neurocognitive medications
Read a selection of your colleagues’ posts. Focus specifically on those colleagues who were assigned your same medication but opposite stance.
Respond to at least two of your colleagues on 2 different days who were assigned your same medication but an opposite stance. For example, if you were assigned the con stance for amphetamine, you should respond to two students who were assigned the pro stance for amphetamine. Support or expand on your original argument to refute their claims. Work to share additional perspectives on the issue described by your colleague.
Linette’s Post:
Patient #1 Malcom is a 9-year-old male diagnosed with combined ADHD. It is important that he receives the most appropriate medication so that he can achieve adequate symptom control and can have a productive life both at home and at school. Studies have shown a higher level of support for the use of stimulant medication as opposed to non-stimulant medication for treating ADHD among elementary school aged children (Wolraich et al., 2019). Amphetamines such as Dextroamphetamine are medications classified as stimulants that act as a full agonist of the trace amine-associated receptor 1 (TAAR1). Once activated, the reuptake of dopamine and norepinephrine is inhibited resulting in increased availability in the presynaptic cleft improving imbalances and reducing ADHD symptoms (Abbas et al., 2023).
While it is still unclear as to what the exact cause of ADHD is, it is believed that there are imbalances of dopamine and norepinephrine, neurotransmitters that work simultaneously with various receptors in the brain and help regulate emotions, as well as help to control the ability to pay attention, think, and behave. Dextroamphetamine inhibits the reuptake of dopamine and norepinephrine creating a surplus and more balanced brain chemistry resulting in symptom relief (Kessi et al., 2022). Side effects to be considered include increased blood pressure, insomnia, decreased appetite, and nervousness. Regular monitoring of these side effects and appropriate adjustments must be made to prevent unnecessary harm to the patient.
Some advantages of dextroamphetamine include that they have years of proven effectiveness, are available in a variety of forms including once-daily extended-release chewable tablets which gives the benefit of symptom relief throughout the day, as well as capsules that can be opened and sprinkled, and liquid formulations which are helpful for those patients that have trouble with swallowing pills (Abbas et al., 2023). A disadvantage is that there are the risks of tolerance, dependence, and addiction. These risks can be controlled if close monitoring of the medication is conducted to ensure that it is taken as prescribed.
The counterpart to amphetamines stimulants is nonstimulants such as clonidine. Non-stimulants such as clonidine take a considerable amount of time to take effect which makes it more difficult when deciding if the medication is going to be effective or not, they cause decreased heart rate and blood pressure, and they are considered less effective in most people when compared to stimulants. An advantage is that these medications have a lower risk of abuse and dependence.
When prescribing medication such as dextroamphetamine, close attention must be paid to the laws governing legality of the prescription. This would include patient rights, inform consent, and treatment of a minor in the healthcare system. Ethical considerations include doing good for the patient in deciding on the appropriate medication by allowing for input of the patient and parent. Social considerations include the fact that ADHD has many social challenges which include relationships with family, friends, as well as teachers. If these challenges become overwhelming, they will need to be addressed, and possible referrals can be made if necessary to assist with ongoing relationship challenges.
Patent #2 Jessica, a 32-year-old female recently diagnosed with ADHD. Alpha adrenergic agonists used to treat ADHD such as clonidine and guanfacine mechanism of action involves activation of post synaptic alpha 2 receptors located in the prefrontal cortex of the brain which results in the increased concentration of norepinephrine in the synaptic cleft. This results in increased neurotransmission leading to increased control of attention, behavior, and thoughts by the prefrontal cortex (Mechler et al., 2022). Alpha adrenergic agonists such as clonidine and guanfacine are good for the patient because they bring about a chemical balance in the brain by causing an increase in norepinephrine in the brain which results in an environment that allows for the brain to better control concentration, thoughts, and behaviors and thus reduce or eliminate ADHD symptoms. Side effects that must be considered include decreased heart rate, decreased blood pressure, irritability, sedation, and insomnia. These side effects must be monitored closely and adjustments made if necessary.
Advantages of alpha-adrenergic agonists include that they have little to no potential for abuse. Disadvantages include reduced heart rate and blood pressure requiring close monitoring, they are considered less effective in comparison to stimulant medication, and they have an extended amount of time to reach their effectiveness.
