Discussion: Foundational Neuroscience NURS 6630C

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Discussion: Foundational Neuroscience NURS 6630C

Discussion: Foundational Neuroscience NURS 6630C

As a psychiatric nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

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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.
    Discussion Foundational Neuroscience NURS 6630C

    Discussion Foundational Neuroscience NURS 6630C

  3. Explain how the role of epigenetics may contribute to pharmacologic action.
  4. Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on two different days in one of the following ways:

  • If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
  • If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

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

To Participate in this Discussion:

Week 2 Discussion


What’s Coming Up in Week 3?

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

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

Next Week

To go to the next week:

Week 3

Week 2: Neurotransmitters and Receptor Theory

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

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

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

Required Readings (click to expand/reduce)

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier.

Required Media (click to expand/reduce)

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

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

Optional Resources (click to expand/reduce)

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

Dr. Norbert Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain. (15m)

 

Introduction to Advanced Pharmacology

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse. (6m)

Week 1 discussion

Explain the agonist-to-antagonist spectrum of action ofpsychopharmacologic agents.To understand the agonist-to-antagonist spectrum of action ofpsychopharmacologic agents, it is first important to understand what does the terms agonist and antagonist means. An agonist refers to a chemical that binds to a receptor, the receptor activates and a biological response is produced. In comparison, an antagonist blocks the action of agonist, and an inverse agonist causes an action opposite to that of the agonist (Stahl, 2013). The agonist spectrum can be classified into four types namely agonist, partial agonist, antagonist and inverse agonist (Stahl, 2013). The agonist opens the channel the maximal amount and frequency allowed by the binding site, while antagonist that lie in the middle of the spectrum retain the resting state with infrequent opening of the channel. The inverse agonist put the ion channel into a closed and inactive state. Antagonists holds the ability to block anything in the agonist spectrum, and ions are returned to their resting state in each instance (Stahl, 2013). An agonist tie to a receptor site and causes a response while an antagonist works against the drug and blocks the receptor. An agonist stimulates the action, while antagonist sit idle, doing nothing (Stahl, 2013). For ideal therapeutic action of a drug, ion flow and signal transduction is required that is not too hot, neither too cold and has the right balance. Such an ideal state varies from one clinical case to another and depends upon the balance between agonism and silent antagonism (Stahl, 2013).Compare and contrast the actions of g couple proteins and iongated channels.Two broad families of receptor proteins perform their functioning in the openingand closing of postsynaptic ion channels. The receptor in one family is called the ionotropic receptor is linked directly to ion channels. These receptors have two functional domains, the first one being an extracellular site that binds neurotransmitters, and the second one being a membrane-spanning domain to form an ion channel (Purves, et al., 2012). Therefore, inotropic receptors combine transmitter-binding and channel functions into one single molecular entity and are called ligand-gated ion channels. Such receptors are multimers and are comprised to four or five individual proteins subunit. Each of these units play a part in pore of the ion channel  (Purves, et al., 2012). The second family of neurotransmitter is the