Question

Mary-Lou is a 75-year-old widow, who lost her husband to cancer over a year ago. Her family and friends have noticed that she has been very teary, has low self-esteem and has lost interest in the things she used to love such as going to bingo with her friends and gardening. Her family initially put this down to the loss of her husband and thought it would pass with time. However, they are now getting really concerned as they have noticed that her mood is not improving still. When asked by her daughter if she is sleeping well, she says she has been drinking wine every night to help her go to sleep. It makes her feel happy and relaxed. What started as one glass a night has now increased to two or three glasses a night, and she has also started drinking during the day. Her daughter has noticed that her mum’s face always appears flushed and that she has had quite a few colds lately. Mary-Lou is also losing her balance and experiencing mood swings. Her daughter is worried that she is relying too heavily on alcohol and fears that she is starting to get short-term memory loss from the alcohol consumption. She has been forgetting things such as where she put her keys, whether she turned on the washing machine, why she opened the fridge and forgetting the topic of conversation when talking with her daughter on the phone. Mary-Lou has also been getting disorientated and getting lost when she goes out on her daily walks. A neighbor rang her daughter one day to tell her that she found Mary-Lou wandering around aimlessly, and when questioned what she was doing Mary-Lou snapped and said she was trying to get home. Her daughter decided it was time to take Mary-Lou to the local GP to work out what was going on with her. After listening to the signs and symptoms Mary-Lou was experiencing, the GP diagnosed her with depression and prescribed 50 mg of Fluoxetine/Prozac daily. Based on the results of clinical and radiological assessments, the GP determined that she had early onset Alzheimer’s disease. He prescribed a cholinesterase inhibitor and gave them information on support groups and tips on what to do from here on in. He also prescribed 10 mg of Diazepam daily to help with the withdrawals from alcohol abuse.

a) Identify and explain two pharmacokinetic factors that are characteristic of/specific to Mary- Lou’s antidepressant medication. Discuss how her age impacts the pharmacokinetics of her medication.

b) Explain what specific considerations need to be made in the present scenario, when two drugs are administered simultaneously.

Answer 1

The Cholinesterase inhibitors are chemicals that prevents the breakdown of the neurotransmitter Acetylcholine. This increases the amount of Acetylcholine in the synaptic cleft that can bind to muscarinic receptors, nicotinic receptors and others.They are generally used to treat Alzheimer's disease and dementia. The effects of this medicine is starting from 2- 3 months. Cholinesterase inhibitors aim to increase communication between the nerve cells to improve symptoms of Alzheimer's disease. This Cholinesterase inhibits Acetylcholinesterase from breaking down into Choline and Acetyl. Thereby increasing both the level and duration of action of the neurotransmitter Acetylcholine in the central nervous system, automatic ganglia and neuromuscular junction. Alzheimer's disease is associated with a decrease of Cholinergic activity in the cortex and other brain regions. The inhibition of acetycholisterase to produce symptomatic improvement. The side of effect of cholinesterase inhibitors are : nausia, vomiting, musclecramps etc.

The diazepam reduces the breakdown of neurons which gains the memory retention. This medicine is a GABAA receptor modulator. It is used as a medicine and known to cause sedative and memory impairing effects. Diazepam prevents Neuro inflammation preserved synaptic plasticity and normalised protein concentration associated with Acetylcholine breakdown and GABAA synthesis.