NURS 6630 Discussion Foundational Neuroscience

Sample Answer for NURS 6630 Discussion Foundational Neuroscience Included After Question

Foundational Neuroscience

As a psychiatric and mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, 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.

For this Discussion, review the Learning Resources and reflect on the concepts of foundational neuroscience as they might apply to your role as the psychiatric mental health nurse practitioner in prescribing medications for patients.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

By Day 3 of Week 2

Post a response to each of the following:

1. Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.
2. Compare and contrast the actions of g couple proteins and ion gated channels.
3. Explain how the role of epigenetics may contribute to pharmacologic action.
4. Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

Read a selection of your colleagues’ responses.

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By Day 6 of Week 2

Respond to at least two of your colleagues on two different days 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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

A Sample Answer For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

1. Different drugs have different effects on receptors. An agonist binds to a receptor and produces a full effect, mimicking the

   

   neurotransmitter that usually binds to that receptor. An antagonist binds to receptors and blocks activation from other agonist producing no effect. Examples of a agonist is hydrocodone and a antagonist is Narcan. A partial agonist binds to a receptor and produces a partial effect not a full effect for example tramadol vs hydrocodone. An inverse agonist binds to a receptor and produces the opposite effects as the agonist for example antihistamines. These concepts are very important regarding the efficacy of psychopharmacology treatments, knowing these concepts the mental health nurse practitioner can prescribe medication appropriately and provide better explanation to patients regarding medications.

2. Both g proteins and ion gate channels are postsynaptic receptors located on the dendrites, however G proteins can be located elsewhere on the neurons and can activate ion-gate channels. G proteins have a slower effect than ion gate channels. Ion gate channels can open or close in response to membrane changes
3. Epigenetics may contribute to pharmacologic action by the way a person’s body reacts to a certain drug. Also, it can help mental health providers treat and understand certain mental health issues. “Current mental health epigenetic research supports the adverse psychosocial experiences are associated with mental heath disorders such as schizophrenia, anxiety, depression and addiction. There are also positive epigenetics associations with counseling interventions, including cognitive behavioral therapy mindfulness diet and exercise” (David E. Jones, Feb 26, 2021).
4. All the mechanisms mentioned earlier will impact the way I prescribe medications in mental health. For example, for example a patient that develops addiction to opiate drugs may benefit from a partial agonist in efforts to ween of opiates. Also having knowledge of ones epigenetics can guide me into providing positive treatment options like counseling interventions and medications for patients with mental health issues in an effort to increase the efficacy of psychopharmacology treatments.

 

References NURS 6630 Discussion Foundational Neuroscience

David E. Jones, J. S. (Feb 26, 2021). Mental Health Epigenetics: A Primer With Implications for Counselors. The Professional Counselor, Volume 11 – Issue 1.

A Sample Answer 2 For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

I agree with you that different drugs have unique effects on receptors. Some effects may be detrimental to the users. Therefore, healthcare professionals should examine the effect of their medical substances on receptors before prescription. An agonist binds to a receptor and produces a full effect, mimicking the neurotransmitter that usually binds to that receptor (Michelini et al., 2021). The receptor’s behaviors can also be displayed the way people’s bodies react to various medical prescriptions. G proteins have a slower effect than ion gate channels. Ion gate channels can open or close in response to membrane changes. These changes are important in the treatment and recovery processes. Patient with mental disorders require elaborate treatment process. The procedure may involve use of different medication that have direct impact of the receptors (Arbuckle et al., 2020). However, healthcare professionals ensure that their medication have positive impact on the users’ receptors. All the mechanisms that influences receptor’s behaviors are important in treating patients of mental complications.

References NURS 6630 Discussion Foundational Neuroscience

Arbuckle, M. R., Travis, M. J., Eisen, J., Wang, A., Walker, A. E., Cooper, J. J., … & Ross, D. A. (2020). Transforming psychiatry from the classroom to the clinic: Lessons from the national neuroscience curriculum initiative. Academic Psychiatry, 44(1), 29-36.

Michelini, G., Palumbo, I. M., DeYoung, C. G., Latzman, R. D., & Kotov, R. (2021). Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience. Clinical Psychology Review, 86, 102025. https://doi.org/10.1016/j.cpr.2021.102025

A Sample Answer 3 For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

• Hello Tinesha, you have a great discussion post this week. I like how you have explained what agonist, partial agonist and antagonist are in a simple and easy to understand manner.  Just to add on your submission of the same, it true that an agonist binds to a receptor and produces a full effect, mimicking the neurotransmitter that usually binds to that receptor as they activate specific receptors of the brain thus effecting the complete effect of the drug (Camprodon & Roffman, 2016). On the other hand, I also acknowledge that antagonist binds to receptors and blocks activation from other agonist producing no effect since they are defined as drugs whose degree of receptor activation is reduced compared to full agonists (Camprodon & Roffman, 2016).

