NURS 6630 Week 6 Discussion: Patient Case Scenario Debate Example

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NURS 6630 Week 6 Discussion: Patient Case Scenario Debate Example

Amphetamines are CNS stimulants that inhibit MAO neurotransmitters Martin & Le, 2023). This is appropriate because Malcolm has been diagnosed with ADHD and CNS stimulants help to improve alertness, attention so he can focus, along with helping him control his impulses. In school Malcolm has a problem with sitting still, staying focus, and problems with self-control. The mechanism of action of amphetamines can help manage Malcolm’s symptoms and are suitable for his age.

Amphetamines come in various administration forms such as liquid, and tablet immediate and extended-release form. These various options allow for different ways to prescribe. Since Malcolm is nine years old, he may not feel comfortable to swallow a pill so liquid form could be used. Extended release can help if Malcolm needs medication gradually over time. Amphetamines can come in different medication options. For short acting you have Adderall, Dexedrine, and Dextrostat. For long acting you have Adderall XR, Dexedrine, and Vyvanse.

Disadvantages of Malcolm taking amphetamines are that Malcolm may have to take multiple doses a day. Since majority of Malcolm’s symptoms are during school hours he may have to take medication during school time. This means that Malcolm will have to be interrupted during class time and come to the nurse’s office to take his medication. Malcolm’s parents will be responsible for having to ensure that he has medications at home and school. Amphetamines are a scheduled ll controlled substance which means he will only get enough for a month supply, so there is no room for error (Common ADHD Medications & Treatments for Children, 2025). He will be required to meet with his physician monthly to get his prescription renewed. Side effects of Amphetamines consist of loss of appetite, fatigue, insomnia, aggression, hypertension, tachycardia (Adderall XR, Mydayis Amphetamine/Dextroamphetamine) Dosing, Indications, Interactions, Adverse Effects, and More., 2025). Amphetamines are known high abuse drugs that can cause psychosis, and acute psychiatric disturbances (Martin & Le, 2023). Amphetamines can cause an increase in dopamine natural stimuli. Overstimulation can occur and sometimes dose changes are needed before you find the correct amount needed. Malcolm could become tired and need naps during the day from the effects of the medication.

Other treatments could be tried before starting Malcolm on medications. In the scenario it does not state if other nonpharmacologic strategies were tried. Malcolm could be started on an individualized education plan (IEP) that could be catered to him to accommodate his needs. Being placed in a smaller class with two teachers who are specialized in different ways of teaching and managing Malcolm’s behaviors could be helpful. Teaching his parents how to eliminate distractions and keep Malcolm on track could help with homework. Malcolm may need redirection with handling chores. Sports could help burn off some of his energy. A structured environment and regular routine could be beneficial. Behavioral therapy could help manage ADHD.

References

Adderall XR, Mydayis amphetamine/dextroamphetamine) dosing, indications, interactions, adverse effects, and more. (2025). https://reference.medscape.com/drug/adderall-mydayis-amphetamine-dextroamphetamine-342997#0.

Common ADHD Medications & Treatments for children. (2025). HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Determining-ADHD-Medication-Treatments.aspx.

Martin, D., & Le, J. K. (2023, July 31). Amphetamine. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK556103/#:~:text=Go%20to%3A-,Mechanism%20of%20Action,through%20a%20variety%20of%20mechanisms.

NURS 6630 Week 6 Discussion: Patient Case Scenario Debate Example 2

Patient Case Scenario Debate

Choosing a suitable drug for a patient requires a comprehensive assessment of its effectiveness, safety, and associated hazards (Azad, 2021). This discussion focuses on two pharmacological agents, amphetamines and atomoxetine, presenting arguments both in favor of and against both in the context of treating particular patient instances. A 42-year-old woman aiming to discontinue alprazolam and a 24-year-old pregnant woman with a generalized anxiety disorder will undergo evaluation. This paper will substantiate the rationale for the selected position, evaluating the advantages and disadvantages of these treatments while considering the legal, ethical, and societal factors that influence prescription practices.

Mechanism of Action and Appropriateness

Atomoxetine is a selective norepinephrine reuptake inhibitor that elevates norepinephrine concentrations in the prefrontal cortex, enhancing attention, impulse regulation, and executive function. This is a feasible alternative for the 42-year-old woman reducing her alprazolam use since it offers cognitive advantages without the addiction risks associated with benzodiazepines. Amphetamines augment dopamine and norepinephrine release, enhancing concentration and vitality (Suarez et al., 2024). Amphetamines may effectively address attention-related disorders; nevertheless, their administration in a 24-year-old pregnant woman is concerning owing to probable teratogenic consequences and heightened risk of fetal problems, making non-stimulants a more prudent option.

