Psychopharmacology week 1 discussion

Please respond to corrines post at the bottom in one of the following ways If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective and use the resources as references or I dont get credit

NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology

Graphic representation of the human brain.
Week 1: Introduction to Neuroscience
Modern psychopharmacology is largely the story of chemical neurotransmission. To understand the actions of drugs on the brain, to grasp the impact of diseases on the central nervous system, and to interpret the behavioral consequences of psychiatric medicines, one must be fluent in the language and principles of neurotransmission.

—Dr. Stephen M. Stahl in Stahl’s Essential Psychopharmacology

By using a combination of psychotherapy and medication therapy, psychiatric mental health nurse practitioners are positioned to provide a very unique type of care to clients with psychiatric disorders. To be successful in this role, you must have a strong theoretical foundation in pathophysiology, psychopharmacology, and neuroscience. This foundation will help you assess, diagnose, and treat clients as you relate presenting symptoms to theoretical neuronal functioning.

This week, as you begin to study psychopharmacology, you explore foundational neuroscience. You examine the agonist-to-antagonist spectrum of action of psychopharmacologic agents, compare the actions of g couple proteins to ion gated channels, and consider the role of epigenetics in pharmacologic action.

Note: In previous courses, the term “patient” was used to describe the person receiving medical care. In traditional medicine and nursing, this term is used to describe the person you do something to, and it often refers to a passive recipient of care and services. As you move into the realm of psychiatric mental health, a transition will occur. You will work with individuals who are active participants in their care, and these individuals are generally referred to as “clients” as opposed to “patients.” It is important to note that the term “client” is also favored in other mental health disciplines, such as psychiatry, psychology, and social work.

Photo Credit: [cgtoolbox]/[Vetta]/Getty Images

Discussion: Foundational Neuroscience
As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

Learning Objectives
Students will:
Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents
Compare the actions of g couple proteins to ion gated channels
Analyze the role of epigenetics in pharmacologic action
Analyze the impact of foundational neuroscience on the prescription of medications
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 1, “Chemical Neurotransmission”
Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action”
Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action”
Document: Midterm Exam Study Guide (PDF)

Document: Final Exam Study Guide (PDF)

Required Media
Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes.

Accessible player
Optional Resources
Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain.

Accessible player
Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse

Corrine post

5 hours ago Corinne Wray
Week 1 discussion: Introduction to neuroscience
COLLAPSE
Week 1 discussion: Introduction to neuroscience

Corinne J Wray

NURS6630: Pharmacologic approaches to treatment of psychopathology

Understanding the pharmacokinetics of drugs within the body is crucial to the prescribing practice of advanced practice nurses. Thinking critically through the drug action keeps clients safe from medication harm. The realm of psychopharmacology moves into the realm of the brain and nervous system that requires a more complex understanding. This discussion will explain the actions of psychopharmacologic agents as agonist or antagonist, the control of the passage of drugs into and out of the neurons, the effects of epigenetics on these agents, and prescribing with these considerations in mind.

Agonist-antagonist action of psychopharmacologic agents

Pharmacologic agents with agonist properties are those exogenous substrates that bind to receptors causing a biologic response (Merck, 2018). For this discussion, the exogenous substrates are drugs that affect the neuronal communications. The agonists produce a conformational change in the G-protein receptors that signal the synthesis of a second messenger (Stahl, 2008). A second way that drugs can affect neuronal communication is boosting the levels of a natural full agonist neurotransmitter (Stahl, 2008). A full agonist neuroreceptor occupies all or a fraction of receptors that results in the maximum response. A partial agonist causes lesser response while occupying all receptors.

Sometimes, the action of a full agonist will cause problems. For example, the neurotransmitter dopamine in excess is thought to contribute to agitation, and, in one case, the death of an infant (Greenberg, 1984). In these cases, blocking the action of the neurotransmitter dopamine is desirable and can be accomplished through the use of an antagonist (Stahl, 2008). There are four types of drug antagonism: chemical, physiological, pharmacokinetic, and pharmacologic. Blocking the excess neurotransmitter dopamine with a drug is an example of chemical antagonism. Physiologic antagonism occurs when two drugs have differing actions at the same receptor creating no response (Merck, 2018). Pharmacokinetic antagonism is when one drug suppresses the effects of another through absorption, distribution or rate of elimination. Pharmacologic antagonism occurs when the action of a full or partial agonist is inhibited in the pathway or at the receptor (Merck, 2018). The antagonist drugs create no action but are only inhibitory (Stahl, 2008). This could be likened to a parent seeking to limit a child’s screen time by removing all chargers to the electronics. Theoretically, it does not stop the child’s use of the electronic device, but it does inhibit the length of time for it to be utilized, creating a self-regulating model.