To elaborate on the issue ofIon-Gated Channels versus the G-protein coupled receptor, it is true that both the G-protein coupled receptors (GPCRs) and the Ion-Gated Channels (IGCs) are two forms of post-synaptic receptors. Ion-Gated Channels (IGCs) are ligand-gated channels with two domains. One domain is used to bind neurotransmitters on the extracellular side while the other domain acts as the ion channel (Camprodon & Roffman, 2016). On the other hand, the G-protein coupled receptors also known as metabotropic receptors acts through the second messenger systems (Camprodon & Roffman, 2016). And since it relies on a variety of metabolic steps it is much slower compared to IGCs.

Reference NURS 6630 Discussion Foundational Neuroscience

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier.

A Sample Answer 4 For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

Great summary here.  Can you share why we would combine a partial agonist such as Buprenorphine with an antagonist such as Naloxone into a single medication such as Suboxone?  As you are probably aware, oral naloxone has nearly 0% bioavailability when given orally.  If none of the drug is absorbed, why use it in the combination?

Thanks!

This was a great question, I had to do some research but I’m glad I did because I learned something new

“When buprenorphine/naloxone is taken sublingually as prescribed, the naloxone exerts no clinically significant effect, leaving the opioid agonist effects of buprenorphine to predominate. However, when buprenorphine/naloxone is parenterally administered in patients physically dependent on full agonist opioids, the opioid antagonism of naloxone causes withdrawal effects, thus reducing the abuse potential of the drug combination”(Orman JS, 2009). These drugs are given in combination to reduce the misuse of buprenorphine.

NURS 6630 Discussion Foundational Neuroscience Reference

Orman JS, Keating GM. Spotlight on buprenorphine/naloxone in the treatment of opioid dependence. CNS Drugs. 2009 Oct;23(10):899-902. doi: 10.2165/11203740-000000000-00000. PMID: 19739698.

A Sample Answer 5 For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

When answering the first part of the question, my first thought of an agonist/antagonist spectrum was in relation to the opioid epidemic. The agonist is Oxycodone or an illicit opiate (Heroin), and the antagonist is naloxone which is a full antagonist. Suboxone, or buprenorphine, is partial. Naloxone blocks the receptors so they are not able to bind to the opioid. In treating a patient with medication-assisted treatment, opiate addiction treatment may include the use of a partial agonist, Suboxone or Sublacade. Suboxone permits a partial binding mechanism to opioid receptors, therefore decreasing withdrawal symptoms and drug cravings ( Seth, et. al, 2018). With a potent opioid agonist, such as Fentanyl, multiple sequential doses of naloxone may be required. In addition, fentanyl appears to differ from other opioids as having a very rapid onset with high systemic levels found in overdose victims (Moss & Carlo, 2019). The rapid antagonistic response is required by naloxone to out-compete large numbers of opioid receptors occupied by fentanyl in the central nervous system.

Moss, R. & Carlo, D.J. (2019). Higher doses of naloxone are needed in the synthetic opioid era. Subst Abuse Treat Prev Policy 14, 6. https://doi.org/10.1186/s13011-019-0195-4.

• ·
  • Links to an external site.Assessed on December 8, 2022.

Seth P, Rudd RA, Noona RK, & Haegerich TM. (2018). Quantifying the epidemic of prescription opioid overdose deaths. AJPH April. 2018;108(4). Assessed on December 9, 2022.

Hi Tinesha, Great post! Let me add the idea of epigenetics since this is one of my favorite subjects. It’s good to know that an individual’s epigenetic makeup affects how a drug works and the illness they are susceptible. The efficacy of a drug may fluctuate if it acts on a particular gene, yet that gene has a different function. For instance, those with abnormal dopamine synthesis and receptor binding may be more inclined to drug addiction or have some innate tolerance (Saad et al., 2021). This reasoning holds for non-addictive substances and explains why some medications are effective for some people but not others.

 

Reference NURS 6630 Discussion Foundational Neuroscience

Saad, L., Zwiller, J., Kalsbeek, A., & Anglard, P. (2021). Epigenetic Regulation of Circadian Clocks and Its Involvement in Drug Addiction. Genes, 12(8), 1263. MDPI AG. Retrieved from http://dx.doi.org/10.3390/genes12081263

A Sample Answer 6 For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

I am the nurse manager and a drug and rehab facility. Along with the treatment we provide on an outpatient or an inpatient status to our clients, we provide Narcan teaching and kits for our clients upon discharge. As most of our patients are addictd to opioiods, this is a way that they have access for their friends or families to help them if they were to begin using again to help revive them if they were to relapse and overdose again once leaving our facility. Narcan, also known as Nalaxone, is an opioid antagonist. It attaches to the opioid receptors and blocks and reverses the effects of opioids (Naloxone drugfacts, 2022). If given soon after an overdose, it can reverse the effects and potentially save a life. The kits we supply are through a grant funding called Project Dawn and are in the nasal spray form. “Project DAWN programs distribute naloxone and provide training at one or various Project DAWN sites, or locations, to prevent opioid overdose and promote harm reduction” (Ohio.gov, n.d.). These kits are offered to anyone with an opioid use disorder, but we recently had a patient who was there for alcohol abuse. He chose to take the training so he could receive a kit to help any family or friends that may need it so he could help them. Our Project Dawn trainer is phenomenal.

