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NURS 6630 Week 2 Explain the Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents Example 1

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.

A full agonist induces a conformational change that turns on signal transduction to the full extent. A partial agonist acts, to a lesser extent, somewhat like an agonist. An antagonist brings about a conformational change that stabilizes the receptor in the baseline state, rendering it “silent.” When agonists or partial agonists are present, the antagonist makes the receptor revert to the baseline state, leading to a reversal in their actions. On the other hand, an inverse agonist causes a conformational change that stops all activities, including the baseline actions (Stahl, 2021). The functionality of the inverse and partial agonists may influence the efficacy of psychopharmacologic treatments, as they may produce less or opposite effects when compared with full agonists.

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

G couple proteins (GPCR) are a family of transmembrane receptors that lead to the activation of signaling pathways through the G proteins. The activation of the downstream signaling pathways is brought on by the binding of the ligand to a GPCR that then activates the G protein (Stahl, 2021). On the other hand, the ion-gated channels, transmembrane proteins, allow the passage of ions through the membrane when a ligand binds with a receptor. The binding of a ligand to an ion-gated receptor leads to a conformational change that opens the channels, causing ions to flow through it.

The critical distinction between the g couple proteins and the ion-gated channels is the speed of their action; GPCRs lead to the activation of signaling pathways that only take seconds to minutes to lead to a response, while ion-gated channels take milliseconds to respond. Another distinction is the type of signaling pathway that is activated by each of them. The GPCRs lead to the activation of the intracellular signaling pathways that influence changes in gene expression; on the other hand, the ion-gated channels directly affect membrane potential changes. Despite these differences, ion-gated channels and GPCRs are vital targets for most psychopharmacologic agents. For many drugs to modulate intracellular signaling pathways, they must act on GPCRs, while others work on the ion-gated channels to modulate the excitability of neurons and membrane potential.

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

Epigenetics refers to how gene expression occurs without changes to the underlying DNA sequences. Several factors can influence these changes, such as pharmacologic agents, stress, and environmental exposures (Stahl, 2021). Pharmacologic agents can alter the activity of the enzymes that act on DNA and histones, the proteins that package the DNA to a composite structure, thus influencing epigenetics. For instance, some drugs that add methyl groups to the underlying DNA can cause gene expression changes, while some medications that cause the removal of ethyl groups from the histones can also lead to these changes. Changes in epigenetics can influence some drugs’ pharmacologic actions by altering the genes involved with their mechanism of action (Stahl, 2021). For example, the drugs that target the receptor may alter the expression of the downstream genes of the receptor, causing neuronal function changes. Epigenetics has also been associated with the development of tolerance or dependence on certain 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 psychiatric mental health nurse practitioner must be aware of the medication’s action.

Understanding the agonist-to-antagonist action of the psychopharmacologic agents and the differences between the ion-gated channels and the G couple proteins is essential to help one make informed decisions when attending to patients under these medications. For instance, when taking care of a patient suffering from anxiety, this knowledge can help one to prescribe full agonist medications that cause a maximal response to help reduce the symptoms quickly. On the other hand, if the patient is only experiencing mild symptoms, it may be prudent to prescribe a partial agonist to produce a favorable response to the patient. Understanding epigenetics can help a nurse anticipate certain side effects in specific patients. For example, when looking after a patient with a family history of addiction, this knowledge can help one to be cautious not to prescribe medications that have been established to lead to addiction, such as benzodiazepines and opioids.

One specific instance where the knowledge of the mechanism of action may come in handy is when taking care of a patient diagnosed with depression. Depression is commonly treated with selective serotonin reuptake inhibitors (SSRIs) that work through the blockage of serotonin reuptake, a neurotransmitter responsible for the regulation of mood. However, certain side effects have been associated with their use, such as gain of weight and sexual dysfunction that may be related to changes caused by epigenetics in genes that regulate sexual function and body metabolism. Therefore, a nurse must be aware of these potential side effects and monitor patients closely for any changes in sexual function and weight when taking SSRIs.

