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Please reply to the 3 posts below whi one paragraph for each and two references for each.
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Patient Case Scenario Debate
The first case is of Malcom, a 9-year-old male patient with a diagnosis of attention deficit hypersensitivity disorder (ADHD), the combined type. He demonstrates ADHD symptoms both in the home and school setting, that meet the diagnostic criteria for is disorder. The second case entails a 32-year-old female patient with a recently diagnosed ADHD, and has sustained problems at her work place that directly result from her symptoms. She presented to have a discussion on her medication management. The management of this disorder may involve either stimulant or non-stimulant medications. Below is a discussion of how methylphenidate, a psychostimulant, works to reduce the symptoms of ADHD, as well as the pros and cons in treating the above two patients.
Mechanism of Action of Methylphenidate
This drug works by modifying the concentration of neurotransmitters in the brain cells. Jaeschke et al. (2021) state that methylphenidate works by reducing the reuptake of neurotransmitters from the synaptic clefts that connects the neurons of the brains of patients with ADHD. By doing so, this drug efficiently manages to raise the density of dopamine neurotransmitter within the spaces between adjacent neurons. patients with ADHD have a significantly altered levels of dopamine and norepinephrine in their brains, which is effectively restored by this drug.
The above discussed mechanism of action of this psycho stimulant explains why it is very effective in the treatment of patients with ADHD. This drug increases the concentration of neurotransmitters, specifically dopamine, within the synaptic clefts which mediates a reduction in the severity of the ADHD symptoms. According to Da Silva et al. (2023), ADHD is associated with a higher concentration of the dopamine transporters, which actively pump out dopamine from the synaptic clefts back into the pre-synaptic neurons. As such, when patients are given methylphenidate, they respond by having an increased level of dopamine and other neurotransmitters in the synaptic clefts, hence modulating the cognitive effects and other high functions such as emotions and memory.
Pros and Cons of Methylphenidate
Methylphenidate has several examples specifically in relation to the treatment of patients with ADHD, such as the one presented in patient 1 scenario. Jaeschke et al. (2021) state that this drug is highly efficacious in reducing the severity of the major symptoms of ADHD, as well as the other symptoms that accompany ADHD cases. Tis drug is also well-tolerated among children and adolescents. There are no reported serious adverse effects that may lead to drug discontinuation.
It also significantly improves the general behavior of the patients. Storebø et al. (2023) state that methylphenidate is associated with improved teacher-rated general behavior of the patients. This applies well to the patient in the assigned scenario, since he had problems at school, getting into trouble with his teachers and peer. It is administered every day in the morning, which allows both parents and teachers to monitor treatment response by the patient. It is a rapidly acting medication, and response is typically recorded within an hour of administration.
The major con associated with this drug is its effect on the gastrointestinal system, especially when used on a long term basis. It makes patients uncomfortable, by reducing the appetite and even leading to gastrointestinal infections, dry mouths and restlessness (Jaeschke et al. 2021). This may be problematic to the patients. The first patient may be affected in that his school activities may be impaired. Patient 2 would also experience problems at her work place.
Pros and Cons of Non-Stimulant- Atomoxetine
Non-stimulant drugs are another option of medications used t treat ADHD. Atomoxetine is an example that has been approved by the FDA to treat patients with ADHD. One of its advantages is that is can be used for patients who fail to achieve significant efficacy when treated with the first line medications such as methylphenidate. Even though there is existing evidence on its efficacy, parents of children with ADHD are often less satisfied with this drug when compared to the outcomes of methylphenidate (Roh & Kim 2021). Unlike methylphenidate, atomoxetine achieves some response after a minimum of one week, hence requires a prolonged duration for efficacy to be realized.
Possible Side Effects of Methylphenidate
The side effects of methylphenidate are only experienced when a patient takes this medication. Jaeschke et al. (2021) state that 20% of patients who use methylphenidate on a long term basis experience a reduced appetite, 15% complain of a dry mouth and another 13% state that they experience palpitations of the heart. Other less common side effects of methylphenidate include infections of the intestinal tract and even restless feeling. Atomoxettine, a non-stimulant, medication whose side effects include dry mouth, headaches, reduced appetite and gastrointestinal upset.