metabotropic receptor. In this case, the movement of ion depends upon one or more metabolic steps. In these receptors, there are no ion channels, but channels are affected by the activation of intermediate molecules called G-proteins. For this same reason, metabotropic receptors are also referred to as G-protein-coupled receptors (Purves, et al., 2012). Metabotropic receptors are monomeric proteins having an extracellular domain for neurotransmitter binding and an intracellular domain for binding to G-proteins. Neurotransmitter binding to metabotropic receptors activates G-proteins, after which it dissociates from the receptor and interact directly with ion channels or bind to other effector proteins, like enzymes to make intracellular messengers to open or close ion channels. Therefore, G-proteins work as transducers that couple neurotransmitter binding to the regulation of postsynaptic ion channels (Purves, et al., 2012).Explain the role of epigenetics in pharmacologic action. Epigenetics is the study of changes that influence the phenotype without causingchanges in the genotype. It is the study on heritable but reversible changes in gene expression without any modifications of primary DNA sequence (Lundstorm, 2015). Epigenetic mechanisms, especially circulating miRNAs have greatly in use today for diagnostic biomarkers (Lundstorm, 2015). Epigenetic regulation of gene activity is important in maintain normal phenotypic activity of cells, as well as in treatment of disease such as cancer and neurodegenerative disorders such as dementia and schizophrenia. New classes of drugs are currently used to regulate epigenetic mechanisms to manage diseases in individuals (Stefanska & MacEwan, 2015).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 healthnurse practitioner must be aware of the medication’s action The understanding of pharmacology of drugs is important for psychiatric mentalhealth nurse practitioner as she must be aware how drug action would be beneficial for the patient. The process involving medication prescription is especially critical for psychiatric and mental health patients as alterations produced by neurocognitive mechanism may lead to alteration of drugs (Angell & Bolden, 2015). Psychiatric mental health nurse practitioner must be aware of medication’s action while working with Alzheimer’s patients. Alzheimer’s disease is a chronic neurodegenerative disease that usually starts slow and gets worse with the progressing time (Winblad, et al., 2016). The disease cannot be treated completely but its worsening symptoms can be controlled. Researchers and scientists are currently finding ways to find complete cure of the disease through epigenetic modifications that can reverse the mechanism causing the neurocognitive decline through pharmacologic agents (Cacabelos & Torrellas, 2014). Therefore, knowledge about pharmacology of drugs is essential important for psychiatric mental health nurse practitioner while treating patients suffering from Alzheimer disease so she can determine whether the focus of treatment is on stopping the symptoms from getting worse, or making an effort to reverse the disease process.ReferencesAngell, B., & Bolden, G. B. (2015). Justifying medication decisions inmental health care: Psychiatrists’ accounts for treatment recommendations. Social Science & Medicine, 138(2), 44-56.Cacabelos, R., & Torrellas, C. (2014). Epigenetic drug discovery for Alzheimer’s disease. Expert Opinion on Drug Discovery, 9(9), 1059- 1086. doi:10.1517/17460441.2014.930124Lundstorm, K. (2015). What is the potential of epigenetics in. Future Medical Chemistry, 7(3), 239-242. doi:10.4155/FMC.15.2Purves, D., Augustine, G., & Fitzpatrick, D. (2012). Neuroscience (5th ed.). Sunderland (MA):: Sinauer Associates.Stahl, S. M. (2013). Ion Channels as Targets of Psychopharmacologic Drug Action. In Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (3rd ed.). New York, NY: Cambridge University Press.Stefanska, B., & MacEwan, D. J. (2015). Epigenetics andpharmacology. British Journal of Pharmacology, 172(11), 2701-2704. doi:10.1111/bph.13136Winblad, B., Amouyel, P., Andrieu, S., Ballard, C., Brayne, C., Brodaty, H., & Fratiglioni, L. (2016). Defeating Alzheimer’s disease and other dementias: A priority for European science andsociety. The Lancet Neurology, 15(5), 455-532.