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

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press. https://www.cambridge.org/us/universitypress/subjects/medicine/mental-health-psychiatry-and-clinical-psychology/stahls-essential-psychopharmacology-neuroscientific-basis-and-practical-applications-5th-edition?format=PB&isbn=9781108971638#:~:text=%E2%80%98Stahl%E2%80%99s%20Essential%20Psychopharmacology%20is

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

• Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
  • Chapter 6, “Mood Disorders and the Neurotransmitter Networks Norepinephrine and y-Aminobutyric Acid (GABA)” (pp. 244-282)
  • Chapter 7, “Treatments for Mood Disorders: So-Called “Antidepressants” and “Mood Stabilizers” (pp. 283-338)
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

• Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. https://doi.org/10.3928/02793695-20080901-06
• Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05
• Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019).  Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/_Resources/Persistent/45bdffb25befc353c9f61988e82105029504ab85/A.7-Psychopharmacology-2019.1.pdf
• Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
• Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—Revised. Western Psychological Services.
• Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.22171
• Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423.

Medication Resources

• U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

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

• Doc Snipes. (2022, April 13). Major depressive disorders in the DSM 5 TR [Video]. YouTube. https://www.youtube.com/watch?v=q5Npw03I0t8
  Note: The approximate length of this media piece is 59 minutes.
• Psych Hub. (2020, October 5). Social determinants of health [Video]. YouTube. https://www.youtube.com/watch?v=17jeXGbKlTQ
  Note: The approximate length of this media piece is 4 minutes.

Optional Resources

• El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. https://doi.org/10.1007/s00787-014-0558-3
• Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. https://doi.org/10.1111/jpc.12655
• Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. https://doi.org/10.2989/17280583.2014.938497

Also read:

NURS 6630 Week 9 A Young Girl With ADHD

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 Week 3: Concepts in Assessing Medication Adherence and Strategies To Mitigate Non-Adherence

Self Assessment QUIZ

Question 1 0 pts

Introducing adherence in facilitating treatment goals is something that would be necessary in a patient who has previously displayed nonadherence patterns.

Group of answer choices

True

False

Question 2 0 pts

G-protein coupled receptors are targets for several psychiatric medications. Given what we know about these receptors, what is the ultimate result we will see when one of them is activated in a way that would potentiate an action?

Group of answer choices

A. Intracellular activation of second messengers

B. Protein phosphorylation

C. Modification of gene expression

Question 3 0 pts

Which neurotransmitter is considered the major excitatory neurotransmitter?

Group of answer choices

A. Glycine

B. GABA

C. Glutamate

D. Serotonin

Question 4 0 pts

G-protein coupled receptors are examples of what type of effector pathway?

Group of answer choices

A. Slow effector pathways

B. Rapid effector pathways

C. NMDA glutamate receptor pathways

D. Modulated effector pathways

Question 5 0 pts

Of the components of patient-focused interventions to enhance adherence, which component includes the following strategies: adaptive thinking, use of cues, and support?

Group of answer choices

Motivation

Skills

Logistics

Education

Question 6 0 pts

Motivation is a component of patient-focused interventions to enhance adherence. Based on the transtheoretical model, readiness to change can fluctuate across five stages. Which stage is represented by the patient who is aware that a problem exists and, while seriously thinking about overcoming it, has not yet committed to a plan of action?

Group of answer choices

Preparation

Action

Contemplation

Maintenance

Question 7 0 pts

The human brain is subcategorized into four major structures. These structures include the cerebral cortex, brainstem, subcortical structures, and the cerebellum. Of these major categories, which one houses the area of the brain that has been found in some neuropathological studies of patients with schizophrenia to be of smaller size?

Group of answer choices

Cerebral cortex

Brainstem

Subcortical structures

Cerebellum

Question 8 0 pts

Neurotransmitters are defined by four essential characteristics. These are:

Group of answer choices

A. Neurotransmitters are synthesized within presynaptic neurons.

B. Depolarization of a neuron results in the release of a neurotransmitter, which exerts a multitude of actions on the postsynaptic neuron.

