Learning Resources (NURS 6630N Week 2: Neurotransmitters and Receptor Theory)

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) NURS 6630N Week 2: Neurotransmitters and Receptor Theory

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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)

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Discussion: Foundational Neuroscience

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. NURS 6630N Week 2: Neurotransmitters and Receptor Theory
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. NURS 6630N Week 2: Neurotransmitters and Receptor Theory

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!

Week 2 Main Post Example Approach

Agonist drugs bind to receptors and mimic them or activate them by increasing their function whereas antagonist drugs prevent receptor activation by blocking their effects. Partial agonists activate at a lower level and can also act as antagonists when used with agonists which is referred to as agonists-antagonists (Rosenthal & Burchum, 2020). For example, the use of a4B2 nicotinic acetylcholine receptor (nAChR) agonists for patients attempting to quit smoking can replace the effects of nicotine by reducing cravings. However, nAChR cannot completely replace high nicotine concentrations produced by smoking.

By co-administering nAChR with nicotine replacement therapy (NRT) an agonist-antagonist response is created which reduces withdrawal symptoms and relapse. This effect can also be achieved with a single drug such as a nACHR partial agonists which has nicotine replacing effects as well as nicotine-blocking effects that cause competition with inhaled nicotine at nAChR binding sites and reduce the effect of smoking (Rollema & Hurst, 2018).  

Inverse agonists produce the opposite effects of agonists such as cannabinoid CB1 which aids in reducing appetite, weight loss, and improving markers of metabolic disorders such as diabetes (McLaughlin et al., 2017). NURS 6630N Week 2: Neurotransmitters and Receptor Theory  NURS 6630N Week 2: Neurotransmitters and Receptor Theory

G-protein-coupled receptors (GPCRs) and ion channels are both neurotransmitter receptors. GPCRs work via second messenger systems which act as on-off switches by converting receptor signals into coordinated effects by altering the function of target proteins. For example, the second messenger glycogen synthase kinase (GSK) medicates therapeutic efficacy of lithium salts in bipolar disorder (Stern et al., 2016, p. 10). Ion channels such as NMDA glutamate cause post synaptic signaling by opening channels for sodium and calcium which cause post-synaptic depolarization, causing the neuron to fire (Stern et al., 2016, p. 10). NURS 6630N Week 2: Neurotransmitters and Receptor Theory

According to Stern et al. (2016) “epigenetics is the idea that gene function may be changed without a specific alteration in the code, and that this change in gene function also may be heritable” (p. 18). Epigenetic mechanisms in patients with schizophrenia, bipolar disorder and major depressive disorders have recently been linked to metabolic syndrome as an adverse effect to treatment with psychotropic medications. Meaning that being on these medications and having these epigenetic mechanisms puts patients at increased risk for obesity and dyslipidemia (Delacrétaz et al., 2019).

This will impact the way that I prescribe medication because a patient who has undergone genetic testing can be better treated for their psychiatric condition. For example, patients with Alzheimer’s disease (AD) can under go gene expression profiles to identify differentially expressed genes. NURS 6630N Week 2: Neurotransmitters and Receptor Theory

This aides in specifically targeting genes in treatment of AD which can narrow down potential therapeutic targets for AD treatment. This can also benefit a patient’s family as they can have genetic testing done to see if they have the genetic risk factors for developing AD. Finding the risk factors early can facilitate early treatment and prolong the patient’s life by slowing the effects of AD (Wang et al., 2020).

References

Delacrétaz, A., Glatard, A., Dubath, C., Gholam-Rezaee, M., Sanchez-Mut, J., Gräff, J., von Gunten, A., Conus, P., & Eap, C. B. (2019). Psychotropic drug-induced genetic-epigenetic modulation of crtc1 gene is associated with early weight gain in a prospective study of psychiatric patients. Clinical Epigenetics, 11(1).  https://doi.org/10.1186/s13148-019-0792-0

McLaughlin, P. J., Jagielo-Miller, J. E., Plyler, E. S., Schutte, K. K., Vemuri, V., & Makriyannis, A. (2017). Differential effects of cannabinoid cb1 inverse agonists and antagonists on impulsivity in male sprague dawley rats: Identification of a possibly clinically relevant vulnerability involving the serotonin 5ht1a receptor. Psychopharmacology, 234(6), 1029–1043. https://doi.org/10.1007/s00213-017-4548-2

Rollema, H., & Hurst, R. S. (2018). The contribution of agonist and antagonist activities of α4β2* nachr ligands to smoking cessation efficacy: A quantitative analysis of literature data. Psychopharmacology, 235(9), 2479–2505. https://doi.org/10.1007/s00213-018-4921-9

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.

Stern, T. A., Fava, M., Wilens, T. E., & F J., Rosenbaum. (2016). Massachusetts General Hospital psychopharmacology and neurotherapeutics (1st ed.). Elsevier.

Wang, M., Wang, S., Li, Y., Cai, G., Cao, M., & Li, L. (2020). Integrated analysis and network pharmacology approaches to explore key genes of xingnaojing for treatment of alzheimer’s disease. Brain and Behavior, 10(6). https://doi.org/10.1002/brb3.1610