 

Discussion Week 2 Main Post:

There are four basic types of signal transduction on the agonist-antagonist spectrum. Full agonists can mimic neurotransmitters and produce maximum signal transduction. This occurs in three ways: direct binding to neurotransmitters, indirectly increasing neurotransmitters’ levels, and indirectly blocking neurotransmitters’ destruction. Antagonists are also referred to as “neutral” or “silent.” Antagonists can block the action of agonists and can reverse partial and inverse agonists. Partial agonists can modulate and stabilize neurotransmitters below that of a full agonist’s transduction but not wholly. Finally, an inverse agonist is essentially the opposite of an agonist. Inverse agonists can take neurotransmitters below the baseline. (Stahl, 2013, pp. 35–43). Dopamine is a common neurotransmitter targeted in the pharmacological intervention. For example, Apripiprazole and a Clozapine metabolite (NMDA) are considered partial agonists of D3 and D4. However, Clozapine is a full agonist at D3 and D4 and may cause some extrapyramidal (EPS) side effects. Using NDMA instead of Clozapine, and aripiprazole the extrapyramidal effects can be modulated (Khilnani & Khilnani, 2011, p. 492).

Neurotransmitter receptors have two types: ion gated channels and G couple proteins. Both of these cause an opening and closing of ion channels. Ion gated channels directly induce change very quickly. In contrast, g coupled proteins produce action much more slowly as they work indirectly on ion gated channels (Lodish et al., 2007).

Epigenetics is the concept that experiences, environments, and behaviors and impact how genes function. For example, childhood trauma is known to influence the hippocampus glucocorticoid receptors (Kyimba, 2016). Research shows that rats exposed to “chronic restraint stress” caused a downregulation of the BDNF gene. Administration of olanzapine stimulated BDNF gene expression in the hippocampus, reversing ACE-like epigenetic changes (Seo et al., 2018).

There are many neurological factors to consider when prescribing psychiatric medications. It is imperative to understand how neurotransmitters influence or are impacted by psychiatric medications. For example, in a patient with bipolar disorder, Selective serotonin reuptake inhibitors (SSRIs) can be catastrophic. Instead of mood stabilization, SSRIs can “flip” a patient into a manic episode (Henry et al., 2001, p. 253).

I enjoyed learning more about how the brain utilizes medication to regulate and balance its functioning. I especially enjoyed how ACEs can change how your body reads DNA

Henry, C., Sorbara, F., Lacoste, J., Gindre, C., & Leboyer, M. (2001). Antidepressant-Induced mania in bipolar patients: Identification of risk factors. The Journal of Clinical Psychiatry62(4), 249–255. https://doi.org/10.4088/jcp.v62n0406

Khilnani, G., & Khilnani, A. K. (2011). Inverse agonism and its therapeutic significance. Indian Journal of Pharmacology43(5), 492. https://doi.org/10.4103/0253-7613.84947.

Kiyimba, N. (2016). Developmental Trauma and the Role of Epigenetics. BACP Healthcare Counselling and Psychotherapy Journal. October, p18-21.

Lodish, H., Berk, A., Kaiser, C. A., Krieger, M., Scott, M. P., Bretscher, A., Ploegh, H., & Matsudaira, P. (2007). Molecular cell biology (6th ed.). W. H. Freeman.

Seo, M. K., Kim, Y. H., McIntyre, R. S., Mansur, R. B., Lee, Y., Carmona, N. E., Choi, A. J., Kim, G.-M., Lee, J. G., & Park, S. W. (2018). Effects of antipsychotic drugs on the epigenetic modification of Brain-Derived neurotrophic factor gene expression in the hippocampi of chronic restraint stress rats. Neural Plasticity2018. https://doi.org/10.1155/2018/2682037

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

Looks like I missed some of the epigenetics portion of the assignment. After further research, I found that epigenetics plays a significant role in developing mental and physical illness by altering how the body reads DNA as a result of external factors, such as stress. These changes can increase an individual’s risk for depression and simultaneously change how the brain responds to SSRIs. Some pharmacological interventions specifically target epigenetic changes to treat disease (Stefanaska & Macewan, 2015). Unfortunately, individuals with low brain-derived neurotrophic factor (BDNF) levels have poorer responses to SSRIs. To further complicate things, taking an SSRI and a BDNF targeted medication increases side effects. In some cases, an SSRI can increase BDNF levels. In these cases, improvement of depression symptoms likely occurs light of these intricacies; further research is needed to fine-tune appropriate individualized interventions (Menke & Binder, 2014).

Menke, A., & Binder, E. B. (2014). Epigenetic alterations in depression and antidepressant treatment. Dialogues in clinical neuroscience16(3), 395–404. https://doi.org/10.31887/DCNS.2014.16.3/amenke

Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. British journal of pharmacology172(11), 2701–2704. https://doi.org/10.1111/bph.13136

Hi Alice, 

Thank you for your knowledge and concepts regarding the agonist- antagonist spectrum. I would like to add to your post by giving insight and more in depth information that relates to the various types of antagonists. We have already discovered that there are numerous types of agonists such as inverse and partial agonists; however, there are also a variety  of antagonists that exist as well. Currie (2018) explains that two types of antagonists that exist are irreversible and reversible antagonists. While we know that antagonists bind to receptor sites and block the action of the agonist, it is important to understand whether the changes at the site are permanent or temporary. Irreversible antagonists bind to the receptor site and may permanently associate itself at the receptor site or be removed much slower than other antagonists (Currie, 2018). While reversible antagonists, on the other hand, are easily removed from cell receptor sites (Currie, 2018). 

