Read a selection of your colleagues’ posts. Focus specifically on those colleagues who were assigned your same medication but opposite stance.
Respond to 3 of your colleagues who were assigned your same medication but an opposite stance. For example, if you were assigned the con stance for amphetamine, you should respond to two students who were assigned the pro stance for amphetamine. Support or expand on your original argument to refute their claims. Work to share additional perspectives on the issue described by your colleague.
Additionally, your response needs to be supported by two (2) scholarly peer-reviewed resources.
See below My orginal post and 3 peer post.
My original post:
Medication Class: Amphetamines
Mechanism of Action
Amphetamines’ mechanisms of action include facilitating the release and blocking the reuptake of dopamine and norepinephrine in the brain. This is an important mechanism for developing attention and reducing impulsivity; thus, this class is really important for Malcolm, 9, with an ADHD diagnosis, and Jessica, 32, with the same diagnosis.
Advantages
Another significant benefit of the use of amphetamines is the quick onset of action in that the symptoms, in most cases, are considerably improved within hours. This is crucial to Malcolm since he requires urgent intervention to keep him calm and focused at school. In addition, amphetamines come in their immediate-release and extended-release forms, thus enabling different dosing options that allow him to be appropriately fitted to his individual needs (Siefried et al.,. 2020).
Disadvantages
On the other hand, there are critical drawbacks. It can include insomnia, suppressed appetite, and anxiety. For Malcolm, who is already sensitive emotionally, the side effects can become highly ominous. There is also a risk of misuse and dependence against which Jessica’s history might include behavioral problems at work.
Side Effects and Considerations
These include cardiac effects, such as tachycardia and elevation of blood pressure. Growth suppression is also a possibility in children. In Malcolm’s case, growth and weight will have to be measured frequently and recorded, whereas in Jessica’s case, a history of psychological disturbance has to be considered as well.
Implications
Legal: Because amphetamines are controlled substances, there needs to be regulation on the prescription of these substances.
Ethical: Clinicians must obtain informed consent from patients and family members. The benefits and risks must be explained to them.
Social: Stigma that may be associated with ADHD medications regarding the self-perception of both Malcolm and Jessica and their relation to peers
Drug Class: Non-Stimulant
Action
Stimulants are usually compared to non-stimulant drugs such as atomoxetine, which selectively inhibits norepinephrine reuptake, increasing availability within the brain. This is an indirect mechanism compared with that of the stimulants and may imply slower symptom improvement. In Malcolm’s case, these non-stimulants represent a potentially helpful option in the event of intolerable side effects caused by the use of stimulants (Hartikainen et al., 2023). Jessica might favor this category even more, considering the potential for stimulant abuse.
Benefits
They are less likely to be abused or lead to dependence and hence considered safer for patients with a history of substance abuse. Acute side effects are fewer than an attractive choice for both patients. Their action may last all day, offering consistent symptom coverage without the highs and lows seen with the use of stimulants.
Disadvantages
Another major disadvantage is that, generally speaking, it takes more time for non-stimulants to reach their peak therapeutic effect, which might be several weeks (Frost et al., 2021). For Malcolm, this can be frustrating in meeting his need immediately to manage the symptoms at hand. The overall impact may be much weaker with some patients, making them less satisfied with the treatment.
Side Effects and Considerations
Possible side effects include GI upset, fatigue, and mood changes. Therefore, it is crucial to follow up closely with both Malcolm and Jessica because these side effects may impact their daily lives and quality of life.
Implications
Legal: The medications are less controlled and, hence, more accessible to prescribe; however, the diagnosis and reason for treating ADHD should nonetheless be appropriately documented.
Ethical: Clinicians must remember the benefits of prescribing a non-stimulant compared to the need for a drug to manage symptoms readily.
Social: Non-stimulant treatment may not be as stigmatized, which will positively affect Malcolm’s self-esteem and his relationships in general.
Conclusion
While amphetamines and non-stimulants have certain advantages and disadvantages in treating ADHD for patients like Malcolm and Jessica, medication treatment should preferably be tailored on an individual basis, considering the needs and circumstances of the patient. In either case, side effects and efficacy need to be closely monitored. This balanced approach will allow optimal treatment results and give comprehensive attention to the complexities inherent in treating ADHD.