C. Their action on postsynaptic neurons can be replicated by administering a drug that mimics the activity of the endogenous neurotransmitter.

D. Their action in the synaptic cleft is terminated by a specific action.

E. A, C, and D only

Question 9 0 pts

Serotonin (5HT) is a neurotransmitter associated with mood, sleep, and psychosis. There are several serotonin receptors all over the human body. A unique aspect of the second generation antipsychotics is their ability to block 5HT2a receptors. What is the effect of this inhibition?

Group of answer choices

A. Stabilizes dopamine concentrations in the CNS

B. Induces anxiety

C. Causes hallucinations

D. Reduces platelet function

Question 10 0 pts

Treatment adherence is affected by several different factors. Clinical factors include mood, anxiety, psychosis, and substance misuse. There are also patient factors such as knowledge, attitude, and beliefs; economic and racial/ethnic disparities, and clinical encounters. A patient who presents hopeless, with decreased energy, and poor concentration is affected by which factor?

Group of answer choices

Substance misuse

Knowledge deficits

Attitude ad belief system

Mood

Question 11 0 pts

A patient arrives in the ED via EMS having a grand mal seizure. The ED physician instructs the RN to give 10 milligrams of Diazepam IV X1 dose STAT. The patient’s seizure breaks within 2 minutes of the Diazepam being administered. The mechanism by which this medication causes rapid resolution of seizure activity is via which receptor type (effector pathway/receptor subtype)?

Group of answer choices

A. Slow effector pathways/G-protein coupled receptor

B. Slow effector pathway/ion channel

C. Rapid effector pathways/G-protein coupled receptor

D. Rapid effector pathway/ion channel

Question 12 0 pts

Neurotransmission is unidirectional insofar as chemical and electrical conduction is concerned within the individual neuron. Of the following descriptions, which best characterizes the order of neurotransmitter/receptor interaction that results in an electrical signal impulse and the release of another neurotransmitter for interaction in the synaptic cleft (signal conduction through a neuron)?

Group of answer choices

Cell body, dendrites, Axon, Axon terminals

Dendrites, Axon, Cell body, Axon, Axon terminals

Dendrites, Cell body, Axon, Axon terminals

Axon terminals, Axon, Cell body, Dendrites

Question 15 0 pts

If a patient admits to taking his medication every other day (instead of daily, as prescribed), a potential concern would be:

Group of answer choices

A. Sufficient understanding or acceptance of the illness

B. Abuse of the medication

C. Expense

D. Is the desired effect recognized at a lower daily dose?

Question 16 0 pts

Receptors trigger one of two effector pathways resulting in changes in neuronal activity. These changes will, ultimately, effect gene expression. Which effector pathway is characterized by ion flux through transmitter-activated channels resulting in an altered membrane potential and neuronal activity?

Group of answer choices

A. Slow effector pathways

B. Modulated effector pathways

C. Rapid effector pathways

D. NMDA glutamate receptor pathways

Question 17 0 pts

Upon blocking a Serotonin reuptake pump, what happens in the synaptic cleft and on the post synaptic cell membrane?

Group of answer choices

A. The result will be an increase in available

NURS 6630 Week 3 Quiz Which Neurotransmitter is Considered the Major Excitatory Neurotransmitter?

NURS 6630 Week 3: Concepts in Assessing Medication Adherence and Strategies To Mitigate Non-Adherence

Question 1

Introducing adherence in facilitating treatment goals is something that would be necessary in a patient who has previously displayed nonadherence patterns.

Group of answer choices

• True
• False

Question 2

G-protein coupled receptors are targets for several psychiatric medications. Given what we know about these receptors, what is the ultimate result we will see when one of them is activated in a way that would potentiate an action?

Group of answer choices

A. Intracellular activation of second messengers

B. Protein phosphorylation

C. Modification of gene expression

Question 3

Which neurotransmitter is considered the major excitatory neurotransmitter?

