ANSWER
Comparing Drug Classes for Treating ADHD: A Discussion Post
Particular Classes: Non-stimulants and Amphetamines
Malcolm, a 9-year-old kid with ADHD, is the first patient.
Amphetamines
Suggested Action Mechanism:
Amphetamines, like Adderall, improve attention and impulse control by raising dopamine and norepinephrine levels in the brain.
Advantages:
Effectiveness: Research indicates that amphetamines are quite successful in controlling the main symptoms of ADHD, such as impulsivity and hyperactivity.
Fast onset: Amphetamines frequently start to work an hour after being administered, which is important for school-age kids who need to concentrate in class.
Flexibility: Dosing can be adjusted to fit school hours or full-day coverage thanks to the immediate-release (IR) and extended-release (ER) formulations.
Cons:
Possible side effects include irritation, decreased appetite, or insomnia, all of which could make Malcolm’s hyperactivity worse.
Abuse Potential: There is a chance that something will be misused, particularly in older people or households with a history of substance abuse.
Growth Suppression: Children who utilize it for an extended period of time may experience moderate growth delays.
Implications for Law, Ethics, and Society:
Legal: Prescriptions must be closely monitored in accordance with controlled substance legislation.
Ethical: Making sure parents give their informed permission and that risks and benefits are communicated clearly.
Social: The possible stigma associated with young children taking medications, especially stimulants.
Not Stimulants
The suggested mechanism of action is that non-stimulants, such as atomoxetine (Strattera), enhance attention and impulse control by selectively blocking norepinephrine absorption without having an impact on dopamine levels.
Advantages:
Reduced Abuse Risk: Non-stimulants don’t fall within the category of restricted substances.
Constant Coverage: Offer regular symptom management, which is particularly beneficial for kids like Malcolm who struggle with their evening homework.
Milder Side Effects: Frequently chosen for kids who have a history of substance abuse or anxiety.
Cons:
Delayed Onset: Malcolm’s parents, who are hoping for an instant improvement, may become frustrated if it takes two to four weeks to reach full effectiveness.
Not as Good for Hyperactivity: In general, non-stimulants are less effective for severe symptoms of impulsivity or hyperactivity.
Possible adverse effects include mood fluctuations, nausea, and exhaustion.
Implications for Law, Ethics, and Society:
Legal: Less restrictive than stimulants, but still needs thorough proof of medicinal effectiveness.
Ethical: Juggling the child’s need for immediate symptom alleviation with a longer onset.
Social: Possibly lessening stigma since it is seen as a safer or “less harsh” alternative.
Patient 2: Jessica, an ADHD-afflicted 32-year-old woman
Amphetamines
The same as before is the suggested mechanism of action. Dopamine and norepinephrine are raised by amphetamines, which enhance focus and task performance.
Advantages:
High Efficacy: Amphetamines are especially helpful for adults in controlling distractions and maintaining task-oriented focus.
Customized Dosage: Jessica may be able to get all-day coverage using ER formulations, which would lessen her problems with distractions at work.
Better Executive Function: Makes organizing and setting priorities easier.
Cons:
Consequences: Adults juggling work-related stress may have insomnia or elevated heart rate.
Dependency Risk: Given the difficulties at work, Jessica’s advanced age makes her more vulnerable to abuse.
Emotional Sensitivity: Jessica may experience more social difficulties at work as a result of amphetamines’ tendency to increase anxiety.
Implications for Law, Ethics, and Society:
Legal: Keeping an eye out for indications of abuse or distraction.
Ethical: Being open about the dangers of stimulant dependency while preserving Jessica’s right to choose her own course of therapy.
Social: If coworkers learn of Jessica’s ADHD diagnosis or medication use, she can experience stigma at work.
The same as above is the suggested mechanism of action for non-stimulants. Focus is supported by norepinephrine reuptake inhibitors without the dopamine-stimulating effects.
Advantages:
Anxiety-Friendly: If Jessica experiences anxiety as well, atomoxetine is a suitable option.
Less Distracting Peaks/Crashes: Offers stable symptom management, which might be appropriate for Jessica’s requirement for constant concentration at work.
Non-Addictive: Reduces dependency worries, particularly for long-term care.
Cons:
Slower Onset: Jessica can become disheartened if she has to wait weeks for her symptoms to go better.
Side Effects: She may be less productive at work if she is tired or lacks energy.
Lower Potency: Stimulants may be more successful in addressing Jessica’s severe impulsivity and distractibility problems.
Implications for Law, Ethics, and Society:
Legal: Not as restricted in prescription as amphetamines.
Ethical: Managing expectations of delayed onset while acknowledging Jessica’s need for quick relief.
Social: Compared to stimulants, this approach is seen to be safer, although its efficacy may be questioned.
Comparative Analysis and Suggestions
Amphetamines: Better for controlling impulsivity and hyperactivity, especially for Malcolm and Jessica. However, cautious supervision is required due to worries about potential usage and negative consequences.
Non-stimulants: A slower-acting, safer substitute that might help people with a history of substance abuse or concomitant anxiety.
Given Malcolm’s urgent requirement for symptom control at school, a stimulant like amphetamine with careful dose titration is probably best.
Jessica might benefit from an amphetamine trial, but it would need to be closely watched for adverse effects. If anxiety or sensitivity to stimulants becomes a problem, non-stimulants may be a good substitute.
Treatment programs are customized to meet the needs and preferences of each patient thanks to this comprehensive approach.
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.