One type of irreversible antagonists used to treat hypertension in persons with pheochromocytomas is phenoxybenzamine (Currie, 2018; Das et al., 2017).  Phenoxtbenzamine acts by binding to alpha-adrenergic receptors, and causing lower blood pressure through vasodilation (Das et al., 2017). Due to its high affinity for alpha adrenergic  and catecholamine receptors, the effects of phenoxybenzamine can can last anywhere from 12 to 24 hours, making it more suitable to control blood pressures during extensive surgery for the removal of adrenal tumors (Das et al., 2017). It is important to be familiar with both irreversible and reversible antagonists so that clinicians are particular in understanding which antagonist would be beneficial to their patients who require either short term or long term treatments.

Currie, G. M. (2018). Pharmacology, part 1: Introduction to pharmacology and pharmacodynamics. Journal of Nuclear Medicine Technology, 46(2), 81-86. https://doi.org/10.2967/jnmt.117.199588

Das, S., Kumar, P., Kiran, U., & Airan, B. (2017). Alpha blockers: A relook at phenoxybenzamine. Journal of the Practice of Cardiovascular Sciences, 3(1), 11. https:// 10.4103/jpcs.jpcs_42_16

Rubric Detail

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Content
Name: NURS_6630_Week2_Discussion_Rubric

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Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
Points Range: 40 (40%) – 44 (44%)
Thoroughly responds to the Discussion question(s).

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

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

Supported by at least three current credible sources.

Points Range: 35 (35%) – 39 (39%)
Responds to most of the Discussion question(s).

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

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

Points Range: 31 (31%) – 34 (34%)
Responds to some of the Discussion question(s).

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

Is somewhat lacking reflection and critical analysis and synthesis.

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

Post is cited with fewer than two credible references.

Points Range: 0 (0%) – 30 (30%)
Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

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

Contains only one or no credible references.
Main Posting:

Writing
Points Range: 6 (6%) – 6 (6%)
Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range: 5 (5%) – 5 (5%)
Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range: 4 (4%) – 4 (4%)
Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 3 (3%)
Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

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

Timely and full participation
Points Range: 9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

Points Range: 8 (8%) – 8 (8%)
Posts main Discussion by due date.

Meets requirements for full participation.

Points Range: 7 (7%) – 7 (7%)
Posts main Discussion by due date.

Points Range: 0 (0%) – 6 (6%)
Does not meet requirements for full participation.

Does not post main Discussion by due date.
First Response:

Post to colleague’s main post that is reflective and justified with credible sources.
Points Range: 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

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

Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range: 7 (7%) – 7 (7%)
Response is on topic, may have some depth.

Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
First Response:
Writing
Points Range: 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

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

Response is effectively written in Standard, Edited English.

Points Range: 5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

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

Response is written in Standard, Edited English.

Points Range: 4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range: 0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.
First Response:
Timely and full participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)
Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)
Posts by due date.

Points Range: 0 (0%) – 2 (2%)
Does not meet requirements for full participation.

Does not post by due date.
Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
Points Range: 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

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

Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range: 7 (7%) – 7 (7%)
Response is on topic, may have some depth.

Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
Second Response:
Writing
Points Range: 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

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

Response is effectively written in Standard, Edited English.

Points Range: 5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

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

Response is written in Standard, Edited English.

Points Range: 4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range: 0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.
Second Response:
Timely and full participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)
Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)
Posts by due date.

Points Range: 0 (0%) – 2 (2%)
Does not meet requirements for full participation.

Does not post by due date.
Total Points: 100
Name: NURS_6630_Week2_Discussion_Rubric

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