Advantages/Disadvantages of Chosen Medication Classes

Atomoxetine is offered in a once-daily dosage, enhancing adherence. It does not possess the addiction risk associated with stimulants, making it a safer option for the 42-year-old female moving off benzodiazepines. Nevertheless, it takes many weeks, which may not be optimal for fast symptom alleviation. Amphetamines provide rapid effectiveness and are offered in both immediate and extended-release formulations, providing versatility (Di Giacomo et al., 2024). Nonetheless, their significant potential for abuse, cardiovascular risks, and contraindications during pregnancy render them inappropriate for the 24-year-old female, requiring alternative therapeutic choices that emphasize the safety of both mother and fetus.

Advantages/Disadvantages of Other Medication Options

Non-stimulants such as atomoxetine provide long-term safety without the danger of addiction but need patience owing to their slow start of efficacy. Conversely, stimulants like amphetamines and methylphenidate provide rapid symptom alleviation but carry hazards of addiction, cardiovascular complications, and fetal safety issues throughout gestation (Rose et al., 2020). Atomoxetine is very beneficial for persons reducing benzodiazepine use, such as the 42-year-old female, but amphetamines should be employed with caution, if at all, during pregnancy. Alternative non-stimulant treatments, such as guanfacine, may provide more choices for pregnant patients without the hazards associated with stimulants.

Side Effects and Considerations

Atomoxetine may induce xerostomia, insomnia, and tachycardia, necessitating monitoring, particularly in those with cardiovascular disorders (Azad, 2021). Amphetamines, however, may induce hypertension, tachycardia, reduced appetite, and increased anxiety, rendering them potentially detrimental for those with pre-existing anxiety disorders. The 24-year-old pregnant patient’s amphetamine usage raises concerns about fetal growth restriction, neonatal withdrawal, and long-term neurological consequences. These dangers need a thorough assessment of alternative drugs that may control symptoms effectively without jeopardizing fetal health.

Legal, Ethical, and Social Considerations

Atomoxetine prescription is not subject to the same legal limitations as amphetamines since it is classified as a non-controlled drug. It is ethically imperative to ensure that the 42-year-old female comprehends the delayed start of the condition to establish appropriate treatment expectations. Amphetamines, designated as Schedule II prohibited drugs, need rigorous oversight owing to their propensity for misuse (Rose et al., 2020). Ethical dilemmas emerge about its use during pregnancy, as the provider must evaluate the advantages against any risks to the fetus. Stimulant drugs may entail social stigma, especially among pregnant women, which may affect adherence and perceptions of therapy. These elements must be carefully evaluated while formulating a suitable treatment strategy.

Conclusion

Selecting between atomoxetine and amphetamines necessitates weighing effectiveness, safety, and individual patient factors. For the 42-year-old female reducing her alprazolam dosage, atomoxetine offers a non-addictive option that enhances cognitive function. However, the beginning of the action has been delayed. Amphetamines should be addressed with care in a 24-year-old pregnant woman owing to potential fetal dangers. Prioritizing patient safety, mitigating possible adverse effects, and complying with ethical prescription standards are crucial in identifying the most appropriate treatment strategy. Continuous observation and personalized treatment are essential for attaining the best patient outcomes.

References

Azad, D. O. A. (2021). Atomoxetine. In Springer eBooks (pp. 362–363). https://doi.org/10.1007/978-3-319-91280-6_1363

Di Giacomo, E., Confalonieri, V., Tofani, F., & Clerici, M. (2024). Methylphenidate and atomoxetine in pregnancy and possible adverse fetal outcomes. JAMA Network Open, 7(11), e2443648. https://doi.org/10.1001/jamanetworkopen.2024.43648.

Rose, S. J., Hathcock, M. A., White, W. M., Borowski, K., & Rivera-Chiauzzi, E. Y. (2020). Amphetamine–Dextroamphetamine and pregnancy: Neonatal outcomes after prenatal prescription mixed amphetamine exposure. Journal of Attention Disorders, 25(9), 1295–1301. https://doi.org/10.1177/1087054719896857.

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