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.

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 this link provided.

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.

Accessible player
To prepare for this Discussion:

Review this week’s Learning Resources.
Reflect on concepts of foundational neuroscience.
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!

By Day 3
Post a response to each of the following:

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents.
Compare and contrast the actions of g couple proteins and ion gated channels.
Explain the role of epigenetics in pharmacologic action.
Explain how this information may impact the way you prescribe medications to clients. Include a specific example of a situation or case with a client 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
Respond to two colleagues 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.

Sample Free Essay
Agonist-To-Antagonist: The spectrum of Action of Psychopharmacologic Agents

The agonist spectrum is classified into four main types; agonist, partial agonist, antagonist, and inverse agonist (Stahl, 2013). The role of the antagonist is to block the actions of all elements in the agonist spectrum. In the presence of an agonist, the antagonist blocks all the actions and returns the receptor conformation to the past state when the agonist is not present. The antagonist also blocks the actions generated by the partial agonist. Stahl (2013) explains that partial agonists generate conformational change in the G-protein-linked receptor, which is between the baseline and the full action of the agonist.

G-protein coupled receptors comprise a single polypeptide and offer adequate targets for psychotropic drugs (Zimmer, 2016). The ionotropic receptors bind to neurotransmitters in the membrane-spanning domain to form ion channels. The role of the G-protein coupled receptors is to mediate between the physiological responses’ neurotransmitters, hormones, and environmental stimulants and the agonist spectrum. The process involves opening of the ion-gated channels to allow sodium, calcium, and potassium ions to pass through the membrane when responding to the chemical biding messenger (Li, Wong & Liu, 2015). Similarly, both the G-protein coupled receptors and ion channels interact for neuroprotection and improve cell survival after the occurrence of various ischemic insults. For example, when ion channels interact with G-protein coupled receptors their various actions can be helpful in the treatment of ischemic stroke and other medical conditions associated with neuronal damage (Li et al., 2015).

Epigenetic regulation maintains the phenotypic activity of cells and helps in the treatment of diseases (Lundstorm, 2015). New classes of drugs are currently used to regulate epigenetic mechanisms and manage the disease process in various individuals (Stefanska & MacEwan, 2015). Epigenetic regulation of gene activity is crucial in maintaining the normal phenotypic activity of cells and is helpful in the treatment of cancer and other neurodegenerative diseases. Understanding drug pharmacology and related physiologic states of the body is useful for a psychiatric mental health nurse practitioner and allows for the proper prescription of medication to clients. Information on the role of epigenetics in pharmacological action helps ensure the medications prescribed are beneficial to the clients (Angell & Bolden, 2015). The knowledge of the pharmacological process of drugs is important and can be used by psychiatric-mental health nurse practitioners when treating patients diagnosed with Alzheimer’s disease. For example, A psychiatric mental health nurse practitioner can establish if the medication prescribed will either stop the symptoms or reverse the disease process.

References

Angell, B., & Bolden, G. B. (2015). Decisions in mental health care: Psychiatrists’ accounts for treatment recommendations.8(2), -56.doi:10.1016/j.socscimed.2015.04.029.

Li, S., Wong, A. H. C., & Liu, F. (2015). Ligand-gated ion channel interacting proteins and their role in neuroprotection. 8(125), 2-5.doi:10.33Lundstorm, (2015). What is the potential of epigenetics7(3), 23-242? doi:10.4155/FMC.15.2

Stahl, S. M. (2013). York, NY: Cambridge University Press. Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology.2(11), 2701-2704. doi:10.1111/bph.13136.

Zimmer, L. (2016). Pharmacological agonists for more-targeted CNS radiopharmaceutical9), 80111(0112). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC53-07-80111.pdf.

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