References
Frost, M. C., Lampert, H., Tsui, J. I., Iles-Shih, M. D., & Williams, E. C. (2021). The impact of methamphetamine/amphetamine use on receipt and outcomes of medications for opioid use disorder: a systematic review. Addiction Science & Clinical Practice, 16, 1-25. https://link.springer.com/article/10.1186/s13722-021-00266-2Links to an external site.
Hartikainen, M., Taipale, H., Tanskanen, A., Mittendorfer-Rutz, E., Lähteenvuo, M., & Tiihonen, J. (2023). Association of pharmacological treatments and hospitalization and death in individuals with amphetamine use disorders in a Swedish nationwide cohort of 13 965 patients. JAMA psychiatry, 80(1), 31-39. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2798882Links to an external site.
Siefried, K. J., Acheson, L. S., Lintzeris, N., & Ezard, N. (2020). Pharmacological treatment of methamphetamine/amphetamine dependence: a systematic review. CNS drugs, 34(4), 337-365. https://link.springer.com/article/10.1007/s40263-020-00711-xLinks to an external site.
Peer 1
Patient Case Scenario Debate
Cherlinx Louis-Jean
The selected medication class is Methylphenidate
What is the proposed mechanism of action of the medication(s)? Why might this be appropriate for the patients?
Methylphenidate is a stimulant medication commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD). Its primary mechanism of action involves inhibiting the reuptake of dopamine and norepinephrine, two neurotransmitters critical for attention, motivation, and impulse control. By blocking the reuptake of these neurotransmitters in the prefrontal cortex and basal ganglia, methylphenidate increases their availability in synaptic clefts, which improves communication between neurons. This helps enhance focus, reduce hyperactive behavior, and improve self-control. These effects are beneficial in addressing the core symptoms of ADHD, such as inattention, impulsivity, and hyperactivity (Gao et al., 2021).
For both Malcolm and Jessica, methylphenidate could be an appropriate treatment option due to its effectiveness in managing symptoms across age groups. For Malcolm, who struggles with hyperactivity, impulsivity, and difficulty focusing, the medication may help him remain seated in class, complete homework more efficiently, and reduce disruptive behaviors like blurting out answers or hitting others when upset. For Jessica, methylphenidate could enhance her focus at work, allowing her to stay on task, reduce distractions from coworkers, and limit excessive socialization, improving her job performance and interpersonal relationships. Both individuals would likely benefit from the increased attentional control and impulse regulation that methylphenidate provides.
What are the advantages or disadvantages to your class of medication (options for different administration, length of duration, etc.)?
Methylphenidate offers several advantages in treating ADHD, particularly due to its flexibility in administration and duration of action. It comes in both immediate-release (IR) and extended-release (ER) formulations, allowing for customizable dosing based on the patient’s needs. Immediate-release versions typically last 3-4 hours, which can be useful for targeting specific parts of the day, while extended-release versions can last 8-12 hours, providing all-day symptom relief with a single dose. This flexibility helps tailor treatment to various settings, such as school or work, and reduces the need for multiple daily doses, which can improve adherence and convenience for both children and adults. Additionally, methylphenidate is available in various forms like tablets, capsules, liquids, and transdermal patches, offering more options based on patient preferences and lifestyle needs (Masi et al., 2022).
What are the advantages or disadvantages of the other medication options?
Methylphenidate, while effective, has some disadvantages compared to other medication options like amphetamines, alpha-adrenergic agonists, and non-stimulants. Amphetamines, such as Adderall, are often considered more potent and may provide longer-lasting symptom control, particularly for individuals who do not respond well to methylphenidate. However, amphetamines also carry a higher risk of side effects like insomnia, appetite suppression, and increased heart rate. Alpha-adrenergic agonists (e.g., guanfacine, clonidine) are non-stimulant options that can help with hyperactivity and impulsivity. Still, they are generally less effective for attention-related symptoms and may cause sedation or lower blood pressure. Non-stimulants like atomoxetine (Strattera) provide a longer-acting, lower-risk option for patients who cannot tolerate stimulants. Still, their onset of action is slower, sometimes taking weeks for full effect. Overall, methylphenidate offers a balance of effectiveness and manageable side effects but may not be suitable for everyone, especially those who need a stronger, longer-lasting, or non-stimulant approach.
What possible side effects or considerations need to be evaluated?