Group of answer choices

A. Glycine

B. GABA

C. Glutamate

D. Serotonin

Question 4

G-protein coupled receptors are examples of what type of effector pathway?

Group of answer choices

A. Slow effector pathways

B. Rapid effector pathways

C. NMDA glutamate receptor pathways

D. Modulated effector pathways

Question 5

Of the components of patient-focused interventions to enhance adherence, which component includes the following strategies: adaptive thinking, use of cues, and support? Group of answer choices

• Motivation
• Skills
• Logistics
• Education

Question 6

Motivation is a component of patient-focused interventions to enhance adherence. Based on the transtheoretical model, readiness to change can fluctuate across five stages. Which stage is represented by the patient who is aware that a problem exists and, while seriously thinking about overcoming it, has not yet committed to a plan of action? Group of answer choices

• Preparation
• Action
• Contemplation
• Maintenance

Question 7 

The human brain is subcategorized into four major structures. These structures include the cerebral cortex, brainstem, subcortical structures, and the cerebellum. Of these major categories, which one houses the area of the brain that has been found in some neuropathological studies of patients with schizophrenia to be of smaller size? Group of answer choices

• Cerebral cortex
• Brainstem
• Subcortical structures
• Cerebellum

Question 8

Neurotransmitters are defined by four essential characteristics. These are:

Group of answer choices

A. Neurotransmitters are synthesized within presynaptic neurons.

B. Depolarization of a neuron results in the release of a neurotransmitter, which exerts a multitude of actions on the postsynaptic neuron.

C. Their action on postsynaptic neurons can be replicated by administering a drug that mimics the activity of the endogenous neurotransmitter.

D. Their action in the synaptic cleft is terminated by a specific action.

E. A, C, and D only

Question 9

Serotonin (5HT) is a neurotransmitter associated with mood, sleep, and psychosis. There are several serotonin receptors all over the human body. A unique aspect of the second-generation antipsychotics is their ability to block 5HT2a receptors. What is the effect of this inhibition?

Group of answer choices

A. Stabilizes dopamine concentrations in the CNS

B. Induces anxiety

C. Causes hallucinations

D. Reduces platelet function

Question 10

Treatment adherence is affected by several different factors. Clinical factors include mood, anxiety, psychosis, and substance misuse. There are also patient factors such as knowledge, attitude, and beliefs; economic and racial/ethnic disparities, and clinical encounters. A patient who presents hopeless, with decreased energy, and poor concentration is affected by which factor?

Group of answer choices

• Substance misuse
• Knowledge deficits
• Attitude and belief system
• Mood

Question 11

A patient arrives in the ED via EMS having a grand mal seizure. The ED physician instructs the RN to give 10 milligrams of Diazepam IV X1 dose STAT. The patient’s seizure breaks within 2 minutes of the Diazepam being administered. The mechanism by which this medication causes rapid resolution of seizure activity is via which receptor type (effector pathway/receptor subtype)?

Group of answer choices

A. Slow effector pathways/G-protein coupled receptor

B. Slow effector pathway/ion channel

C. Rapid effector pathways/G-protein coupled receptor

D. Rapid effector pathway/ion channel

Question 12

Neurotransmission is unidirectional insofar as chemical and electrical conduction is concerned within the individual neuron. Of the following descriptions, which best characterizes the order of neurotransmitter/receptor interaction that results in an electrical signal impulse and the release of another neurotransmitter for interaction in the synaptic cleft (signal conduction through a neuron)?

Group of answer choices

• Cell body, dendrites, Axon, Axon terminals
• Dendrites, Axon, Cell body, Axon, Axon terminals
• Dendrites, Cell body, Axon, Axon terminals
• Axon terminals, Axon, Cell body, Dendrites

Question 15

If a patient admits to taking his medication every other day (instead of daily, as prescribed), a potential concern would be:

Group of answer choices

A. Sufficient understanding or acceptance of the illness

B. Abuse of the medication

C. Expense

D. Is the desired effect recognized at a lower daily dose?

Question 16

Receptors trigger one of two effector pathways resulting in changes in neuronal activity. These changes will, ultimately, effect gene expression. Which effector pathway is characterized by ion flux through transmitter-activated channels resulting in an altered membrane potential and neuronal activity?

