When a patient is started on a new medication
3 days ago Dava Hooper
Week 1 Main Discussion
COLLAPSE
Introduction to Neuroscience
Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents
Psychopharmacologic drugs have many mechanisms of action in the brain and target specific molecular sites that have effects on the neurotransmission based on a spectrum of agonist to an antagonist. An agonist is a chemical that binds to a brain receptor and activates the receptor to produce a biological response (Stahl, 2013). While an agonist causes an action, an antagonist will block the action of the agonist and create an opposite action of the agonist (Stahl, 2013). The drugs with partial agonists bind to and activate the receptor, but have partial efficacy on the receptor (Stahl, 2013). The full agonist such as opioids activates the receptor so the brain will get the full effect of the opioid (The National Alliance of Advocates for Buprenorphine Treatment, 2016). Depending on a psychopharmacological drug is on the agonist-to- antagonist spectrum will determine the interacts of the receptors of the brain.
G Couple Proteins and Ion Gated Channels
G couple proteins are a large family of cell surface receptors (Li, Wong, & Liu, 2014).
There are seven different types of proteins in the G couple family, and they are highly diverse, recognizing a wide range of ligands, including photons, small molecules, and proteins (Li, Wong, & Liu, 2014). Once the drug connects to the receptor site, a full or partial blocking will occur causing a molecular change thus allowing the drug to take action and create changes in which the phosphoproteins are activated or inactivated, or determine which enzymes, receptors, or ion channels are modified by the neurotransmission (Stahl, 2013).
Ion gated channel receptors are a vital component of the nervous system and allow rapid and direct conversion of a chemical neurotransmitter message to the receptors (Li, Wong, & Liu, 2014). Ion cannot normally pass through the membranes because of their charge (Stahl, 2013). The essential ion channels in psychopharmacology are calcium, sodium, chloride, and potassium, and many of these ions can be modified by various drugs (Stahl, 2013).
Epigenetic
Epigenetics is a chemical compound that is added to a person’s DNA to regulates the activity of the genes within the genome (U.S. National Library of Medicine, 2020). The chemical compounds of the epigenome are not part of the DNA but are attached to the DNA (U.S. National Library of Medicine, 2020). Epigenetic alterations remain as the cells divide and, in some cause, can inherit through the generations (U.S. National Library of Medicine, 2020). Environmental influence, such as pollution, diet, can impact the epigenome (U.S. National Library of Medicine, 2020). Epigenetic changes can help determine whether a gene or genes are turned on or off and can influence the production in cells (U.S. National Library of Medicine, 2020). Errors can occur in the epigenetic process, such as adjusting the wrong gene or failing to add a compound to a gene, which can result in abnormal gene activity or inactivity and can cause genetic disorders (U.S. National Library of Medicine, 2020).
Impact on Prescribing Medications
As Psychiatric mental health nurse practitioner (PMHNP), must understand the drug interactions and possible side effects when prescribing medication to patients. Furthermore, PMHNP an understanding of the pharmacokinetic and pharmacodynamic actions of medications, as well as the patient motivation in taking the medication. Sertraline is a conventional medication that is prescribed for major depressive disorder (MDD). As a PMHNP, the provider should explore any drug interaction with the current patient medication; patient education provided for the patient on the medication side effects, along with information on dosage and timeliness of the medicine. Also, the patient needs to be instructed on how long it will take to build the therapeutic level for optimal treatment. When a patient is started on a new medication, it is good practice to reevaluate the patient in a few weeks. This follow visit will ensure that the drug is working or there needs to be an adjustment in the medication regime. Stahl (2013), explains the pharmacologic action of serotonin works as an agonist by increasing the serotonin on the serotonin receptor, causing an improvement in mood and insomnia. Healthcare providers most always keep safety and efficacy in their minds when prescribing medications.
References
Li, S., Wong, A. H., & Liu, F. (2014). Ligand-gated ion channel interacting proteins and their role in neuroprotection. Frontiers in cellular neuroscience, 8, 125. https://doi.org/10.3389/fncel.2014.00125
The National Alliance of Advocates for Buprenorphine Treatment. (2016). What’s this agonist/antagonist stuff. Retrieved from https://www.naabt.org/faq_answers.cfm?ID=5
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
U.S. National Library of Medicine. (2020). What is epigenetics? Retrieved from https://ghr.nlm.nih.gov/primer/howgeneswork/epigenome
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