Legal, Ethical and Social Implications
Prescribing atomoxetine and methylphenidate to the patients in the scenarios provided can be associated with legal, ethical and social implications. The ethical framework requires that best outcomes are achieved by avoiding harm to the patients. The 9-year-old patient is a minor, who has no legal capacity to consent to treatment. His guardian should therefore be involved in the multidisciplinary approach for the best outcomes possible. Doing so alleviates possible legal implications in case of adverse side effects. The patient in the second scenario has a history of being dismissed from her employment due to symptoms of ADHD. The social implications of these drugs therefore is that the possible side effects may worsen her interactions with other people. Therefore, close monitoring should be done to adjust the dose to the most tolerable possible.
References
Da Silva, B. S., Grevet, E. H., Silva, L. C., Ramos, J. K., Rovaris, D. L., & Bau, C. H. (2023). An overview on neurobiology and therapeutics of attention-deficit/hyperactivity disorder. Discover Mental Health, 3(1). https://doi.org/10.1007/s44192-022-00030-1Links to an external site.
Jaeschke, R. R., Sujkowska, E., & Sowa-Kućma, M. (2021). Methylphenidate for attention-deficit/hyperactivity disorder in adults: A narrative review. Psychopharmacology, 238(10), 2667-2691. https://doi.org/10.1007/s00213-021-05946-0Links to an external site.
Roh, H., & Kim, B. (2021). A brief replication study comparing stimulants and non-stimulants for attention-deficit/Hyperactivity disorder treatment with a focus on the compliance, efficacy, and satisfaction. Journal of the Korean Academy of Child and Adolescent Psychiatry, 32(1), 10-16. https://doi.org/10.5765/jkacap.200024Links to an external site.
Storebø, O. J., Storm, M. R., Pereira Ribeiro, J., Skoog, M., Groth, C., Callesen, H. E., Schaug, J. P., Darling Rasmussen, P., Huus, C. L., Zwi, M., Kirubakaran, R., Simonsen, E., & Gluud, C. (2023). Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews, 2023(3). https://doi.org/10.1002/14651858.cd009885.pub3Links to an external site.
Reply 2
The use of amphetamine and methylphenidate in the treatment of ADHD has been studied. The mechanism of action for amphetamine as a central nervous system stimulant is through the increase of the amount or levels of serotonin and, to a lesser extent, dopamine levels (Faraone, 2018). The amphetamine is released into the nerve terminal, and this signals the increase of dopamine levels or the feel-good chemical. The mechanism of action for methylphenidate results from inhibiting the reuptake of norepinephrine and dopamine, resulting in increased noradrenergic and dopaminergic activity in the brain’s prefrontal cortex (Faraone, 2018). Both these medications may be appropriate for the patients. In the case of Malcolm, the 9-year-old is hyperactive and unable to focus because of his ADHD. The use of these medications increases central dopamine and norepinephrine activity, which affects attention and executive functions (Faraone, 2018). This will also work in Jessica’s case, as she is always hyperactive and interrupts the work of her colleagues at their workplace.
The use of amphetamine and methylphenidate differs in the length of time that they work in symptom relief and the dosages. One of the pros for the amphetamine is that it controls symptoms with fewer dosages as it lasts in the body longer. The disadvantages of the use of amphetamines are that they are highly addictive, and when used in excessive dosage, it is highly dangerous and might result in death (Goldin, 2023). Another disadvantage is that the use of amphetamines starts working slower after more than thirty minutes. The advantage of methylphenidate is that it starts working faster at bout 20-30 minutes after administration (Goldin, 2023). The disadvantage of the use of methylphenidate is that it lasts in the body for a shorter period, which means higher dosages are needed to control the symptoms. Risks of addiction and overdose exist, like in the use of amphetamine.
