NURS 6630 Week 2 Explain the Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents Sample Solution Included

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. 

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.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

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 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! 

NURS 6630 WEEK 4 ASSIGNMENT – ASSESSING AND TREATING VULNERABLE POPULATIONS FOR DEPRESSIVE DISORDERS

TO PREPARE FOR THIS ASSIGNMENT:

  • Review this week’s Learning Resources, including the Medication Resources indicated for this week.
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of vulnerable patient populations requiring antidepressant therapy.

THE ASSIGNMENT: 5 PAGES

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your patient guide, include discussion on the following:

  • Depressive disorder causes and symptoms
  • How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
  • Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
  • Medication considerations of medication examples prescribed (see last bullet item)
  • What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
  • Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
  • Where to follow up in your local community for further information
  • Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. 

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632).

All papers submitted must use this formatting.

LEARNING RESOURCES

Required Readings

Medication Resources

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

  • bupropion
  • citalopram
  • clomipramine
  • desipramine
  • desvenlafaxine
  • doxepin
  • duloxetine
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • imipramine
  • ketamine
  • mirtazapine
  • nortriptyline
  • paroxetine
  • selegiline
  • sertraline
  • trazodone
  • venlafaxine
  • vilazodone
  • vortioxetine

Required Media

Optional Resources

NURS 6630 Week 2 Explain the Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents Example Solution

Neurotransmitters and Receptor Theory

Neurotransmitters mediate the transmission of electrical impulses from one neuron to another. Multiple neurotransmitters are involved in central nervous system function, including amines (catecholamines, acetylcholine, and serotonin), amino acids (GABA, aspartate, and glutamate), peptides (neuropeptide Y), and gases such as nitric oxide (Sheffler et al., 2022). As discussed further, psychopharmacologic medications bind to specific neurotransmitter receptors, either activating (agonistic) or inhibiting (antagonistic).

Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents

Psychopharmacologic agents are useful in the treatment of a variety of psychiatric disorders, including mood disorders, trauma and stressor disorders, behavioral disorders, and psychotic disorders. The drugs exhibit either agonistic or antagonistic activity when acting at the receptor site. Whereas agonists bind to and activate a receptor to produce specific actions, antagonists bind to and block specific actions or responses (Katzung, 2018; Stern et al., 2015). The dopamine hypothesis, for example, is widely accepted in the etiology of schizophrenia. 

Excessive dopaminergic transmission is thought to be responsible for schizophrenic symptoms, and research has found higher levels of dopaminergic receptors in schizophrenic patients (Stahl, 2018). This epiphany is why psychopharmacologic agents that block Dopamine receptors, such as chlorpromazine, are used to treat schizophrenia. In contrast, neurodegenerative disease such as Parkinson’s Disease (PD) has been linked to decreased dopamine levels and receptors, which is why dopamine agonists such as Levodopa are used to treat it.

Partial agonists bind to and activate receptors but have only partial efficacy. Partial agonists exhibit both agonistic and antagonistic actions, such as Buspirone, a partial agonist for 5HTA1 receptors and an antagonist for D2 receptors (Katzung, 2018). As a result, Buspirone can be used as both an anxiolytic and an antidepressant medication. Conversely, inverse agonists bind to receptors to produce effects opposite to those of the agonist (Katzung, 2018). Naltrexone is an example of a partial inverse agonist that is used to treat opioid addiction.

G-coupled Proteins and Ion-gated Channels

G-coupled proteins and Ion-gated chandelles are both cell surface receptors. To release ions, ligand-gated ion channels are controlled by neurotransmitters, whereas G-coupled receptors are entirely dependent on the second messenger system (Miller & Lappin, 2022). Because of the differences in stimulation mechanisms, the receptors take varying amounts of time to activate.

While ligand-gated ion channels are activated in milliseconds, G-coupled protein receptors take seconds (Miller & Lappin, 2022). Furthermore, nicotinic acetylcholine receptors and GABA A receptors are examples of ligand-gated ion channels, whereas G-coupled receptors include muscarinic acetylcholine receptors and adrenoceptors (Katzung, 2018; Miller & Lappin, 2020). Regardless of the differences, receptors are critical in carrying out physiologic functions at the molecular level.

Role of Epigenetics in Pharmacologic Action

Genes play an essential role in the body but so do the behaviors and environment.  Epigenetics is the study of how behavior and environment influence gene expression (CDC, 2022). Unlike genetic changes, epigenetic changes are reversible and alter how the body reads the DNA sequence rather than changing the DNA sequence itself. The epigenetic changes may influence the pharmacology of certain drugs. 