Group of answer choices

A. Slow effector pathways

B. Modulated effector pathways

C. Rapid effector pathways

D. NMDA glutamate receptor pathways

Question 17

Upon blocking a Serotonin reuptake pump, what happens in the synaptic cleft and on the post-synaptic cell membrane?

Group of answer choices

A. The result will be an increase in available Serotonin in the synaptic cleft causing the post-synaptic cell to increase the number of Serotonin receptors.

B. The result will be an increase in the available Serotonin in the synaptic cleft causing the post-synaptic neuron to reduce the number of Serotonin receptors.

C. The result will be an increase in Serotonin in the synaptic cleft resulting in an increase in reuptake pumps on the presynaptic neuron.

D. The result will be an increase in Serotonin in the synaptic cleft resulting in a decrease in reuptake pumps on the pre-synaptic neuron.

Question 180 pts

When dopamine (subtype 2) receptors are blocked in this pathway (system), it is evident by EPS.

Group of answer choices

A. Mesocortical

B. Tuberoinfundibular

C. Nigrostriatal

D. Mesolimbic

Question 19

Which of the following consists of all the known major neurotransmitters that are relevant in psychiatry?

Group of answer choices

1. glutamate, GABA, dopamine, serotonin, norepinephrine, histamine, steroids, nitric oxide
2. glutamate, GABA, dopamine, norepinephrine, serotonin, acetylcholine, histamine, endogenous opioids, steroids, cannabinoids, nitric oxide
3. glutamate, GABA, dopamine, serotonin, acetylcholine, endogenous opioids, nitric oxide, cannabinoids, steroids
4. glutamate, GABA, dopamine, serotonin, norepinephrine, endogenous opioids, steroids, histamine, nitric oxide

Question 20

Glia cells play a supportive role to the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia and macroglia. Of these two cell types, which one plays an active and critical role in glutamatergic neurotransmission by providing a co-agonist required for glutamate receptor function?

Group of answer choices

• microglial
• macroglial

NURS 6630 Week 9 A Young Girl With ADHD

Attention Deficit Hyperactivity Disorder (ADHD) Sample Paper

Neurodevelopmental disorders have undertaken several diagnostic evolutions in several past years. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is one of the standard diagnostics tools used. A popular belief is that attention deficit hyperactivity disorder (ADHD) is prevalent among children. It is stereotyped that it only affects the attention of children. New information has however shown that ADHD not only affect attention in children, but also involves hyperactivity and impulsivity. According to the National Institute of Mental Health (NIH, 2019), it is possible that this disorder can be present in adults contrary to common beliefs. 

ADHD is usually recognized in early childhood, especially during the preschool years and early school years and can continue into adulthood. It can cause issues such as inattention, hyperactivity, and impulsivity and patients usually present with these as the core symptoms. Some ADHD patients only present with one of the behaviors while other present with a combination. Specific issues seen with ADHD include poor performance in school, inability to think properly and behavioral problems. According to Krull (2019), patients can also have a difficulty in expressing their feelings and building relationships.

Using the DSM-5 criteria, ADHD symptoms must be present before the age of 12 years and also in more than one setting (APA, 2013). To diagnose ADHD, an authorized medical practitioner such as a psychiatrist or a pediatrician should be present. An expert in ADHD who is licensed to determine the presence of this disorder can also make the diagnosis. The signs to look out for in order to make a diagnosis are inattention, hyperactivity and impulsivity that has been present over a long period.

ADHD management and treatment consists of counseling, behavioral therapy, medication, or a combination of these options. The goal in managing and treating ADHD is to ensure the patient regains full function and can perform better in school, or work and have better relationships. Another goal is to ensure the patient can function in a society by being able to follow the rules. Successful treatment will increase the patient’s attention span, regulate their level of activity to normal and decrease their impulsiveness.

