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NURS 6630C Discussion Foundational Neuroscience Walden University

NURS 6630C Discussion Foundational Neuroscience Walden University

Week 2 Discussion

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.

When creating a treatment plan for a psych patient, the provider needs to have information about the agonist and antagonist spectrum and how it affects psychopharmacology drugs. Psychopharmacology drugs works to help change a person’s behavior and their way of thinking. Psychoactive drugs can either increase activity at the synapse (agonist) or can decrease activity at the synapse (antagonist). The function of the agonist is to bind to a receptor and activate the receptor to produce a physiologic effect

(Barron, 2021). Antagonists block the effects of endogenous neurotransmitters and oppose normal synaptic transmission. Partial agonist acts directly on receptors but if used in the presence of an agonist, they compete for the receptor and can have partial blocking properties. For example, aripirazole is a partial agonist and dopamine is a full agonist. When an aripirazole is taken, it will occupy brain receptors and in brain regions where dopamine is high, it will partially block the effects of dopamine leading to an antipsychotic effect (Nutt & Lingford-Hughes, 2007).

Compare and contrast the actions of g couple proteins and ion gated channels.

Ion channeled receptors binds to a ligand and opens a channel that allows for a rapid response in the post-synaptic response whereas the g protein binds to a ligand and activates a membrane called a g protein which interacts with the ion channel or an enzyme in the membrane. Unlike ion channeled receptors which have a rapid post-synaptic response, the g protein coupled mediators have a slow post-synaptic response (Bountless Biology n.d.).

Explain how the role of epigenetics may contribute to pharmacologic action.

Epigenetics is the study of how behaviors and environmental changes affect the way genes work. Epigenetic changes are reversible and do not change the DNA sequence but can change how the body reads a DNA sequence (Centers for Disease Control and Prevention, 2020). Epigenetics in drug agents includes drug metabolism and transport in the body which changes to the phenotype instead of a genotype. Interactions with noncoding RNA’s contribute to protein expression and thereby modulate drug action (Cascorbi & Schwabi, 2016). NURS 6630C Discussion Foundational Neuroscience

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.

NURS 6630C Discussion Foundational Neuroscience Walden University

NURS 6630C Discussion Foundational Neuroscience Walden University

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Having knowledge of this information is important because it will help the providers to determine which drug will be effective in treating whatever condition the patient presents with. Especially with starting a new drug like psychotropics. The provider needs to weight the risk of adverse reactions over the benefits before starting the drug. For example, clozapine is a drug used to treat schizophrenia can cause agranulocytosis therefore bloodwork needs to be done regularly to monitor white blood cell count. The drug can also cause seizures, heart and breathing problems therefore close monitoring will need to be done. Antidepressants also poses a risk to benefit as most children and adolescent who take them will have suicidal thoughts and behavior. The providers will need to carefully assess all the patient’s history before giving them any kind of medication (Ghoshal, 2019). NURS 6630C Discussion Foundational Neuroscience

References for NURS 6630C Discussion Foundational Neuroscience Walden University

Barron, S. (2021). Psychopharmacology. Psychology. Retrieved from http://noba.to/umx6f2t8

Boundless Biology. (n.d.). Signaling Molecules and Cellular Receptors. Retrieved from https://courses.lumenlearning.com/boundless-biology/chapter/signaling-molecules-and-cellular-receptors/

Cascorbi, I., & Schwab, M. (2016). Epigenetics in drug response. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27061003/

Centers for Disease Control and Prevention. (2020). What is Epigenetics? Retrieved from https://www.cdc.gov/genomics/disease/epigenetics.htm

Ghoshal, M. (2016). What Is a Psychotropic Drug? Retrieved from https://www.healthline.com/health/what-is-a-psychotropic-drug

Nutt, D., & Lingford-Hughes, A. (2007). Key concepts in psychopharmacology. Retrieved from http://www.med.monash.edu.au/assets/docs/scs/psychiatry/psychopharmacology/nutt-pharmacodynamics-2007.pdf

RE: Week 2 Discussion Psychopharmacology

Hi Prof…

An example of epigenetics is the DNA methylation which is the addition of a methyl group or a chemical cap to part of the DNA molecule and this will prevent certain genes from being expressed ( Rettner, 2013). According to Kinoshita et al., 2017 a study was done to patients who were being treated with clozapine for schizophrenia and the study showed that changes in DNA methylation was observed after the treatment with clozapine. The genes were enriched for the cell substrate adhesion which is essential for cells to interact with their environments and cell matrix adhesion which is essential for cell migration, tissue organization and differentiation.