Brain-Derived Neurotrophic Factor (BDNF), for example, promotes neuronal survival and synaptic plasticity and is involved in learning, memory, and neurotransmitter release (Webb et al., 2020). BDNF is expressed differently across brain regions depending on environmental stressors, ushering in the concept of epigenetics. Human studies show that BDNF brain levels decrease in untreated major depressive illness and increase with antidepressant treatment (Webb et al., 2020). As a result, BDNF has emerged as a viable candidate for predicting response to antidepressant therapy.

Significance of the Information

Information regarding the pharmacology of drugs is critical in healthcare. In addition to understanding disease mechanisms, psychiatric mental health nurse practitioners (PMHNP) must be proficient in drug pharmacology knowledge. For example, in the etiology of PD, the PMHNP is aware of the link between the disease and Dopamine. As a result, a PMHNP may decide to prescribe a Dopamine agonist, such as Levodopa, rather than a Dopamine antagonist, which would worsen the symptoms. 

Additionally, the pharmacology of a drug allows PMHNPs to understand the potential side effects of a drug. In the treatment of schizophrenia, for example, 12.5-50 mg of Risperidone may be injected into the deltoid or gluteal muscle every two weeks (McNeil et al., 2022), and a nurse should be aware that it is capable of causing extrapyramidal side effects, so the treatment should be used with caution. The information thus improves the way nurses perform their duties, resulting in better patient outcomes.

Conclusion

It is imperative for a PMHNP to have a concrete background in neuroscience. Understanding the pathophysiology of the disease is important in treating psychiatric patients, but knowledge of the medications used to treat the conditions is far more critical. This enables PMHNPs to practice competently and with full practice authority, even in the absence of a supervising psychiatrist consultant. While foundational neuroscience can be difficult to grasp, interacting with colleagues and patients broadens one’s understanding and alleviates the agony of trying to decipher difficult concepts.

References

CDC. (2022, August 15). What is epigenetics? Centers for Disease Control and Prevention. https://www.cdc.gov/genomics/disease/epigenetics.htm

Katzung, B. G. (2018). Basic & Clinical Pharmacology. Basic & Clinical Pharmacology.

McNeil, S. E., Gibbons, J. R., & Cogburn, M. (2022). Risperidone. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459313/

Miller, E. J., & Lappin, S. L. (2022). Physiology, Cellular Receptor. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554403/

Sheffler, Z. M., Reddy, V., & Pillarisetty, L. S. (2022). Physiology, Neurotransmitters. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539894/

Stahl, S. M. (2018). Beyond the dopamine hypothesis of schizophrenia to three neural networks of psychosis: dopamine, serotonin, and glutamate. CNS Spectrums, 23(3), 187–191. https://doi.org/10.1017/S1092852918001013

Stern, T. A., Fava, M., Wilens, T. E., & Rosenbaum, J. F. (2015). Massachusetts general hospital psychopharmacology and neurotherapeutics. Elsevier Health Sciences.

Webb, L. M., Phillips, K. E., Ho, M. C., Veldic, M., & Blacker, C. J. (2020). The relationship between DNA methylation and antidepressant medications: A systematic review. International Journal of Molecular Sciences, 21(3), 826. https://doi.org/10.3390/ijms21030826