Other medication options such as Methylphenidate/Stimulants have the disadvantage of an increased risk of abuse and addiction. An advantage of methylphenidate/stimulants such as Ritalin is that they have an extensive history of their effectiveness and are the first line treatment option.
Legal considerations would be to ensure that the chosen medication has been approved by the FDA and that it has been approved legally to treat the specific patient population. Ethical considerations would be ensuring informed consent and making sure that benefits outweigh the risks when determining which medication to use. Social considerations would be to ensure that the medication is having a positive effect on the outcomes of the patient and results in the patient having the ability to have a productive life at home, in school, and on the job.
References
Abbas, K., Barnhardt, E. W., Nash, P. L., Streng, M., & Coury, D. L. (2024). A review of amphetamine extended release once-daily options for the management of attention-deficit hyperactivity disorder. Expert Review of Neurotherapeutics, 24(4), 421–432.
Kessi, M., Duan, H., Xiong, J., Chen, B., He, F., Yang, L., Ma, Y., Bamgbade, O. A., Peng, J., & Yin, F. (2022). Attention-deficit/hyperactive disorder updates. Frontiers in Molecular Neuroscience, 15, 925049.
Mechler, K., Banaschewski, T., Hohmann, S. & Häge, A. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology and Therapeutics, 230, 107940.
Shoar, N. S., Marwaha R, & Molla M. (2025). Dextroamphetamine-Amphetamine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
to an external site.
Wolraich, M.L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D. & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.
Pediatrics, 144(4):e20192528.
Ransford’s Post:
ADHD medication options: ADHD stands out as a neurodevelopmental condition marking a person through troubles with paying attention and losing self-control while feeling too active. Pharmacological treatments work as the main methods to control ADHD symptoms in patients (Vasiliadis et al., 2025). This discussion evaluates how amphetamine stimulants and non-stimulant drugs treat ADHD symptoms in nine-year-old Malcolm and thirty-two-year-old Jessica.
Medication Option 1: Amphetamine Stimulants: Amphetamine stimulants, including Adderall, help the brain produce more dopamine and norepinephrine. These brain signals control attention and executive abilities, so amphetamine stimulants work best for people with ADHD. Amphetamine stimulants function as highly effective drugs to treat ADHD based on scientific research (Sharafi et al., 2024). Research supports the straightforward ways these medications improve attention focus, impulse management, and task accomplishment. The medications exist in two design formats, both short-acting and long-acting versions, to match patient requirements. The drugs start working quickly within thirty to sixty minutes, which makes them perfect for controlling symptoms during an active school or work schedule.
Amphetamine stimulants come with essential disadvantages. Pills typically trigger sleeplessness and hunger loss and speed up your heart while making you anxious. Bad cardiovascular health problems occur at higher levels of amphetamine use. People need increased medication strength with time to reach the same effect when they take amphetamines. Using them long-term creates fatigue, depression, and irritability when you stop.
The medication will help Malcolm and Jessica concentrate better at school and work by reducing unwanted movement and creating better focus. Amphetamines might help Jessica perform better at work, enabling her to concentrate and meet her project deadlines (Vasiliadis et al., 2025). Prescribing amphetamines requires awareness of multiple legal, ethical, and social factors. The rule of amphetamines as controlled substances means healthcare providers must watch for misuse and illegal sales. PMHNP should always get correct consent from young patients parent before starting any treatment. Social views about stimulant medications discourage many adult patients from pursuing proper medical treatment, including Jessica.
Medication Option 2: Non-Stimulant Medications: Atomoxetine, under the brand name Strattera, helps ADHD patients by slowing norepinephrine reabsorption, which enhances focus and impulse control without impacting dopamine as stimulants do. Since non-stimulants do not create controlled substances, they present less risk of drug abuse for patients (Sharafi et al., 2024). People at risk of drug misuse should select non-stimulant medications because these options help keep them safe from possible substance abuse. Patients receive twenty-four hours of continuous symptom relief from these medications as they stay active in their bodies for one day. The medications prove especially useful in treating people who have anxiety-related health concerns or tic disorders because these conditions often worsen during stimulant treatment.