In this paper, the focus will be on an 8-year-old Caucasian female presenting to the clinic with symptoms that indicate ADHD. The best treatment option for this patient will rely on three decisions informed by ethical and treatment guidelines for the disorder. The overall pharmacodynamics and pharmacokinetics for the drugs will be discussed

Decision 1

After reviewing the patient, a diagnosis of ADHD is made. Decisions have to be made in order to properly manage and treat this patient. My first treatment decision for this 8-year-old school-going female is to start her on Ritalin chewable tablet 10 mg orally in the morning. This choice is mainly influenced by the patient’s clinical manifestations, and the benefit-risk assessment of the available options.

The objective of treatment is to improve the patient’s symptoms. According to Verbeeck et al. (2017), most pharmacological treatments for ADHD facilitate the transmission of catecholamines. ADHD patients are usually treated with stimulant drugs. Ritalin is a stimulant agent which is FDA approved for use as the first-line treatment for ADHD. Approximately 90% of patients on Ritalin show improvement of symptoms (Verbeevk et al., 2017).

Ritalin achieves this by increasing the action dopamine and noradrenaline in the prefrontal cortex thus stimulating the CNS. CNS stimulation helps foster cognition and attention and restores the patient’s ability to focus. The reason for prescribing the drug in the morning is because of the need to achieve concentration during the day. The drug also has a potential of causing insomnia.

The use of Bupropion is not selected because it is an antidepressant which is only used as an alternative when the patients cannot tolerate stimulants because of the side effects or if patients do not respond well to stimulants (Ng, 2017). Bupropion is registered as an antidepressant and is used off-label to treat ADHD. Despite its extensive use, it is not FDA approved for the treatment of ADHD in children. It is also associated with suicidal ideations as a side effect and evidence has shown that it is only effective in the treatment of ADHD that is comorbid with depression.

Intuniv is also not selected as it is a non-stimulant that is not recommended as the first-line treatment of ADHD. It usually takes long to start producing effects as opposed to Ritalin that takes a few minutes to start exhibiting its effects. Intuniv is however suggested as an augmenting agent if stimulants do not offer adequate improvement in symptoms (Stahl, 2017).

With the treatment option selected, I hope to see an improvement in the symptoms as soon as possible, with the patient reporting an improvement in school performance when she returns for a follow-up after 4 weeks. The patient returns four weeks later with improved symptoms but complains of some adverse effects including daydreaming and cardiac symptoms such as tachycardia. With this new information, a re-evaluation is necessary and another decision needs to made to manage this patient.

Decision 2

With new findings in the patient, my decision is to change to Ritalin LA 20 mg orally in the morning. The reason for this is that the symptoms shown could be as a result of Ritalin 10 mg chewable tablets being a short acting agent. The symptoms could also be prevented by reducing the dose to 5 mg. This would reduce the potential side effects but also the efficacy. A longer acting agent is therefore the best option to use on this patient. This way she gets a pulse dose in the morning and another dose four hours later.

I would not want to switch to another drug option because Ritalin seems to be effective in improving the symptoms. Keeping her on the same dose would not change anything in terms of relieving or minimizing the side effects. She would still have symptoms of tachycardia on the same dose. Changing her medication to Adderall is not an option I would consider because she seems to be responding well to Ritalin, an aspect Cortese et al. (2018) identify as a basis for sticking to the current treatment medication. It is recommended that when patients experience side effects, waiting and making adjustments on the current medications are made before switching to a different drug. If the patient does not show any improvement, then a change in medication can be made (Stahl, 2017).

The goals of treatment remain the same as before but with a new target of reducing the patients heart rate without affecting her concentration throughout the day. The patient returns to the clinic after four weeks and reports a relief of the side effects. Her heart rate is at 92 beats a minute. This shows that the new treatment with Ritalin LA 20 mg is working with significant improvement recorded over the past four weeks.

