In Week 5, you were assigned by Faculty to argue either the pro (for) or con (against) for a particular medication

In Week 5, you were assigned by Faculty to argue either the pro (for) or con (against) for a particular medication.  You were also provided information for a patient case study scenario. Week 5 was your opportunity to conduct research for this debate.This week, you will present and defend your assigned stance (pro or con) and specific medication for your patient case study scenario with your peers. Within the debate, you will also share your perspective on why the alternative medication class would not be appropriate for the patient case scenario.

Support your answers with evidence-based, peer-reviewed scholarly literature.

Note: APA style format with citations and references will apply.

As a reminder, these were the assigned medications:

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.

Post your response detailing your argument for the following:

• 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.

Note: Your response needs to be supported by three 3 scholarly peer-reviewed resources located outside of your course learning resources.

Expert Answer and Explanation

Con Position on Methylphenidate for ADHD Treatment

Mechanism of Action and Appropriateness for Patients

Methylphenidate is a central nervous system stimulant that primarily functions by inhibiting the reuptake of dopamine and norepinephrine in the brain. Methylphenidate enhances attention, focus, and impulse control, which are often deficient in individuals with ADHD. While this mechanism can be effective for many patients, it may not be the most appropriate option for everyone (Chamakalayil et al., 2021).

For the case of Malcolm, concerns such as potential side effects, tolerance development, and exacerbation of underlying anxiety or emotional dysregulation should be considered before initiating stimulant therapy. Non-stimulant medications, such as atomoxetine or guanfacine, offer alternative approaches that do not pose the same risks associated with stimulants, particularly in patients with comorbid conditions.

Advantages and Disadvantages of Methylphenidate

One of the primary advantages of methylphenidate is its rapid onset of action, which can provide symptom relief within 30 to 60 minutes of administration. This is beneficial for patients who require immediate improvement in attention and impulse control. Additionally, methylphenidate is available in various formulations, including short-acting, intermediate-acting, and long-acting versions, allowing for tailored dosing schedules to meet individual patient needs (Focalin et al., 2024). The drug’s stimulant properties make it a Schedule II controlled substance, meaning it carries a high risk for misuse, especially in adolescent and adult populations.

Advantages and Disadvantages of Alternative Medications

Non-stimulant medications, such as atomoxetine (a selective norepinephrine reuptake inhibitor) and guanfacine (an alpha-2 adrenergic agonist), provide viable alternatives to methylphenidate (Ilipilla & Arnold, 2024). These medications are not controlled substances, reducing concerns about misuse or dependence. Atomoxetine can take several weeks to reach full therapeutic effect, making it less desirable for patients needing immediate symptom relief (Ilipilla & Arnold, 2024). Guanfacine, while beneficial for impulsivity and hyperactivity, can cause excessive sedation, particularly in younger patients.

Side Effects and Considerations

Methylphenidate is associated with several side effects that must be carefully evaluated before prescribing. Common side effects include appetite suppression, insomnia, increased heart rate, and irritability. In pediatric patients like Malcolm, appetite suppression can be particularly concerning as it may lead to inadequate weight gain or nutritional deficiencies (Focalin et al., 2024). Given these potential risks, a thorough assessment of patient history and comorbid conditions is essential before initiating stimulant therapy.

Legal, Ethical, and Social Considerations

From a legal perspective, prescribing methylphenidate requires adherence to strict regulations due to its classification as a controlled substance. Physicians must follow guidelines regarding prescription monitoring and be vigilant about potential misuse or diversion (Focalin et al., 2024). Ethically, the decision to prescribe stimulants involves weighing the benefits of symptom control against the potential for side effects and long-term dependency.

Physicians must ensure that they are prescribing the medication based on clinical necessity rather than parental or societal pressure for improved academic performance. Socially, the stigma associated with ADHD and stimulant medications can impact a patient’s self-perception and social interactions (Focalin et al., 2024). Malcolm may face labeling or bullying from peers if others become aware of his medication use. Addressing these concerns through education and support is crucial to ensuring a positive outcome for patients receiving ADHD treatment.

In conclusion, while methylphenidate is a well-established treatment for ADHD, its potential for abuse, side effects, and impact on comorbid conditions make it a less desirable option for some patients. Non-stimulant alternatives offer safer long-term use but may require more time to achieve full efficacy. An evaluation of each patient’s needs, medical history, and personal circumstances is necessary to determine the most appropriate treatment plan while considering legal, ethical, and social implications.

References

Chamakalayil, S., Strasser, J., Vogel, M., Brand, S., Walter, M., & Dürsteler, K. M. (2021). Methylphenidate for attention-deficit and hyperactivity disorder in adult patients with substance use disorders: good clinical practice. Frontiers in psychiatry, 11, 540837. https://doi.org/10.3389/fpsyt.2020.540837

Focalin, X. R., Narcolepsy, O., & Nomenclature, N. B. (2024). Methylphenidate (D). Prescriber’s Guide–Children and Adolescents: Stahl’s Essential Psychopharmacology, 353.

Ilipilla, G., & Arnold, L. E. (2024). The role of adrenergic neurotransmitter reuptake inhibitors in the ADHD armamentarium. Expert Opinion on Pharmacotherapy, 25(8), 945-956. https://doi.org/10.1080/14656566.2024.2369197

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