Nursing Week 6 Discussion assignment Reply svm

  Respond to 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. 

Mechanism of Action and Why It Fits These Patients

Amphetamine Stimulants

Amphetamines increase dopamine and norepinephrine in the brain by promoting their release and blocking their reuptake. According to Goldin (2023), this improves attention, impulse control, and behavioral regulation. Research has shown that these neurotransmitters are essential for the prefrontal cortex, which manages focus, planning, and emotional control (Stahl, 2021).

Why appropriate for Malcolm and Jessica:

• Malcolm struggles with hyperactivity, impulsive hitting, blurting, and distractibility. Increasing dopamine and norepinephrine helps him sit still, follow directions, and complete tasks.
• Jessica struggles with task completion, distractibility, and interrupting coworkers. Amphetamines help adults sustain attention and reduce impulsive talking.

Advantages and Disadvantages of Amphetamine Stimulants

Advantages

• Strongest evidence for ADHD treatment
  Research has shown that stimulants have the largest effect size for ADHD symptoms (American Academy of Pediatrics, 2019).
• Fast onset (30–60 minutes) (Goldin, 2023).
• Many formulations
  Immediate‑release, extended‑release, chewables, liquids, and patches (Drugs.com, 2023).
• Long-duration options
  XR products last 10–14 hours, helpful for school or workdays.
• Useful across the lifespan
  Works well for both children like Malcolm and adults like Jessica.

Disadvantages

• Appetite suppression and slowed growth in children (Goldin, 2023).
• Insomnia, especially if taken late (Stahl, 2021).
• Mood changes or irritability, especially rebound.
• Cardiovascular effects (increased heart rate and blood pressure).
• Schedule II controlled substances with misuse and diversion risk (Drugs.com, 2023).
• Rare stimulant‑induced psychosis
  Research has shown that both therapeutic and non‑therapeutic stimulant use can trigger psychotic symptoms in vulnerable individuals (Jangra et al., 2024; Bouthillier et al., 2026; Miller, 2025).

Advantages and Disadvantages of Non‑Stimulants

Advantages

• No abuse or addiction risk
  Helpful for adults with misuse concerns (CHADD, 2023).
• Good for patients with anxiety, tics, or sleep problems (Stahl, 2021).
• 24‑hour symptom coverage
  Atomoxetine and viloxazine work all day and into the evening.
• Alpha‑2 agonists (guanfacine, clonidine) help with emotional regulation and aggression—useful for children like Malcolm.

Disadvantages

• Slower onset (2–6 weeks) (Goldin, 2023).
• Less effective than stimulants for core ADHD symptoms (Stahl, 2021).
• Side effects
  • Atomoxetine: stomach upset, fatigue
  • Guanfacine/clonidine: sedation, low blood pressure
• May require twice‑daily dosing depending on formulation.

Side Effects and Key Considerations

1. Cardiovascular Safety

• Must monitor heart rate and blood pressure.
• Example: Malcolm or Jessica with a family history of heart disease may need extra screening.

1. Growth and Appetite in Children

• Appetite loss and slowed growth require monitoring.
• Example: Malcolm may need growth checks every visit.

1. Sleep and Mood

• Insomnia, irritability, or rebound symptoms may occur.
• Example: Jessica may need an earlier dosing time if she cannot sleep.

1. Psychosis or Mania

• Rare but serious.
• Example: If either patient reports hallucinations, the stimulant must be stopped immediately.

1. Misuse and Diversion

• Especially important for adults in workplace settings.
• Example: Jessica may need smaller quantities or pill counts if misuse risk is present.

Legal, Ethical, and Social Implications

Legal Implication

Amphetamines are Schedule II controlled substances, requiring strict documentation, no refills, and careful monitoring (Drugs.com, 2023).
Example: A provider must document every prescription for Jessica to avoid legal issues related to diversion.

Ethical Implication

Prescribers must balance benefit with risk. According to Miller (2025), misuse and addiction risks require careful ethical judgment.
Example: If Jessica has a history of substance use, the provider must ethically consider a non‑stimulant instead.

Social Implication

There is stigma around ADHD and stimulant use. Research has shown that families may fear judgment or misunderstanding (Stahl, 2021).
Example: Malcolm’s parents may worry that others will think he is “on drugs,” which may affect their willingness to start treatment.

Conclusion

Amphetamine stimulants are highly effective for improving attention, impulse control, and hyperactivity because they increase dopamine and norepinephrine in the brain. This makes amphetamines appropriate for both Malcolm and Jessica, who struggle with distractibility and difficulty completing tasks. While stimulants offer fast and strong symptom relief, they also require careful monitoring for appetite changes, sleep problems, cardiovascular effects, and misuse. Non‑stimulants provide safer alternatives for patients who cannot tolerate stimulants, though they work more slowly and are generally less effective. By weighing the benefits, risks, and individual needs of each patient, clinicians can choose the most appropriate and responsible treatment plan.

References

American Academy of Pediatrics. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528

Bouthillier, A., Sharafi, H., Bisaga, A., & Jutras-Aswad, D. (2026). A call for action: Closing the evidence gap in management of stimulant-induced psychosis. Addiction.

CHADD’s National Resource Center on ADHD. (2023). ADHD medications approved by the U.S. Food and Drug Administration: Stimulant medications.

Drugs.com. (2023). Amphetamine: Professional monograph. https://www.drugs.com

Goldin, D. S. (2023). Fast facts for psychopharmacology for nurse practitioners. Springer Publishing.

Jangra, D., Tejwani, R., Ahluwalia, Y., Sarkar, S., & Balhara, Y. P. S. (2024). Stimulant-induced psychosis: A comparative systematic review and meta-analysis. Journal of Addiction Medicine.

Miller, N. (2025). Amphetamines: A current epidemic. Frontiers in Psychiatry, 16, 1460341.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.