Nursing Week 6 Discussion assignment Reply KY

 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.  

Discussion post week 6

Patient 1 - Malcolm

      Malcolm's behaviors are typical of ADHD, combined presentation, and can be treated using an amphetamine medication, which is a stimulant medication used first-line for ADHD in children (Goldin, 2023). The mechanism of action of amphetamines involves increasing central levels of dopamine and norepinephrine, which enhances attention, focus, and impulse control (Faraone, 2018). They work by increasing the release of these neurotransmitters and preventing their reuptake into the neuron.

      The advantages of this class of medications for Malcolm are that amphetamines are highly effective in treating ADHD in children and help normalize neurotransmitter activity in the prefrontal cortex (Stahl, 2021). This supports improved regulation of impulsiveness and hyperactivity in the school setting, as well as enhanced attention and focus, allowing him to complete schoolwork more effectively. There are short-acting amphetamines that can be administered twice daily, but this would require a dose given at school, which may not be the most reliable, and long-acting amphetamines that would be the most effective to get Malcom through school and homework time.

      Disadvantages of this medication for Malcolm include appetite suppression, which can affect growth, insomnia if a dose is given too late, and rebound behavior when the medication wears off (Medscape, n.d). Amphetamines are also a controlled substance and can be addictive, which is more of a concern in Malcolm's teenage years (Drugs.com, 2023). Other medication options for Malcolm would be to use an Alpha-2 agonist, which would include guanfacine or clonidine. The advantages of this class of medication are that it can help with impulsiveness and aggression Malcolm is displaying and can improve sleep without having the side effects of a stimulant medication. However, the disadvantages include hypotension, bradycardia, and syncope as well as hallucinations (Medscape, n.d).

      Side effects and monitoring considerations include Malcolm's weight/growth, sleep patterns, and any other complaints, including headaches or stomach upsets. Monitoring vital signs for any changes in heart rate and blood pressure will also be important. Lastly, it will be important to monitor any irritability, especially in the late afternoon, as there can be a rebound behavior when the stimulant wears off.

      Legally, amphetamines are a schedule II-controlled substance, so medications cannot have refills. It is important to schedule follow-up visits, so Malcolm does not miss doses. Ethically, Malcolm must receive services and support for his behavior and not just medication. Lastly, there is a stigma around being labeled as "troublemakers" or "bad kids" in school due to their ADHD symptoms, and this impacts the children and their families too (Schoeman & Voges, 2021). It is therefore important to make Malcolm feel that this is helping him, rather than making him feel different from other children.

Patient 2 - Jessica

      An appropriate medication for Jessica is to start methylphenidate, a stimulant medication. The mechanism of action of methylphenidate is a central nervous system stimulant that blocks the reuptake of dopamine and norepinephrine at the presynaptic neuron, increasing their availability in the prefrontal cortex, which is responsible for executive function and impulsivity (Medscape, n.d.). This is an appropriate medication for Jessica due to her classic ADHD symptoms, including not completing tasks, being easily distracted, and excessive talking. Stimulants like methylphenidate are FDA-approved and first-line treatment for ADHD in adults due to the strong efficacy (Verghese et al., 2024).

      The advantages of using methylphenidate for Jessica are the high efficacy and a very effective class of medication to target ADHD. It can be prescribed as an immediate-release form, which works within 30-60 minutes but only lasts 3-5 hours, or as an extended-release form, which lasts 8-12 hours and can be helpful for covering the full workday (Verghese et al., 2024). The disadvantages of methylphenidate are that there is potential for habit forming, leading to misuse and addiction, and due to its being a controlled substance, it is monitored by medical providers closely (Drugs.com, 2023). If Jessica were on the immediate-release form of methylphenidate, she would more than likely need a further dose during the day to maintain her executive functioning at work. Like any other stimulant medication, another disadvantage is appetite suppression, insomnia, and anxiety, with a possibility of increased irritability as the medication wears off (Drugs.com, 2023).

      Another medication option for Jessica would be to use a non-stimulant medication such as atomoxetine, which is a selective norepinephrine reuptake inhibitor (SNRI). The advantages of using this medication in adults with ADHD are that it is not addictive, so there is no potential for abuse, and it can be used if an individual has a history of dependency (Fedder et al., 2023). Another advantage is that you can stop atomoxetine without tapering. The disadvantage of non-stimulant medication is that it can take several weeks to have a full therapeutic effect, it is not as effective as a stimulant to treat ADHD, and it can cause GI upset (Fedder et al., 2023).

      Side effects that need to be considered when using methylphenidate are decreased appetite, cardiovascular issues, including increased heart rate and blood pressure, and possible headaches (Drugs.com, 2023). Evaluating Jessica for potential abuse, misuse, and addiction risk prior to prescribing, and educating her on these risks, as well as proper storage and disposal (Medscape, n.d.). It is important to continuously reassess risk and monitor for signs of addiction throughout treatment. It will also be important to monitor the effectiveness of this medication at work and how it is affecting her with her issues arising at work.

      Legally, methylphenidate is a Schedule II controlled substance, so the prescriber has to follow strict protocols and cannot prescribe refills. Follow-ups with the provider will be essential to continue the medication. Ethically, it will be important to ensure Jessica is using the medication appropriately and not sharing it with coworkers. Lastly, Jessica may worry about being labeled or judged for taking ADHD medication, or disclosure at work could affect relationships with colleagues

References

Drugs.com. (2023). Drugs.com. https://www.drugs.com/Links to an external site.

Faraone, S. V. (2018). The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neuroscience & Biobehavioral Reviews, 87, 255–270. https://doi.org/10.1016/j.neubiorev.2018.02.001Links to an external site.

Fedder, D., Patel, H., & Saadabadi, A. (2023). Atomoxetine. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493234/Links to an external site.

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

Medscape. (n.d.). Medscape reference: Drugs, diseases & medical procedures. https://reference.medscape.com/Links to an external site.

Schoeman, R., & Voges, T. (2022). Attention-deficit hyperactivity disorder stigma: The silent barrier to care. South African Journal of Psychiatry, 28, Article 1865. https://doi.org/10.4102/sajpsychiatry.v28i0.1865Links to an external site.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
(Chapter 11: Attention deficit hyperactivity disorder and its treatment, pp. 449–485)

Verghese, C., Patel, P., & Abdijadid, S. (2024). Methylphenidate. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482451/Links to an external site.