Decision 3

Because the patient seems to be doing well on the current treatment regimen, my plan would be to maintain her on the current dose of Ritalin LA and do a re-evaluation after four weeks. Ritalin seems to be working as Katie’s heart rate is back to normal and her attention is sustained throughout the day. She also reports no additional side effects. It is recommended that the lowest dose of a stimulant needed should be used to correct a disorder and for this reason, I would not increase the dose to 30 mg. Her heart rate of 92 is within the normal range for her age and an EKG is unnecessary at this point.

Ethical Considerations

When treating patients with ADHD, many ethical considerations have to be taken into account. These include choosing the right medication for the treatment of the condition. This is important as some drug classes such as nonstimulants have harmful side effect which the patient may not be able to tolerate. This is also important because the patients are still developing and some of these drugs may impede their development. Another consideration is the patient autonomy. Because the patient is a minor, she is not able to make any decisions as regards their health and treatment.

Parents therefore have to be incorporated in making decisions that pertain to the treatment of this patient and they have a right to agree to or deny treatment they don’t agree with. It is also important to try and involve the child in the treatment and breakdown everything to a language they can understand (NIH, 2019). Another ethical consideration is the cardiac effects that are associated with psychostimulants. A family history of cardiac disease should be taken into account before commencing treatment with stimulants. The last consideration is the side effects and the lowest effective dose should be prescribed and the patients monitored regularly for side effects (NIH, 2019). The patient should also be educated on these side effects.

Conclusion

In conclusion, ADHD is a disorder that starts in early childhood and can progress into adulthood if not managed well with psychotherapy and pharmacotherapy. ADHD usually present with three core symptoms i.e., inattention, hyperactivity and impulsiveness but not all patients present with all the symptoms at once. The NP has the ethical obligation to treat ADHD with the most effective options available.

The first-line treatment for ADHD are stimulants such as Ritalin. Other options of treatment include non-stimulants amphetamines and antidepressants such as bupropion. When treating patients with stimulants it is important to consider the potential side effects such as cardiac effects such as tachycardia as seen in the patient. It is also important to use the lowest effective dose to treat the patients. The patient should also be involved in their treatment and patient preference is key to ensure compliance to medication.

NURS 6630 Week 9 A Young Girl With ADHD References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://psycnet.apa.org/doi/10.1176/appi.books.9780890425596

Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., & Carucci, S. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network metanalysis. Lancet Psychiatry, 5(9), 727-738. https://doi.org/10.1016/S22150366(18)30269-4

Krull, K. (2019). Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis. Retrieved from https://www.uptodate.com/contents/attentiondeficit-hyperactivity-disorder-in-children-and-adolescents-clinical-features-and-diagnosis

National Institute of Mental Health. (2019). Attention-Deficit/Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorderadhd/index.shtml

Ng, X. Q. (2017). A systematic review of the use of bupropion for attention-deficit hyperactivity disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 27(2), 112-116. https://doi.org/10.1089/cap.2016.0124

Stahl, S. M. (2017). Prescriber’s guide (6th ed.). New Delhi, India: Cambridge University Press. https://assets.cambridge.org/97811076/75025/frontmatter/9781107675025_frontmatter.pdf

Verbeeck, W., Bekkering, G. E., Van den Noortgate, W., & Kramers, C. (2017). Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane Database Of Systematic Reviews, 10(10), CD009504. https://doi.org/10.1002/14651858.CD009504.pub2

Also read:

NURS 6630 Week 3 Quiz Which Neurotransmitter is Considered the Major Excitatory Neurotransmitter?

ASSESSING AND TREATING PATIENTS WITH ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

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 patients with ADHD.

THE ASSIGNMENT: 5 PAGES

Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

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 formattingLinks to an external site..

LEARNING RESOURCES

Required Readings

• Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
  • Chapter 11, “Attention Deficit Hyperactivity Disorder and Its Treatment” (pp. 449-485)
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
• Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS DrugsLinks to an external site., 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000
• Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric TimesLinks to an external site.. https://www.psychiatrictimes.com/view/5-question-quiz-adhd

Medication Resources

• U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugsLinks to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
  Links to an external site.

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.