Aside from their uses, non-stimulants bring specific issues. These medications take more time to work since they differ from stimulants, which produce effects within one hour. People taking non-stimulants often feel sleepy plus tired while experiencing nausea and hunger loss, plus their heart rates and blood pressure might increase. The power of non-stimulant medications to treat ADHD symptoms is lower than what stimulants can achieve.
When treating Malcolm, PMHNP will prescribe non-stimulants instead of stimulants because of his family history of drug misuse and problems managing anxiety with stimulants. Jessica would benefit from a non-stimulant since it matches her preferences for a safer medication choice (Idrees et al., 2023). PMHNP find non-stimulant prescriptions simpler to implement and monitor than stimulant medicines. They offer people who do not want or cannot endure stimulant medications another possible treatment option. Socially, people tend to see non-stimulants as safer medicines, helping to lessen public attitudes about ADHD treatments.
I would argue that
Amphetamine stimulants and non-stimulant drugs present different strengths and disadvantages for ADHD treatment. Although amphetamines offer fast symptom relief, they trigger addiction risks and adverse effects for patients. (Idrees et al., 2023). Patients benefit from non-stimulants because these medications have lower abuse risks, although they need more time before producing effects. The specific treatment approach works better for Malcolm since amphetamines help his overactive behavior, whereas Jessica needs a non-stimulant medication. Each patient requires a specialization-based plan to discover the best treatment.
References
Idrees, I., Bellato, A., Cortese, S., & Groom, M. J. (2023). The effects of stimulant and non-stimulant medications on the autonomic nervous system (ANS) functioning in people with ADHD: A systematic review and meta-analysis.
Neuroscience & Biobehavioral Reviews,
144, 104968.
Sharafi, H., Bakouni, H., McAnulty, C., Drouin, S., Coronado‐Montoya, S., Bahremand, A., … & Jutras‐Aswad, D. (2024). Prescription psychostimulants for the treatment of amphetamine‐type stimulant use disorder: a systematic review and meta‐analysis of randomized placebo‐controlled trials.
Addiction,
119(2), 211-224.
Vasiliadis, H. M., Rochette, L., Massamba, V., Lesage, A., Rahme, E., Gignac, M., … & Lunghi, C. (2025). Association between stimulant and non-stimulant ADHD medications and completed suicide in adolescents and adults: A population-based nested case-control study.
Psychiatry Research,
344, 116309.
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Olivia’s Post
I have chosen two medication classes: Amphetamine-Amphetamine and Methylphenidate-Methylphenidate. Below, I have provided pro and con arguments for these medication classes in the context of the two patient cases provided.
Patient 1: Malcolm (9-year-old male with ADHD, combined presentation)
Amphetamine-Amphetamine
Pros:
Mechanism of action: Amphetamines work by increasing the levels of dopamine and norepinephrine in the brain, this improves focus, attention, and impulse control. This mechanism may be particularly beneficial for Malcolm, who struggles with fidgeting, hyperactivity, and focusing on tasks.
Advantages: Amphetamines have a longer duration of action compared to methylphenidate, which can be helpful for Malcolm, who struggles with homework and chores taking up a significant amount of time in the evenings.
Side effects: The most common side effects include decreased appetite, sleep disturbances, and headaches. However, these side effects are generally manageable and less frequent than those associated with methylphenidate.
Legal implications: Classified as Schedule II controlled substance, which means they have a high potential for abuse and dependence. Prescribing amphetamines to Malcolm would require careful monitoring and documentation by his parents, teachers, and physician to ensure proper usage and prevent diversion.
Cons:
Ethical implications: The long-term effects of amphetamine use in children are not well understood. Prescribing amphetamines to Malcolm could raise ethical concerns about the potential risks and benefits of long-term use.
Social implications: Stigma surrounding the use of stimulant medications for ADHD may impact Malcolm’s social interactions and self-perception. It is essential to educate Malcolm and his family about the benefits and potential side effects of amphetamines to help any negative social implications.
Methylphenidate-Methylphenidate
Pros:
Mechanism of action: Methylphenidate works by blocking the reuptake of dopamine and norepinephrine, increasing availability in the brain and improving focus, attention, and impulse control. This mechanism may be helpful for Malcolm’s symptoms.
Advantages: Methylphenidate has a shorter duration of action compared to amphetamines, which may be beneficial for Malcolm, as it allows for a more precise titration of the medication’s effects throughout the day, while at school and activities. Generally methylphenidate is prescribed for younger children (Cramer et. al, 2002).