Project Dawn. Project dawn. (n.d.). Retrieved December 9, 2022, from https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/violence-injury-prevention-program/projectdawn/

U.S. Department of Health and Human Services. (2022, August 4). Naloxone drugfacts. National Institutes of Health. Retrieved December 9, 2022, from https://nida.nih.gov/publications/drugfacts/naloxone

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A Sample Answer 7 For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

It is interesting to note how agonist and antagonist medications work in the body. You have mentioned the drug Narcan which is known as an opioid antagonist. This drug is widely used to combat the effects of especially in heroin overdose and is even carried by first responders in their emergency kits. The best painkillers are opioid peptides, which work by binding to membrane receptors to cause their desired effects. After the brain system, the gastrointestinal tract is the location where opioid receptors are highly expressed (Cosola et al., 2006). In the treatment of chronic pain, opiate-mediated analgesia is commonly implemented using morphine and fentanyl. It has been shown that the opioid agonist morphine significantly inhibits both intestinal immune motility and function, responding ability reversing the mu-opioid receptor’s (MOR) modulatory effect on ion channels and second messenger effectors in response to opioid agonists (Cosola et al., 2006) their adverse effects, opioid-induced hyperalgesia, constipation, respiratory depression, and analgesic tolerance, are also associated with their use (Ricarte et al., 2021). In this case, the opioid antagonist naloxone can also be used. Naloxone prevents the considerable inhibition of intestinal motility caused by the opioid agonist morphine, thereby can ease the discomfort from constipation and counteract the adverse effects of these opiates.

References: NURS 6630 Discussion Foundational Neuroscience

Adrián Ricarte, James A. R. Dalton, and Jesús Giraldo (2021).

Structural Assessment of Agonist Efficacy in the μ-Opioid Receptor: Morphine

and Fentanyl Elicit Different Activation Patterns. Journal of Chemical Information

and Modeling 61 (3), 1251-1274. DOI: 10.1021/acs.jcim.0c00890

Cosola, C., Albrizio, M., Guaricci, A. C., De Salvia, M. A., Zarrilli, A., Sciorsci, R. L.,

&   Minoia, R. (2006). Opioid agonist/antagonist effect of naloxone in

modulating rabbit jejunum contractility in vitro. Journal of physiology and

pharmacology: an official journal of the Polish Physiological Society, 57(3),

439–449.

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A Sample Answer 8 For the Assignment: NURS 6630 Discussion Foundational Neuroscience

Title: NURS 6630 Discussion Foundational Neuroscience

Allthough I have been always amazed on how we have used medicines, especially psychotropic meds to induce agonist or antagonist effects to treat multiple psychiatric medications, what really amazes me is how we can use and benefit from epigenetics to treat and control these disoders, and may be prevent this from being passed from a parent to his/her own offsprings (Stahl, 2021). Mountain evidence suggests that epigenetic mechanisms, which induce stable and lasting changes in gene expression in response to environmental events and behavioral experiences, may play a role in the processess that contribute to the pathophysiology of psychiatric disorders (Mahgoub & Monteggia, 2013).

Epigenetics is a process that can change gene expression, without alterations of the DNA sequence and promote stable changes in the Chromatin structure (Stahl, 2021; Maghoub & Monteggia, 2013; Stern, et. al., 2016). A good application of epigenetics in psychiatric disoderders are the following examples:

1. The modification of brain derived  neurotrophic factor  (BDNF) as a potential therapeutic target in antidepressant action as well as in mediating antidepressant response (Mahgoub & Monteggia, 2013)
2. The involvement of BDNF to addiction. Acute administration of cocaine induces release of BDNF in the ventral tegmented area (reward system)
3. Involvement of histone H4 deacetylases in cocaine addiction. Histone play a crucial role in regulating gene activity by inducing modifications in chromatin structure (Mahgoub & Monteggia, 2013)
4. The involvement and modification of DNA methylation within  GABA in schizophrenia. There was a downward regulation of several genes expressed within the GABA neurons (Chen, et. al, as cited in Mahgoub & Monteggia, 2013)

Much emphasis has been placed right now on histone modifications and DNA methylation for using pharmacologic inhibitors in treating multiple disorders. Both histone acetylation and DNA methylation can induce lasting and stable changes in gene expression, and therefore have been implicated in adaptive behaviors and neuronal changes that accompany many psychiatric disorders.

 

References: NURS 6630 Discussion Foundational Neuroscience

Mahgoub, M., & Monteggia, L. (2013). Epigenetics and Psychiatry. https://ncbi.nlm.nih.gov/pmc/articles/PMC3805856

Stahl, S. (2021). Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Approach. 5th ed. Cambridge

Stern, T., et. al (2016). Massachusetts General Hospital Psychopharmacology and Neurotherapeutics. 1st ed. Elsevier

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