The possible side effects of amphetamine include slow growth in children, seizures, blurred vision, serotonin syndrome, decreased appetite, nervousness, and stomach ache (Goldin, 2023). The common side effects of methylphenidate include agitation, nervousness, anxiety, stomach pain, insomnia, nausea, loss of appetite, vomiting, headache, vision problems, numbness, and dizziness (Faraone, 2018). Serious conditions include increased heart rate and blood pressure (Faraone, 2018). Considerations needed in the prescription and administration of these drugs include drug interactions.
Legal, ethical, and social implications for the prescription of these medications are needed. One example of the legal consideration is the need to observe the patient’s rights and ensure monitoring and education. The social considerations needed include considering the affordability of the medication for the patients. Finally, ethically, it is essential to ensure that observing their safety through the medication does not cause harm to the patients through non-maleficence. The prescription should also be done for the benefit of the patient by observing the principle of beneficence (American Academy of Pediatrics. (2019).
References
American Academy of Pediatrics. (2019, October). Clinical practice guidelines for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescentsLinks to an external site.Links to an external site.. Pediatrics, 144(4), Article e20192528. https://doi.org/10.1542/peds.2019-2528Links 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
Goldin, D. S. (2023). Fast facts for psychopharmacology for nurse practitioners. Springer Publishing.
Reply 3
What is the proposed mechanism of action of the medication(s)? Why might this be appropriate for the patients?
Amphetamines and Methylphenidate are two classes of medication that are used to help with the stipulations of the central nervous system. The mechanism of action include inhibiting dopamine and neropinephrine reuptake which results in an increase of this neurotransmitters in the brain. The rationale of this approach is to help with improving ADHD symptoms including hyperactivity, impulsivity and inattention (Goldin, 2023).
What are the advantages or disadvantages to your class of medication (options for different administration, length of duration, etc.)?
The primary advantage of Amphetamines is that it is a long-acting medication with some of its forms lasting up to 12 hours. However, it has disadvantages in terms of its side effects, considering that it results in mood swings, increased blood pressure, increased heart rate, insomnia, and decreased appetite (American Academy of Pediatrics, 2019).
Methylphenidate is also associated with the advantage of the availability of multiple administration options such as immediate release, sustained release, and extended-release. The disadvantages include immediate release forms requiring multiple doses throughout the day and the side effects including loss of appetite, increased heart rate, and insomnia.
What are the advantages or disadvantages of the other medication options?
Non-stimulants are some of the alternative medication options available for the treatment of ADHD. The main advantage is that it is associated with less severe symptoms on the part of the patient, which means that it can generate positive outcomes with limited activity on the health, general well-being, and recovery prospects of the patient. The disadvantage is slow onset, which can take several weeks to generate any positive effect in terms of actualizing the objectives of the healthcare process (Coles et al., 2020).
What possible side effects or considerations need to be evaluated?
The common side effects of Amphetamines and Methylphenidate include decreased appetite, insomnia, nervousness, increased heart rate, and mood swings coupled with an increase in blood pressure (Goldin, 2023).
Provide one example for each consideration—legal, ethical, and social implications—for prescribing the medication category.
Legal considerations when prescribing Amphetamines and Methylphenidate are that they are both addictive as part of schedule II controlled substances. This explains why it is important that strict regulations are followed in the prescription process (Coles et al., 2020).
Ethical considerations when using this medication in the treatment of ADHD require understanding the benefits and challenges associated with the use of these drugs and facilitating quality interventions (Goldin, 2023).
Social considerations include understanding the stigma associated with taking medication for mental health diseases such as ADHD. Education targeting community members on ADHD and its treatment measures is appropriate for mitigating the stigma (Coles et al., 2020).
References
American Academy of Pediatrics. (2019, October). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescentsLinks to an external site.Links to an external site.. Pediatrics, 144(4), Article e20192528. https://doi.org/10.1542/peds.2019-2528
Goldin, D. S. (2023). Fast facts for psychopharmacology for nurse practitioners. Springer Publishing.
Coles, E. K., Pelham, W. E., Fabiano, G. A., Gnagy, E. M., Burrows-MacLean, L., Wymbs, B. T., … & Pelham, W. E. (2020). Randomized trial of first-line behavioral intervention to reduce need for medication in children with ADHD. Journal of Clinical Child & Adolescent Psychology, 49(5), 673-687.
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