Side effects: The most common side effects of methylphenidate include decreased appetite, sleep disturbances, and stomachaches. These side effects are generally manageable but may be more frequent and severe compared to amphetamines.
Legal implications: Methylphenidate is also a Schedule II controlled substance, requiring careful monitoring and documentation to ensure proper usage.
Cons:
Ethical implications: Similar to amphetamines, the long-term effects of methylphenidate use in children are not well understood, raising ethical concerns about potential risks and benefits.
Social implications: Stigma surrounding stimulant medication use for ADHD may also affect Malcolm’s social interactions and self-perception. It is crucial to educate Malcolm and his family about the benefits and potential side effects of methylphenidate to help with any negative social implications.
Patient 2: Jessica (32-year-old female with ADHD)
Amphetamine-Amphetamine
Pros:
Mechanism of action: Amphetamines can help improve focus, attention, and impulse control, which may be beneficial for Jessica’s difficulties at work and with colleagues (Winterstein et. al, 2009).
Advantages: Amphetamines have a longer duration of action, which can be helpful for Jessica, who needs full coverage throughout her workday.
Side effects: The most common side effects of amphetamines include decreased appetite, sleep disturbances, and headaches. These side effects are generally manageable and less frequent than those associated with methylphenidate.
Legal implications: A Schedule II controlled substance, prescribing amphetamines to Jessica would require careful monitoring and documentation to ensure proper usage.
Cons:
Ethical implications: The long-term effects of amphetamine use in adults are not well understood, raising ethical concerns about potential risks, addiction, and benefits.
Social implications: Stigma surrounding stimulant medication use for ADHD may impact Jessica’s professional and personal relationships. It is essential to educate Jessica about the benefits and potential side effects of amphetamines to help with negative social implications.
Methylphenidate-Methylphenidate
Pros:
Mechanism of action: Methylphenidate can help improve focus, attention, and impulse control, which may be beneficial for Jessica’s difficulties at work and with colleagues.
Advantages: Methylphenidate has a shorter duration of action, which may be beneficial for Jessica, as it allows for a more precise titration of the medication’s effects throughout her workday.
Side effects: The most common side effects of methylphenidate include decreased appetite, sleep disturbances, and stomachaches. These side effects are generally manageable but may be more frequent and severe compared to amphetamines.
Legal implications: Methylphenidate is also a Schedule II controlled substance, requiring careful monitoring and documentation to ensure proper usage.
Cons:
Ethical implications: Similar to amphetamines, the long-term effects of methylphenidate use in adults are not well understood, raising ethical concerns about potential risks and benefits. Careful explanation and education on the medication for Jessica to fully understand the risks vs. benefits.
Social implications: Stigma surrounding stimulant medication use for ADHD may also affect Jessica’s professional and personal relationships. It is crucial to educate Jessica about the benefits and potential side effects of methylphenidate.
In conclusion, both Amphetamine-Amphetamine and Methylphenidate-Methylphenidate medication classes have their advantages and disadvantages for Malcolm and Jessica. It is important to consider the mechanism of action, advantages, disadvantages, potential side effects, and legal, ethical, and social implications when selecting the most appropriate medication for each patient. A thorough understanding of the patient’s needs, preferences, and medical history will assist in guiding the decision-making process and ensure the best possible outcome for both patients.
Cramer K, Miller A, Page J, Hartling L, Crumley E, Klassen TP. Is methylphenidate effective in reducing symptoms of attention deficit hyperactivity disorder in school-aged children? Paediatr Child Health. 2002 Dec;7(10):689-92. doi: 10.1093/pch/7.10.689. PMID: 20046450; PMCID: PMC2796530.
Faraone SV. The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev. 2018 Apr;87:255-270. doi: 10.1016/j.neubiorev.2018.02.001. Epub 2018 Feb 8. PMID: 29428394; PMCID: PMC8063758.
Winterstein AG, Gerhard T, Shuster J, Saidi A. Cardiac safety of methylphenidate versus amphetamine salts in the treatment of ADHD. Pediatrics. 2009 Jul;124(1):e75-80. doi: 10.1542/peds.2008-3138. PMID: 19564272; PMCID: PMC3856396.
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