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Peer feedback
Dear writer could you please commend my peer on what she did right and contribute to her discussion post with scholarly reference not more than five years old.
Diagnosis: (F90.2) Attention-Deficit/Hyperactivity Disorder, Combined Presentation.
Selected drug: Lisdexamfetamine (Vyvanse)
Medication class: Dopamine/ norepinephrine reuptake inhibitor & releaser (DN-RIRe). Mechanism of action: Lisdexamfetamine is a prodrug of dextroamphetamine and thus is not active until after it has been absorbed by the intestinal tract & is converted to dextroamphetamine (active component) & L-lysine. Enhances dopamine & norepinephrine in certain brain regions (dorsolateral prefrontal cortex) may improve executive functioning, attention, concentration & wakefulness. Enhances dopamine in other brain regions (basal ganglia) may improve hyperactivity. Enhancement of dopamine & norepinephrine & sleepiness.
Prescriiption:
Date issued: 06/15/2022
Pt name: Doe, John, DOB: 99/99/2016
Lisdexamfetamine 30mg capsule, PO, daily
SIG: take one tablet by mouth daily in morning
Dispense 30 (thirty) capsules
No refills
Signature: Keith Hartley
DEA prescriber # CH 9999999
Lisdexamfetamine (Vyvanse) is the medication I would prescribe John Doe. Lisdexamfetamine is a norepinephrine/ dopamine reuptake inhibitor and releaser. Vyvanse is a stimulant FDA approved for the treatment of attention deficit hyperactivity disorder (ADHD) in patients as young as 6 years. Vyvanse has a 10-hour to 12-hour clinical duration. The length of time for clinical duration allows for once-a-day administration. According to Tan and King (2022) managing drug therapies for children with ADHD can be incredibly taxing. Stimulant therapy for ADHD requires dopamine receptors to become occupied at the correct speed and duration of time. The optimal percentage of dopamine receptor occupation must also be maintained. If too few dopamine receptors are occupied there will be no clinical effect. If too many dopamine receptors are occupied there will be more adverse effects and potential for abuse. The child may have a dose of medication due during school or when a parent is not present. There is also less risk for insomnia if a once daily dose in provided in the morning.
Vyvanse has two other properties which make it a good choice for 6year old John Doe. The capsule form of Vyvanse allows it to be opened and dissolved in water. Administering the medication as a liquid can be easier for parents with a resistant child. Stahl states, “Eliminating evening doses at school reduces non- compliance, storage issues, and professional supervision” (pg. 418). Lisdexamfetamine is inactive until it is metabolized into dextroamphetamine (active ingredient) and l- lysine. Vyvanse’s metabolization process reduces the likelihood of abuse associated with most stimulants.
Test: Family history and physical assessment for cardiac disease; monitor height & weight, & blood pressure throughout treatment. Recommendation for ECG in children controversial.
Teaching points: *Patient maybe given drug holiday over the summer to reassess therapeutic efficacy. *Do not divide a single dose capsule. *Do not stop this medication without professional supervision, may cause withdrawals and severe depression.
References
Stahl, S. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
Tan, D., & King, T. (2022). Finding the “sweet spot”: sharing the decision-making in ADHD treatment selection. Annals of General Psychiatry, 21(1), 14–14. https://doi.org/10.1186/s12991-022-00394-2
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