When prescribing methylphenidate, several potential side effects must be closely monitored. Common side effects include insomnia, reduced appetite, weight loss, and stomach pain, which can affect daily functioning, especially in children. Additionally, methylphenidate can cause increased heart rate and elevated blood pressure, necessitating periodic cardiovascular monitoring, particularly in patients with a history of heart problems. Other possible side effects include mood swings, irritability, or increased anxiety. In rare cases, more serious side effects like tics or exacerbation of preexisting tics, as well as psychiatric symptoms such as hallucinations or mania, may occur. Because of its stimulant nature, there’s also the potential for misuse or dependence, particularly in older adolescents and adults. Therefore, regular follow-ups are important to evaluate tolerance, efficacy, and the emergence of any adverse effects (Yoo et al., 2020).
Provide one example for each consideration—legal, ethical, and social implications—for prescribing the medication category.
Legal Implication: Methylphenidate is a Schedule II controlled substance, meaning it has a high potential for abuse and addiction. Prescribers must follow strict regulations, including issuing prescriptions with limited refills, documenting the rationale for their use, and monitoring for signs of misuse. Failure to adhere to these regulations could result in legal repercussions for the prescriber, including penalties or loss of medical licensure.
Ethical Implication: There is a moral responsibility to ensure that methylphenidate is prescribed only when medically necessary and after a thorough evaluation. Overprescription, particularly in cases where ADHD may be misdiagnosed or overstated, can lead to unnecessary exposure to medication risks. Prescribers must balance the potential benefits against the risks of side effects or dependence, especially in pediatric populations.
Social Implication: The use of methylphenidate in children and adults can carry a social stigma, as individuals taking the medication may feel labeled or judged for having ADHD or requiring stimulants for cognitive control. This can affect self-esteem, social interactions, and perceptions in school or work environments, leading to social isolation or pressure to discontinue the medication despite its therapeutic benefits.
References
Gao, L., Man, K. K. C., Chan, E. W., Chui, C. S. L., Li, X., Coghill, D., Hon, K. L., Tse, M. L., Lum, T. Y. S., Wong, K. H. T. W., Ip, P., & Wong, I. C. K. (2021). Treatment with Methylphenidate for Attention Deficit Hyperactivity Disorder (ADHD) and the Risk of All-Cause Poisoning in Children and Adolescents: A Self-Controlled Case Series Study. CNS Drugs, 35(7), 769–779.
Masi, G., Pfanner, C., Liboni, F., Lenzi, F., Villafranca, A., D’Acunto, G., Fantozzi, P., Falcone, F., Simonelli, V., Muratori, P., Levantini, V., Favole, I., Amianto, F., Davico, C., & Vitiello, B. (2022). Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice. Pediatric Drugs, 24(2), 147–154.
Yoo, J. H., Sharma, V., Kim, J.-W., McMakin, D. L., Hong, S.-B., Zalesky, A., Kim, B.-N., & Ryan, N. D. (2020). Prediction of sleep side effects following methylphenidate treatment in ADHD youth. NeuroImage Clinical, 26, 102030–102030.
Peer 2
Stephanie Lathers
Patient one
Malcolm is a 9-year-old male in fourth grade attending a public elementary school. He is diagnosed with ADHD and presents with fidgeting and hyperactivity. He often gets in trouble at school for outbursts, hitting other kids, and exhibiting hyperactive behavior. Malcolm has attention deficit disorder with schoolwork, difficulty focusing, often gets distracted, is forgetful, has a short attention span, has difficulty sitting still, and is unable to complete activities. Stimulants and nonstimulants treat ADHD. Methylphenidate is a typical stimulant medication used to treat patients with ADHD such as (Ritalin and Concerta) which function as norepinephrine and dopamine reuptake inhibitors, improving the presence of the neurotransmitters and extending their action.
Non-stimulant medications are clonidine and guanfacine; they also increase norepinephrine in the brain (Zhang et al., 2023). It is appropriate for the brain to use Methylphenidate and Non-stimulant medications because they help children focus, improve attention span, and decrease impulsivity. There are advantages and disadvantages to all medications. Methylphenidate can improve performance but can cause minor side effects. The cons are that they can be habit-forming, leading to serious side effects such as lethargy, jitteriness, and poor appetite. Nonstimulants (Strattera, Wellbutrin) are uncontrolled substances that can be utilized with stimulants and other medications and are not habit-forming, which are advantages. The disadvantages of taking nonstimulants are that they take longer to work with children. Other medications can be taken, such as Ritalin patches, antidepressants, and Kapvay. Antidepressants are inexpensive and less habit-forming; however, they can increase the risk of suicidal thinking. Kapvay is less effective in helping focus and improving attention span, but it enhances aggression, hyperactivity, and impulsiveness. Ritalin patches are more controlled in use with children, but some children hate wearing them. Professionals should review medications with the patient for potential side effects. Therefore, provide careful consideration of the side effects of dry mouth, dizziness, mood swings, stomach upset, weight loss, and suicidal ideation. Methylphenidate side effects are xerostomia, acute abdominal pain, insomnia, irritability, hyperhidrosis, jitteriness, and insomnia.
