Please Select Two Of The Below Medication Classes

Please select two of the below medication classes

Discussion Assignment Please select two of the below medication classes. Your primary post should outline arguments both for and against the medication class in BOTH patient cases below. Pro Amphetamine Methylphenidate Alpha Adrenergic Agonist Non-Stimulant Con Amphetamine Methylphenidate Alpha Adrenergic Agonist Non-Stimulant What is the proposed mechanism of action of the medication(s)? Why might this be appropriate for the patients? What are the advantages or disadvantages to your class of medication (options for different administration, length of duration, etc.)? What are the advantages or disadvantages to the other medication options? What possible side effects or considerations need to be evaluated? Provide one example for each consideration—legal, ethical, and social implications—for prescribing the medication category. Patient 1: Malcolm is a 9-year-old male in the 4th grade at the public elementary school. Malcolm has recently been diagnosed with ADHD, combined presentation. Malcolm struggles with being fidgety and hyperactive; he often gets into trouble at school for blurting out answers, getting out of his desk when he should not be, and hitting other children when upset. Malcolm also has a hard time focusing on anything other than video games at home. His parents report homework takes “all night” though it should only take 30 minutes. Malcolm has assigned chores but often gets distracted. For example, Malcolm was to take out the trash but got distracted in the driveway while taking out the trash and left the full bag in the driveway. He often misplaces the combination code for the lock on the house door. Patient 2: Jessica is a 32-year-old female that was recently diagnosed with ADHD. She was referred to your office by the psychologist that completed the ADHD assessment. Jessica has always struggled in school and jobs. She is often “written up” at her job for not completing tasks that are assigned to her. She becomes easily distracted by her other co-workers. She finds herself spending a lot of time conversing with colleagues. Her colleagues are frequently annoyed with her for constantly talking to them and interrupting their work and tasks. Jessica is here to discuss medication options to treat ADHD.

Paper For Above instruction

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning across multiple settings. Pharmacological treatment is a cornerstone in managing ADHD, with various medication classes offering different mechanisms of action, benefits, and side effect profiles. This paper explores two primary medication classes: stimulant medications—specifically amphetamines and methylphenidate—and non-stimulant medications—such as alpha-2 adrenergic agonists. The discussion examines their mechanisms, appropriateness for the given patients, advantages and disadvantages, side effects, and broader implications relating to legal, ethical, and social considerations.

Stimulant Medications: Amphetamines and Methylphenidate

Stimulant medications, including amphetamines and methylphenidate, are the first-line treatment for ADHD due to their rapid onset of action and proven efficacy in reducing core symptoms. Their proposed mechanism involves increasing the availability of monoamines—dopamine and norepinephrine—in the synaptic cleft, thereby enhancing neuronal communication in prefrontal cortex regions responsible for attention and impulse control (Arnsten & Pliszka, 2011). Amphetamines such as dextroamphetamine promote the release of dopamine and norepinephrine from presynaptic neurons and inhibit reuptake, while methylphenidate primarily blocks the reuptake transporters, increasing synaptic concentrations.

For Malcolm, who exhibits hyperactivity, impulsivity, and distractibility, stimulants like methylphenidate or amphetamines could be highly effective in improving focus, reducing hyperactivity, and controlling impulsive behaviors. They are appropriate because of their rapid onset and well-established efficacy in children. Conversely, for Jessica, stimulants can help enhance her attention span and task completion at work but may also present challenges, including side effects or misuse risks.

Advantages and Disadvantages of Stimulants

The advantages of stimulants include their high efficacy, rapid symptom control, and flexible dosing options, including immediate-release and extended-release formulations, allowing for tailored treatment. Their duration varies from several hours to all-day coverage, supporting different daily routines (Faraone et al., 2015). However, disadvantages encompass potential side effects such as insomnia, decreased appetite, weight loss, increased heart rate and blood pressure, and the rare risk of psychosis or cardiovascular events (Castells et al., 2012).

