ANSWER
Discussion Task: Assessment of ADHD Medication Classes
Certain Classes of Medication
Amphetamines: Benefits and Drawbacks
Alpha Adrenergic Agonists: Benefits and Drawbacks
Patient 1: Malcolm, a male 9-year-old
1. Amphetamines
Action Mechanism:
By preventing reuptake and promoting release, amphetamines (like Adderall) raise the amount of dopamine and norepinephrine available in the brain. In ADHD, this process lessens impulsive and hyperactivity while increasing focus.
Advantages:
Suitable for Malcolm: The main symptoms of ADHD, including impulsivity, hyperactivity, and inattention, can be effectively treated with amphetamines.
Benefits:
Malcolm can see progress during school hours thanks to the quick start of action.
Dosing flexibility is offered by several formulations, including immediate-release and extended-release.
high rates of effectiveness in kids with ADHD.
Cons:
Cons: Because immediate-release formulations have a short half-life, they may need to be taken several times a day, which might make adherence difficult.
Insomnia, appetite suppression, irritability, and an increase in emotional outbursts are possible adverse effects.
Things to think about:
Legal: Schedule II controlled substances, amphetamines need to be closely watched for possible abuse.
Ethical: Prescribers have to weigh the possible risks of reliance against the necessity to control symptoms.
Social: Malcolm’s peer interactions and self-esteem may be impacted by the stigma associated with children using stimulants.
2. Agonists of Alpha Adrenergic
Mechanism of Action: By regulating postsynaptic alpha-2 adrenergic receptors, alpha adrenergic agonists (such as guanfacine and clonidine) enhance emotional control and lessen impulsivity and hyperactivity in the prefrontal cortex.
Advantages:
Suitable for Malcolm: Children with ADHD who exhibit violent behaviors, emotional dysregulation, or concomitant anxiety benefit most from these drugs.
Benefits:
Sleep problems can be alleviated by sedative effects.
A non-stimulant profile lowers the possibility of reliance or abuse.
can improve symptom control when used as an adjuvant with stimulants.
Cons:
One drawback is that it acts more slowly than stimulants.
less successful at enhancing attention than methylphenidate or amphetamines.
Fatigue, hypotension, and sedation are among the adverse effects.
Things to think about:
Legal: Requires monitoring for off-label use but has a lower regulatory burden than stimulants.
Ethical: Might not improve academic achievement as well as stimulants, which could impede Malcolm’s growth.
Social: Malcolm’s energy levels and engagement in physical activities may be impacted by increased sedation.
Patient number two: Jessica, a 32-year-old woman
1. The Way Amphetamines Work:
As previously mentioned, amphetamines increase dopamine and norepinephrine levels in the brain, which enhance focus and decrease distractibility.
Advantages:
Suitable for Jessica: Her inattentiveness and distractibility can be addressed with amphetamines, which will enhance her effectiveness at work and lessen social conflict.
Benefits:
Immediate symptom relief makes it easier to concentrate and finish tasks at work.
Because long-acting formulations offer coverage throughout the day, lunchtime dose is not as necessary.
Cons:
Cons: Jessica’s everyday life may be disrupted by side effects include appetite suppression, irritability, and insomnia.
Adults are more likely than children to become dependent.
Monitoring is necessary for any potential cardiovascular consequences, such as elevated blood pressure.
Things to think about:
Legal: Due to their Schedule II status, amphetamines require meticulous paperwork and regular monitoring.
Ethical: Providers need to assess Jessica’s risk of abuse or distraction from social pressures or work-related stress.
Social: Jessica might be deterred from taking her medicine as prescribed by the stigma associated with treating adult ADHD.
2. Agonists of Alpha Adrenergic
Mechanism of Action: As previously mentioned, these drugs work by altering the prefrontal brain to lessen hyperactivity and enhance emotional control.
Advantages:
Suitable for Jessica: Alpha adrenergic agonists can be a good choice if Jessica has severe emotional dysregulation or sleep issues.
Benefits:
less likely to get dependent than stimulants.
can lessen signs of stress like hyperarousal or anxiety.
may help with sleep, which is a typical problem for adults with ADHD.
Cons:
Cons: Limited effectiveness in treating Jessica’s primary ADHD symptoms, which include distractibility and inattention.
Work performance may be hampered by side effects like sedation and hypotension.
Things to think about:
Legal: It is easier to prescribe because there aren’t any major legal constraints.
Ethical: Jessica’s professional life may suffer if she decides to use this drug since it may cause her symptoms to worsen.
Social: Frustration may result from decreased efficacy, especially in a high-pressure job setting.
Comparing the Criteria for Medication ClassesAlpha Adrenergic Agonists and Amphetamines
EffectivenessExcellent for impulsivity and attentionModerately effective; better for hyperactivity and emotional dysregulation
Beginning of ActionQuick onsetdelayed onset
Adverse Reactionsirritability, appetite suppression, and insomniaFatigue, hypotension, and sedation
Reliance DangerHigh (substance on Schedule II)Minimal Population AdequacyPerfect for adults and children who need effective symptom managementBetter for adults or kids who have emotional and sleep issues
In conclusion
Although they provide quick and efficient symptom relief, amphetamines have the potential to cause dependence and adverse effects. Alpha adrenergic agonists are a safer alternative for treating emotional control and sleep disorders, even though they are less effective for the main symptoms of ADHD. Legal, ethical, and societal ramifications must be taken into account while choosing a medicine, along with patient preferences, possible hazards, and symptom control.
QUESTION
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 oneexample 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