One legal example of prescribing Methylphenidate is being cautious about prescribing due to it being a Schedule two controlled substance drug that can be sold or misused in substantial amounts. Ethical examples can lead to behavioral rigidity; therefore, parents should be educated. A social example is the drug that causes disruptive social behavior in adolescents. Nonstimulants carry a black box warning for suicidal behaviors and thoughts; monitor for mood changes when prescribing, and ethical considerations when prescribing. The prescriber should remember that the non-stimulant must be taken daily to be effective, or it will not produce successful results. The social implication is that it is a safe and effective medication for children. According to studies, utilizing either one of these medications will cause improved advanced cognitive impairment in patients with ADHD (Luo et al., 2023)
Patient Two
Jessica is a thirty-two-year-old female newly diagnosed with ADHD. The assessments completed by psychologists validate her struggle to complete work tasks and schoolwork. She is easily distracted by coworkers constantly talking, and she disrupts her coworkers. Therefore, she requires ADHD treatment options such as any non-stimulant medication or stimulant medication. Starting Jessica on any medication will improve her concentration, change her mood, decrease her activity, and help her function more appropriately at work. The methylphenidate mechanism is unclear, but it improves neurotransmitters in extra neural space linger the action, inhibiting the reuptake of dopamine and norepinephrine reuptake. Non-stimulants work similarly but are slower in preventing norepinephrine and dopamine reuptake inhibition. By utilizing this process, adults can improve concentration levels, focus, and organizational skills and complete tasks to avoid losing their jobs. It is appropriate for the patient to initiate to be able to start a new job with a fresh start and mood change.
The advantage of a stimulant (Methylphenidate) for Jessica would be it would treat her symptoms in a few weeks; the disadvantage is the medication wears off quickly, and the potential adverse health consequences such as substance abuse or overdose that lie as a reaction (McCabe et al., 2024). The advantage of non-stimulants is that there are no addictive properties in non-stimulants, there are longer lasting effects 24 hours, and they are easy to taper off. In Jessica’s case, the disadvantage of a non-stimulant is that it is slow to work, taking over two weeks to show results. Jessica had struggled all her life with ADHD, untreated, when there were advantages to using other medication options, such as having a safer drug and fewer side effects. There were also disadvantages to their medication options: Tenex, an alpha-adrenergic agonist, can help with ADHD but can increase fatigue. Amphetamines can boost memory but increase heart rate and blood pressure, and long-term use increases the risks of drug abuse. Side effects and considerations that should be considered are reduced appetite effects, tachycardia, blurred vision, and paranoia. Alpha-adrenergic can cause low blood pressure (postural hypotension), swollen ankles or legs, tremors, allergic reactions, itching, and inability to breathe, requiring immediate evaluation. One example of an ethical consideration is the medication should be prescribed safely when the benefits outweigh the risks. The social implications can cause falls from blood pressure drops, resulting in broken bones. The legal issue is that alpha-1 adrenergic blockers can cause rare acute liver injury, so monitor enzymes.
An ethical consideration with Amphetamines is they, too, can cause addiction. Monitor adults for drug overuse because they can be smoked, dabbed, swallowed, inhaled, shot in a vein, or snorted. Socially, this drug may increase anxiety and emotional expression, causing emotional outbursts. Ethically, it would be best if you remember at any time, a person can start misusing these drugs. Alpha Adrenergic Agonists (AAA) are ethically and legally prescribed for off-labeling. Terazosin is one that the Food & Drug Administration approves for high blood pressure. These AAA can cause social sexual issues such as the inability to ejaculate or priapism.
Reference
Luo, X., Dang, C., Guo, J., Li, D., Wang, E., Zhu, Y., Liu, L., Wang, Y., Song, Y., & Sun, L. (2023). Overactivated contextual visual perception and response to a single dose of Methylphenidate in children with ADHD. European Archives of Psychiatry and Clinical Neuroscience, 274, 35–44. https://doi.org/10.1007/s00406-023-01559-0Links to an external site.