Non-Stimulant Medications: Alpha-2 Adrenergic Agonists

Non-stimulant options like alpha-2 adrenergic agonists—including guanfacine and clonidine—act on presynaptic adrenergic receptors to decrease sympathetic outflow, which can result in sedation and improved impulse control (Scahill et al., 2016). Their mechanism indirectly enhances prefrontal cortex function and reduces hyperactivity. These medications are often considered when stimulants are ineffective or contraindicated, especially in children with comorbid tics or sleep disturbances.

Advantages and Disadvantages of Non-Stimulants

The advantages include a lower risk of abuse and adverse cardiovascular effects, with smoother symptom control over long periods. They may also improve comorbid conditions like tics or sleep issues. Disadvantages include a slower onset of action, usually days to weeks, and side effects such as sedation, hypotension, and fatigue (Scahill et al., 2016). The dosing flexibility is limited compared to stimulants, and titration may need careful management.

Side Effects and Considerations

For stimulants, side effects such as appetite suppression, sleep disturbances, and potential cardiovascular effects warrant regular monitoring. Ethical considerations include ensuring informed consent, especially in pediatric cases where parental approval is necessary, and avoiding misuse or diversion of stimulant medications. Social implications involve concerns about stimulant misuse among adolescents and adults for performance enhancement or recreational use (Wilens & Spencer, 2019).

Non-stimulants require monitoring for sedation, hypotension, and potential impacts on sleep patterns. Ethical considerations include prescribing practices that account for patient safety and informed consent about the slower onset of efficacy. Social implications involve reducing stigma around medication use for ADHD and addressing disparities in access to care.

Application to Patients

In Malcolm’s case, stimulants would likely offer rapid behavioral improvements, crucial for school success and social functioning. Given his age and behavioral profile, methylphenidate could be prescribed initially, with close monitoring for side effects and efficacy. For Jessica, a non-stimulant like guanfacine might be more suitable if she has a history of anxiety or sleep issues, or if there are concerns about potential misuse of stimulants. Alternatively, a stimulant could be considered if immediate symptom relief is prioritized and there is appropriate oversight.

Legal, Ethical, and Social Implications

Legally, prescribing controlled substances like stimulants requires careful documentation and adherence to regulations to prevent misuse and diversion (Davis et al., 2018). Ethically, clinicians must ensure informed consent, especially for children, balancing the benefits of symptom control with potential risks. Socially, there is ongoing debate about overprescription vs. undertreatment of ADHD, impacting stigma, access, and perceptions of medication use (Biederman & Faraone, 2005). Addressing these considerations involves comprehensive patient and family education, vigilant monitoring, and advocating for equitable healthcare practices.

Conclusion

Both stimulant and non-stimulant medications play vital roles in managing ADHD, with specific advantages and disadvantages pertinent to individual patient profiles. Tailoring treatment to patient needs involves considering the mechanism of action, side effect profiles, and broader implications to optimize outcomes and minimize risks. An integrated approach combining pharmacotherapy with behavioral interventions remains critical for effective ADHD management.

References

• Arnsten, A. F., & Pliszka, S. (2011). Catecholamine influences on prefrontal cortical networks. Biological Psychiatry, 69(12), e89–e99.
• Biederman, J., & Faraone, S. V. (2005). The nature and heritability of attention deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities Research Reviews, 11(3), 162–171.
• Castells, X., et al. (2012). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and meta-analysis. CNS Drugs, 26(3), 199–214.
• Davis, N. O., et al. (2018). Regulatory considerations for prescribing controlled substances in ADHD management. Journal of Substance Abuse Treatment, 90, 44–50.
• Faraone, S. V., et al. (2015). Efficacy of methylphenidate and amphetamines for ADHD: a meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 54(12), 980–993.
• Scahill, L., et al. (2016). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 55(2), 180–189.
• Wilens, T. E., & Spencer, T. J. (2019). Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder. Pediatrics, 144(4), e20192769.