G-couple-proteins vs. ion-gated channels

Neural transduction relies on chemical messengers in a cascade of reactions that Stahl compares to “pony express.” (Stahl, 2008). The G-couple-proteins and ion-gated channels are two of four primary sites of transduction. The G-couple-proteins span the membrane of the neuron seven times, and each span forms around a central core where it binds to a neurotransmitter. Drugs can interact at any of the transmembrane sites (Stahl, 2008). This interaction results in the possibility of numerous reactions. Ion-gated channels are transmembrane openings where the passage of neurotransmitters is gated by the electrical charges of the neurotransmitter. The reaction sites for ion-gated channels are less than G-couple-proteins. Drugs act on ion-channels to make it more or less conducive to the opening (Stahl, 2008). G-couple-proteins and ion-gated channels both rely on the first messenger to be chemical. However, in ion-gated channels, the second messenger the second messenger can be a chemical or a positively charged ion like calcium or sodium.

Epigenetics in pharmacologic action

Epigenetics is the study of how genes are expressed or rather modulated by our inner environment (thoughts, mental, spiritual, and feelings from the ventral tegmental area (VTA) of the brain) as well as the outer environment (Dossey & Keegan, 2013). In epigenetics, there are no changes to the structure of the deoxyribonucleic acid (DNA) of the gene. Rather, it is the complex chemical changes through methylation and deacetylation to the organism that allow the gene to be expressed or repressed. The stress response system (SRS) of the organism can affect gene expression as the body struggles to maintain homeostasis. Dossey and Keegan state that long-term unrelenting stress influences the cardiovascular and gastrointestinal systems and can lead to depression, addiction, accidents from poor concentration, and learning (2013, p. 714). Uncontrolled pain is another area that the brain forms pathways harmful to the organism.

Stahl (2008) describes epigenetics and the process of gene expression in the brain in writing a story. It can be a story with a happy ending or a tale of drug addiction, trauma, and violence. The story unfolds from the beginning of the neural tube in utero (Myslinksi, 2012) as the external environment of maternal nutrition affects the development of a healthy brain. It is later impacted by the experiences that create memories of safety or stress that are stored in the hippocampus, promoting or inhibiting the ability to develop further neural pathways. Pharmacologic agents should be utilized to create feelings of safety and security and allow the client to gain new stored memories for the brain to utilize as resources in the quest for homeostasis. A thorough assessment is completed to rule-out overlooked medical or psychosocial problems that might contribute to anxiety or agitation. Medications are chosen to alleviate symptoms that can affect the brain’s ability to relearn new adaptations to stressors.

Implications for prescribing with example

The understanding that initial events in the “pony express” messenger system occur in less than a second, but the effects on the overall nervous system can last the lifetime of the synapse or neuron shape the considerations for prescribing. The drugs prescribed for disorders of the brain and nervous system carry the potential for lifetime consequences. In addition to complete and thorough health assessments and review of all prescription and over-the-counter medications, proper education of client, family or caregivers about the medication is critical.

A recent example is of a 36-year-old male with a second admission to the local psychiatric hospital. During his first admission, he is given lamotrigine (trade name Lamictal) for bipolar symptoms. Lamotrigine is a voltage-gated channel blocker (ion-gated channel) (Stahl, 2017). His symptoms improved and discharges. A few months later, he readmits, and his previous medication regiment resumes. Later, he develops a 103-degree fever that the medical doctor treated with acetaminophen and antibiotics without physically assessing the client. The fever is refractory, and the client is assessed two days later to have a rash on the palmar surfaces of his hands, lips, and neck. The client is transferred to the community hospital and air-evacuated to a burn unit where he succumbed to Stevens-Johnson Syndrome.

The drug literature for lamotrigine discusses skin rash as a common side effect (Stahl, 2017). However, it also discusses the importance of dosing when a patient stops taking the medication for more than five days (Stahl, 2017). The patient was readmitted without documentation or reports of continued use of lamotrigine and was prescribed the same dosage as his previous discharge. The drug literature states that the dose should be titrated from low doses upon restarting. The importance of dosing is related to the drug concentration and the drug’s potential to exert its effects when there is higher concentration.

In the example, education of the prescriber, caregivers, and patient about the medication might have averted the patient’s death. Though it is not possible to memorize all the side effects and details of the numerous drugs available to treat all human ailments, having an understanding of the mechanism of action forms a basis for general understanding.

References

Dossey, B. M., & Keegan, L. (2013). Holistic nursing: A handbook for practice (6th ed.). Burlington, MA:

Jones & Bartlett Learning.

Greenberg, J. (1984). Infant death tied to dopamine excess. Science News, 126, p. 165.

Laureate Education (Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD:

Laureate Education.

Merck & Co., Inc. (2018). Drug action and pharmacodynamics. Retrieved August 24, 2018 from

https://www.merckvetmanual.com/pharmacology/pharmacology-introduction/drug-action-

and-pharmacodynamics#v3329184

Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved August 27, 2018 from

https://stahlonline-cambridge-

org.ezp.waldenulibrary.org/essential_4th_chapter.jsf?page=chapter2.htm&name=Chapter%202

&title=G-protein-linked%20receptors#c02598-99-526

Stahl, S. M. (2017). Essential psychopharmacology: Prescriber’s guide (6th ed). Cambridge: Cambridge

University Press.

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