McCabe, V. V., Veliz, P. T., Wilens, T. E., Schepis, T. S., Pasman, E., Evans-Polce, R. J., & McCabe, S. E. (2024). Adolescents’ Use of Medications for Attention-Deficit/Hyperactivity Disorder and Subsequent Risk of Nonmedical Stimulant Use. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 75(1), 188–191. https://doi.org/10.1016/j.jadohealth.2024.01.024Links to an external site.
Zhang, Y., Yin, L., You, C., Liu, C., Dong, P., Xu, X., & Zhang, K. (2023). Efficacy and Safety of Methylphenidate and Atomoxetine in Medication-Naive Children with Attention-Deficit Hyperactivity Disorder in a Real-World Setting. Drugs in R & D, 24, 29–39. https://doi.org/10.1007/s40268-023-00445-3Links to an external site.
Peer 3
Patrick PizarroOct 2 8:40pmManage Discussion by Patrick Pizarro
Reply from Patrick Pizarro
Discussion Week 6
Patient 1
For this scenario, we consider the case of Malcolm, a 9-year-old with an ADHD diagnosis. For the treatment of ADHD, Amphetamine is commonly prescribed since the medication works to increase dopamine release in the brain, the neurotransmitter associated with attention (Ferrucci et. al, 2019).
In this case, the medication would be advantageous to this patient as amphetamines reduce the severity of ADHD symptoms as rated by patients and clinicians (Castells et. al, 2018). However, the disadvantages are many and these may actually outweigh the benefits. Amphetamine use carries the risk of a litany of potential side effects: increased heart rate, mood changes, anxiety, restlessness, dry mouth, stomach pain, nausea, vomiting and many more unpleasant effects for which regular monitoring is necessary (Alalalmeh et al., 2023). Additionally, the legal implications can be a problem as it is a controlled substance. Ethical concerns involve a provider weighing the benefit of prescribing amphetamines to Malcolm versus the potential side effects, legal considerations, and social implications – a 9-year-old “on meds” for ADHD opens the doors to stigma and as a result, negative interactions with peers.
Patient 2
In this scenario, 32-year-old Jessica is an adult suffering from ADHD. Stimulants, considered first-line treatment for adult ADHD, offer to help increase focus and reduce impulsive behaviors by blocking reuptake of dopamine and norepinephrine (Gottlieb, 2001). Methylphenidate, a frequently prescribed stimulant for the treatment of adult ADHD has the advantage of having been extensively studied and proven to reduce distractibility, improve attention, and curbing impulses (Arnsten, 2006). It is not without its disadvantages, however, as (similarly to amphetamines) there exists abuse potential with stimulants. Side effects can also be troublesome – loss of appetite, trouble sleeping, and headaches (2006) can make compliance difficult.
Additionally, much like in the case of amphetamines, legal implications include substance abuse and misuse. Ethical concerns must also be considered due to stimulants’ potential for developing tolerance in certain individuals. Finally, social considerations include the potential for shame and isolation from peers when considering the common stigmas often associated with her condition and the medications used to treat it.
Alalalmeh, S. O., Hegazi, O. E., Shahwan, M., Alshehri, F. S., Ashour, A. M., Algarni, A. S., & Alorfi, N. M. (2023). Amphetamines in child medicine: a review of ClinicalTrials.gov. Frontiers in Pharmacology, 14. https://doi.org/10.3389/fphar.2023.1280562Links to an external site.
Arnsten A. F. (2006). Stimulants: Therapeutic actions in ADHD. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 31(11), 2376–2383. https://doi.org/10.1038/sj.npp.1301164
Castells, X., Blanco-Silvente, L., & Cunill, R. (2018). Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 8(8), CD007813. https://doi.org/10.1002/14651858.CD007813.pub3
Ferrucci, M., Limanaqi, F., Ryskalin, L., Biagioni, F., Busceti, C. L., & Fornai, F. (2019). The Effects of Amphetamine and Methamphetamine on the Release of Norepinephrine, Dopamine and Acetylcholine From the Brainstem Reticular Formation. Frontiers in Neuroanatomy, 13. https://doi.org/10.3389/fnana.2019.00048Links to an external site.
Gottlieb S. (2001). Methylphenidate works by increasing dopamine levels. BMJ (Clinical research ed.), 322(7281), 259. https://doi.org/10.1136/bmj.322.7281.259