Clinical and regulatory concerns in Alzheimer's disease management: Role of the pharmacist

The role of the pharmacist in managing Alzheimer's disease (AD) is discussed. Health-system pharmacists can play a critical role in the management of AD, provided they remain up-to-date on new drug therapies, recent clinical findings, and educational resources for caregivers and families. Pharmacists in a long-term-care setting must know and apply the federal regulations set forth in the Omnibus Budget Reconciliation Act of 1987. Pharmacists have an excellent opportunity to optimize pharmacotherapy by carefully reviewing treatment regimens to identify potential drug-related problems. These might include improper drug selection, inappropriate dosage, adverse drug reactions, and interactions. Pharmacists should encourage the use of cholinesterase inhibitors in patients with mild to moder ate AD and should monitor such therapy by interacting with nurses, physicians, and caregivers. AD patients not only suffer cognitive decline but may have psychiatric and behavioral disturbances, which can be especially problematic for the caregiver. When possible, these disturbances should be managed by nonpharmacologic strategies, such as environmental changes and behavior modification. The pharmacist can recommend and monitor the use of psychotropic agents for psychiatric and behavioral symptoms that do not respond to nonpharmacologic strategies. These drugs must be carefully selected and monitored, and gradual dosage reductions must be periodically attempted. Finally, pharmacists should provide caregivers and families with education, emotional support, and referrals. Pharmacists who are well-grounded in the regulatory and clinical issues surrounding AD can play a major role in managing this illness.