NURS 6630 Week4 Assignment Rubric

CriteriaRatingsPts
This criterion is linked to a Learning Outcome Develop a patient medication guide for treatment of depressive disorders in a vulnerable population you selected.
• Depressive disorder causes and symptoms
• How depression is diagnosed for the vulnerable population of your choice
20 to >17.0 pts Excellent Point range: 90–100
Discussion includes Depressive disorder causes and symptoms; Discussion includes how depression is diagnosed for the chosen vulnerable population. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
17 to >15.0 pts Good Point range: 80–89
Discussion is vague regarding Depressive disorder causes and symptoms; Discussion is vague on how depression is diagnosed for the chosen vulnerable population.
15 to >13.0 pts Fair Point range: 70–79
Discussion is vague regarding Depressive disorder and missing causes and/or symptoms; Discussion is vague on how depression is diagnosed for the chosen vulnerable population.
13 to >0 pts Poor Point range: 0–69
Discussion is inaccurate regarding Depressive disorder and missing causes and/or symptoms; Discussion is missing and/or inaccurate on how depression is diagnosed for the chosen vulnerable population.		20 pts
This criterion is linked to a Learning Outcome
• Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
• Medication considerations of medication examples prescribed
• What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring of medications prescribed
20 to >17.0 pts Excellent Point range: 90–100
Medication treatment options are discussed including risk vs benefits; side effects; FDA approvals for the chosen vulnerable population; Medication considerations of medication examples prescribed; contains discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.
17 to >15.0 pts Good Point range: 80–89
Medication treatment options are briefly discussed and vague regarding risk vs benefits; side effects; FDA approvals for the chosen vulnerable population is vague; vague discussion medication considerations of medication examples prescribed; contains discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.
15 to >13.0 pts Fair Point range: 70–79
Medication treatment options are vague and missing risk vs benefits; side effects; missing discussion of FDA approvals for the chosen vulnerable population; no medication considerations of medication examples prescribed; missing elements of discussing items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.
13 to >0 pts Poor Point range: 0–69
Medication treatment options are inaccurate, vague and/or missing including risk vs benefits; side effects; missing or inaccurate discussion on FDA approvals for the chosen vulnerable population; no medication considerations of medication examples prescribed discussed; contains inaccurate, minimal, or no discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.		20 pts
This criterion is linked to a Learning Outcome
• Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
• Where to follow up in your local community for further information
20 to >17.0 pts Excellent Point range: 90–100
Special Considerations are discussed and specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion includes directions for where to follow up in local community for further information.
17 to >15.0 pts Good Point range: 80–89
Special Considerations are discussed not specific, but general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion includes directions for where to follow up in local community for further information.
15 to >13.0 pts Fair Point range: 70–79
Special Considerations are discussed not specific, but general and missing 1-2 of EACH category and does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion directions for where to follow up in local community for further information are vague.
13 to >0 pts Poor Point range: 0–69
Special Considerations are discussed not specific, is inaccurate and/or general and missing 3+ or more or does not discuss any of EACH category, inaccurate discussion and/or does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion does not include directions for where to follow up in local community for further information.		20 pts
This criterion is linked to a Learning Outcome
• The medication guide discusses why the chosen population is considered vulnerable. The medications guide language is appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables.
15 to >13.0 pts Excellent Point range: 90–100
The medication guide discusses why the chosen population is considered vulnerable. The medications guide language is appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables.
13 to >11.0 pts Good Point range: 80–89
The medication guide is vague in discussion why the chosen population is considered vulnerable. The medications guide language is not consistently appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables.
11 to >9.0 pts Fair Point range: 70–79
The medication guide does not discuss why the chosen population is considered vulnerable. The medications guide language is not consistently appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide has limited appeal with use of graphics/tables.
9 to >0 pts Poor Point range: 0–69
The medication guide does not discuss why the chosen population is considered vulnerable. The medications guide language is not appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is not interesting and appealing in and/or missing use of graphics/tables.		15 pts
This criterion is linked to a Learning Outcome Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.
15 to >13.0 pts Excellent Point range: 90–100
Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.
13 to >11.0 pts Good Point range: 80–89
Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 1-2 elements of the following; date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.
11 to >9.0 pts Fair Point range: 70–79
Provides two examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 3 of the following: date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.
9 to >0 pts Poor Point range: 0–69
Provides one example of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 4+ or is inaccurately written for date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.		15 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 pts Excellent Point range: 90–100
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 to >3.5 pts Good Point range: 80–89
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5 to >3.0 pts Fair Point range: 70–79
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Purpose, introduction, and conclusion of the assignment is vague or off topic.
3 to >0 pts Poor Point range: 0–69
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. … No purpose statement, introduction, or conclusion were provided.		5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources. Paper is limited to 5 pages not including title and reference page.
5 to >4.0 pts Excellent Point range: 90–100
Uses correct grammar, spelling, and punctuation with no errors; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources; Paper is limited to 5 pages not including title and reference page.
4 to >3.5 pts Good Point range: 80–89
Contains a few (one or two) grammar, spelling, and punctuation errors; includes the following: title page and reference page. Only contains 2 scholarly supporting resources outside of course provided resources; Paper is 6 pages not including title and reference page.
3.5 to >3.0 pts Fair Point range: 70–79
Contains several (three or four) grammar, spelling, and punctuation errors; missing one of the following; title page or reference page; only contains 1 scholaraly supporting resources outside of course provided; Paper is 7 pages not including title and reference page resources.
3 to >0 pts Poor Point range: 0–69
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding; missing the following; title page and reference page; contains no scholaraly supporting resources outside of course provided resources; Paper is 8+ pages not including title and reference page.		5 pts
Total Points: 100

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