The Novartis website makes the case for a patch over a pill by saying "On average, an older American takes 5 prescription medicines. These medicines may need to be taken at different times and managing them all may seem overwhelming" (Novartis, para. 1). In this case, a patch eliminates having to remember several doses each day of one of the medications.
5. What is "moderate" dementia? What is dementia?
Dementia affects brain function. There is no known cure for dementia. It refers to several illnesses (Alzheimer's disease, Lewy or DLB) involving behavior, memory, communication and learning problems. There are other conditions in the brain which damage nerves or blood vessels, which also can create dementia. Dementia diseases are usually progressive, so "moderate" dementia usually refers to the beginning stages of the illness.
6. What are the implications of the health issue from an economic, social, lifestyle, legal, political, medical and ethical standpoint?
Treating a patient with Alzheimer's disease with rivastigmine may create false hopes in the caregiver's mind, which affects the economic, social, lifestyle, legal, political, medical and ethical considerations of both patient and caregiver. If the drug, which seems to promise delay of full-time care of a progressive disease, does not deliver this delay, the expectations and therefore the planning of future activities and care are deeply affected. Liability increases on the part of diagnostician, the one prescribing the drug and the administrator. The political ramifications are multiple, as a body of people prepare for long-term care of millions of affected patients. Much time and money is being spent by the government to determine whether this drug affects the millions who take it in a positive way.
7. What circumstances contributed to this being a current health care issue?
The drug companies seem to promise that this drug is a cure-all, at the very least delaying full-time care for patients, which it does not. Moreover, at high doses, rivastigmine causes gastrointestinal distress, including nausea, diarrhea, vomiting, weight loss and decreased appetite. Therefore, a patient should start with a low dose and increasing the dose to the next level...
One must remember, also, to apply the patch every day. If it is not applied daily and is forgotten (which is likely in cases of dementia) for several days, a person should not reapply the patch until they talk with their doctor.
What are the opportunities and challenges this issue poses to my practice in healthcare as a dental hygienist? i.e. how is it a challenge or opportunity for a hygienist?
A person wearing an Exelon patch must not be used at the same time as other medicines that contain cholinomimetic agents, which may be part of the anesthetics that a dental hygienist or dental assistant uses.
Liability issues arise in connection with using the Exelon patch which may affect the work of the hygienist, therefore becoming a challenge to their practice.
References
Activa. (2008). Symptoms of Parkinson's Disease. Activa Deep Brain Stimulation. Retrieved January 20, 2008 from website: http://www.activadbs.com/symptoms.asp.
Medications and treatment. (2008). Parkinson's Disease Foundation Retrieved January 20, 2008 from website: http://www.pdf.org/AboutPD/med_treatment.cfm.
NHS. (2005). Holding Statement. National Institute for Clinical Excellence. Retrieved January 20, 2008 from website: http://www.nice.org.uk/nicemedia/pdf/Alzheimer_holdingstatement.pdf.
NHS. (2007). Final appraisal determination: Donepezil, rivastigmine, galantamine (review) and memantine for the treatment of Alzheimer's disease. Centre Director Report for Guidance Executive. National Institute for Clinical Excellence. Retrieved January 20, 2008 from Website: http://www.nice.org.uk/nicemedia/pdf/GE050705AlzFADSignoffReport.pdf.
Novartis. (2007). Why Exelon patch? Website retrieved January 20, 2008 at http://www.exelonpatch.com/info/treating/exelon/why-exelon-patch.jsp?WT.svl=CM
Rivastigmine. (2008). How should this medicine be used? Medline Plus. Retrieved January 20, 2008 from website: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a602009.html#brand-names.
What is Alzheimer's? (2008). Alzheimer's Association. Retrieved January 20, 2008 from website: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp.
