dementia.
The goal of this Partnership is to enhance the quality of life of American residents in nursing homes. Previously, it has been common practice to use numerous types of psychopharmacological medications in nursing homes to address behaviors (without first determining the cause in which these behaviors developed.) These behaviors are commonly associated with symptoms of anxiety, depression, psychological distress, and insomnia all of which can be addressed without antipsychotic drugs, and their adverse effects (sedation, parkinsonism and increased risk of: infections, falls, strokes, etc.)
The primary concern with the use of medications, like antipsychotics, is that nursing homes and other medical facilities are using these drugs as a “quick fix” for behavioral symptoms. The Partnership to Improve Dementia Care in Nursing Homes recognizes that there are instances in which antipsychotic drugs are needed, but only after:
- Specific and documented therapy
- Ongoing examination of the resident to assess effectiveness and any development or presence of adverse effects from the medication
When a case for these drugs is concluded the medication should be administered only for the duration needed, and at the lowest effective dose. Often, these drugs are not necessary after using more holistic approaches to solving these behavioral issues – through a more thorough, individualized assessment of underlying sources.
The intolerance, hostility, delusions, apathy and sleep troubles these Alzheimer’s and dementia patients encounter can be solved with alternatives to antipsychotic prescriptions. Holladay suggests first trying non-drug treatments such as reminiscence therapy and social interaction. Research implies that various symptoms can be decreased by simply 10 minutes of individualized, daily talking therapy. Treatments including aromatherapy, animal therapy, music, dance, and massage therapy can also significantly lessen unfavorable behavior.
For more information on Alzheimer’s and dementia treatment options feel free to speak with a knowledgeable Holladay accociate at 336-760-3446.