Reference for NURS 6630C Discussion Foundational Neuroscience Walden University

Kinoshita, M., Numata, S., Tajima, A., Yamamori, H., Yasuda, Y., Fujimoto, M., Watanabe, S., Umehara, H., Shimodera, S., Nakazawa, T., Kikuchi, M., Nakaya, A., Hashimoto, H., Imoto, I., Hashimoto, R., & Ohmori, T. (2017). Effect of Clozapine on DNA Methylation in Peripheral Leukocytes from Patients with Treatment-Resistant Schizophrenia. International journal of molecular sciences18(3), 632. https://doi.org/10.3390/ijms18030632

Rettner, R. (2013). Epigenetics: Definition & Exampleshttps://www.livescience.com/37703-epigenetics.html#:~:text=One%20example%20of%20an%20epigenetic,proteins%20that%20DNA%20wraps%20around.

RE: Week 2 Discussion Psychopharmacology

Hi there, your post was well organized. I want to add a few things to your post. First, the fourth main group on the agonist spectrum is an inverse agonist. Inverse agonists can take signal transduction below the baseline instead of antagonists, which block any outside changes while signal transduction remains at its current state. Literature suggests that antagonists are relatively rare, and many drugs previously categorized as antagonists are truly inverse agonists (Berg & Clarke, 2018). Second, you made excellent points about important considerations when prescribing. However, there are specific considerations related to the agonist spectrum and epigenetics. For example, if a PMHNP is trying to help treat anxiety, agonists would be a good choice, as they would maximize a neurotransmitter dedicated to reducing anxiety. An inverse agonist would increase anxiety, and a partial agonist would weakly impact anxiety (Stahl, 2013). NURS 6630C Discussion Foundational Neuroscience

Berg, K. A., & Clarke, W. P. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. The international journal of neuropsychopharmacology21(10), 962–977. https://doi.org/10.1093/ijnp/pyy071.

Stahl, S. M. (2013). Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (4th ed.). Cambridge University Press.

RE: Week 2 Discussion Psychopharmacology

Hi Beryl, wonderful post indeed! You are correct that the creation of a treatment plan of a patient should always involve the consideration of the present information about antagonists and agonists, and how they affect the psychopharmacology of drugs. The primary difference between g coupled proteins and the ion gated proteins is that the ion gated channels have platforms in which they can initiate post synaptic response through allowing entry of ions (Berg & Clarke, 2018). I like how you will use this information in improving the treatment of patients. For me, I believe this information is crucial for providers as it helps them to understand the reasons why patients experience some of the uncommon side effects and how they should work to correct the necessary processes (Weir, 2020). Also, I believe information on epigenetics and pharmacology can help in both the diagnosis of patient diseases and the administration of relevant drugs that the patients need.

References for NURS 6630C Discussion Foundational Neuroscience Walden University

Berg, K. A., & Clarke, W. P. (2018). Making sense of pharmacology: inverse agonism and           functional selectivity. International Journal of Neuropsychopharmacology21(10),  962-977. https://doi.org/10.1093/ijnp/pyy071

Weir, C. J. (2020). Ion channels, receptors, agonists and antagonists. Anaesthesia & Intensive      Care Medicine21(1), 62-68. https://doi.org/10.1016/j.mpaic.2019.10.022

Discussion: Foundational Neuroscience

Week 2: Neurotransmitters and Receptor Theory

Receptors and neurotransmitters are like a lock-and-key system. Just as it takes the right key to open a specific lock, it takes the right neurotransmitter to bind to a specific receptor. Not surprisingly, as it concerns psychopharmacology, the pharmacotherapeutics that are prescribed must trigger the release of certain neurotransmitters that bind to the correct receptors in order to elicit a favorable response for the patient. The mechanism of this binding and the response that follows reflects receptor theory and lies at the foundation of pharmacology.

This week, you will continue your examination of neuroanatomy and neuroscience as you engage with you colleagues in a NURS 6630C Discussion Foundational Neuroscience Walden University. You will also explore the potential impacts of foundational neuroscience on the prescription of pharmacotherapeutics.

Learning Objectives for NURS 6630C Discussion Foundational Neuroscience Walden University

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 for NURS 6630C Discussion Foundational Neuroscience Walden University

Required Readings (click to expand/reduce)

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.

Required Media (click to expand/reduce)

The University of British Columbia. (n. d.). Neuroanatomy videos. http://neuroanatomy.ca/videos.html

Note: Please review all of the media under the neuroanatomy series.

Optional Resources (click to expand/reduce)

Pathopharmacology: Disorders of the Nervous System: Exploring the Human Brain

Dr. Norbert 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. (15m)

Introduction to Advanced Pharmacology

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. (6m)


Discussion: Foundational Neuroscience

As a psychiatric 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.

Photo Credit: Getty Images/Cultura RF

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.

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.

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 “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

What’s Coming Up in Week 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will explore medication adherence and strategies to help overcome non-adherence to pharmacotherapeutics. You will also complete a Quiz that addresses the content covered throughout this module.

Next Week

Week 3

Discussion – Week 2
  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.

Agonist agents are chemicals that stimulate a reaction by binding to a target site made explicitly for that chemical. If the site or chemical is incorrect, the two cannot bind and will not elicit another reaction. An antagonist is also a chemical that binds to a specific location, but instead of producing a reaction, it blocks an agonist chemical that would then elicit a reaction. Both antagonist and agonist can create an excitatory or inhibitory response depending on the desired effect. Partial agonists induce less than the full response when they occupy the receptor. An example of a partial agonist would be buprenorphine, which binds to the opioid receptor site but only elicits a partial effect (Whelan, P. J., et al.,2012). The benefits of buprenorphine partial effects, versus. Methadone that creates a full effect does not produce the same euphoria and respiratory effect as methadone. This partial effect can help with misuse, side effects, and the eventual withdrawal of the medication. An inverse agonist will cause the exact opposite reaction as the usual chemical messenger for that site (Camprodon, J. A., et al., 2016). Beta-blockers and antihistamines are examples of inverse agonists. Beta-blockers, like carvedilol, not only block an increase in heart rate and blood pressure, they can also lower heart rate and blood pressure (Khilnani, G., et al., 2011).

  1. Compare and contrast the actions of g couple proteins and ion gated channels.

Ion gated channels are the primary neurotransmitter site locations on the pre and post-synaptic sites that open ion channels to elicit the next neuron to receive a signal. A Gated ion channel creates a rapid membrane potential creating fast neuron activity (Camprodon, J. A., et al., 2016).  G-protein-coupled receptors (GPCRs) are a slower secondary neurotransmitter site, triggers a multi-enzyme cascade. When they receive a specific neurotransmitter, the GPCRs, located on plasma membranes, release Alpha, Beta, or Gamma subunits into the cell membrane to be converted into new chemical reactions or signals that either create or inhibit a response (Camprodon, J. A., et al., 2016).

3. Explain how the role of epigenetics may contribute to pharmacologic action.

Epigenetic differences have been shown to change a pharmacological reaction that an individual may have versus someone with a different gene expression. DNA methylation is an excellent example of how these differences can occur. The methylation of DNA is responsible for multiple processes. Gene expression, imprinting, chromatin organization, and X-chromosome inactivation are examples (Rasool, M., et al., 2018). Methylation can affect how medications work on cells by decreasing or increasing their effectiveness and metabolizing too quickly or slowly. DNA tests are available for patients to determine their responses to drugs.

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 a psychiatric mental health nurse practitioner must be aware of the medication’s action.

A good example of why a mental health nurse practitioner needs to understand the Mechanism of Action (MOA) of medications is with multiple drugs that can create steven Johnson syndrome. Steven Johnson’s syndrome is a medical emergency that can be caused by too much serotonin.  Two examples are Lamictal and selective serotonin reuptake inhibitors (SSRIs). SSRIs block the ion channels that generally pull back the extra serotonin between the pre and post synapse of two neurons. By blocking the reuptake ion channel on the pre-synaptic site, there is more serotonin available for the post-synaptic neuron to receive serotonin through their ion channels. Lamictal, another medication used for an anti-seizure and commonly bipolar disease, is also believed to increase serotonin. Specifically, Lamictal has an increased chance to cause SJS with patients who have recently started taking the medication (Frey et al., 2017). The risk for SJS can also be increased using another medicine that raises serotonin levels. Knowing the mechanism of action and the results of the MOA can help nurse practitioners and their patients stay safe.

 

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.

Frey, N., Jossi, J., Bodmer, M., Bircher, A., Jick, S., Meier, C., & Spoendlin, J. (2017). The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the UK. Journal of Investigative Dermatology. Retrieved 9 September 2021, from https://www.sciencedirect.com/science/article/pii/S0022202X17301768.

Khilnani, G., & Khilnani, A. K. (2011). Inverse agonism and its therapeutic significance. Indian journal of pharmacology43(5), 492–501. https://doi.org/10.4103/0253-7613.84947.

Rasool, M., Malik, A., Naseer, M.I. et al. The role of epigenetics in personalized medicine: challenges and opportunities. BMC Med Genomics 8, S5 (2015). https://doi.org/10.1186/1755-8794-8-S1-S5

Whelan, P. J., & Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of neurosciences in rural practice3(1), 45–50. https://doi.org/10.4103/0976-3147.91934

Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with fewer than two credible references.

(0%) – 30 (30%)

Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.

Main Posting:

Writing

(6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

(5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

(4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

(0%) – 3 (3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

(9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

(8%) – 8 (8%)

Posts main Discussion by due date.

Meets requirements for full participation.

(7%) – 7 (7%)
Posts main Discussion by due date.
(0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

(9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

(8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
(7%) – 7 (7%)
Response is on topic, may have some depth.
(0%) – 6 (6%)
Response may not be on topic, lacks depth.
First Response:
Writing
(6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.

(5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

(4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

(0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:
Timely and full participation
(5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

(4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

(3%) – 3 (3%)
Posts by due date.
(0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
(9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

(8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
(7%) – 7 (7%)
Response is on topic, may have some depth.
(0%) – 6 (6%)
Response may not be on topic, lacks depth.
Second Response:
Writing
(6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.

(5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

(4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

(0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation
(5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

(4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

(3%) – 3 (3%)
Posts by due date.
(0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100
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