Week 1: Introduction to Neuroscience

Week 1: Introduction to Neuroscience
Modern psychopharmacology is largely the story of chemical neurotransmission. To understand the actions of drugs on the brain, to grasp the impact of diseases on the central nervous system, and to interpret the behavioral consequences of psychiatric medicines, one must be fluent in the language and principles of neurotransmission.

—Dr. Stephen M. Stahl in Stahl’s Essential Psychopharmacology

By using a combination of psychotherapy and medication therapy, psychiatric mental health nurse practitioners are positioned to provide a very unique type of care to clients with psychiatric disorders. To be successful in this role, you must have a strong theoretical foundation in pathophysiology, psychopharmacology, and neuroscience. This foundation will help you assess, diagnose, and treat clients as you relate presenting symptoms to theoretical neuronal functioning.

This week, as you begin to study psychopharmacology, you explore foundational neuroscience. You examine the agonist-to-antagonist spectrum of action of psychopharmacologic agents, compare the actions of g couple proteins to ion gated channels, and consider the role of epigenetics in pharmacologic action.

Note: In previous courses, the term “patient” was used to describe the person receiving medical care. In traditional medicine and nursing, this term is used to describe the person you do something to, and it often refers to a passive recipient of care and services. As you move into the realm of psychiatric mental health, a transition will occur. You will work with individuals who are active participants in their care, and these individuals are generally referred to as “clients” as opposed to “patients.” It is important to note that the term “client” is also favored in other mental health disciplines, such as psychiatry, psychology, and social work.

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

Learning Objectives
Students will:
Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents
Compare the actions of g couple proteins to ion gated channels
Analyze the role of epigenetics in pharmacologic action
Analyze the impact of foundational neuroscience on the prescription of medications
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 1, “Chemical Neurotransmission”
Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action”
Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action”
Document: Midterm Exam Study Guide (PDF)

Document: Final Exam Study Guide (PDF)

Required Media
Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes.

Accessible player
Optional Resources
Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

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

Accessible player
Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

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

Accessible player
To prepare for this Discussion:

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

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

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents.
Compare and contrast the actions of g couple proteins and ion gated channels.
Explain the role of epigenetics in pharmacologic action.
Explain how this information may impact the way you prescribe medications to clients. Include a specific example of a situation or case with a client in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.
Read a selection of your colleagues’ responses.

Sample Essay Solution
Week 1 Discussion Main Post
COLLAPSE

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents

To explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, one should start with identifying each of these terms. Agonists and antagonists act oppositely of each other. With medications, an agonist refers to a chemical that binds to a receptor site to produce a response. An antagonist is a chemical that attaches to the receptor site blocking the receptor’s ability to be activated by other agonists. (Stahl, 2008). The agonist spectrum is classified into four group types, agonist, partial agonist, antagonist, and inverse agonist (Stahl, 2013). A full agonist can produce a maximum response when all available receptors are bound to the agonist. A partial agonist at the highest dose will result in a lessened response. Antagonists can block anything in the agonist spectrum, and ions in each instance return to their resting state (Stahl, 2008). An inverse agonist is a drug that binds to the same receptor as an agonist but promotes an opposite pharmacological response. (Stahl, 2013).

Actions of a G couple protein and ion gated channels

Metabotropic receptors, also called G-protein-coupled receptors, (GCPRs), do not have ion channels as part of their structure. (Purves D, Augustine GJ, Fitzpatrick D, et al., 2001). These receptors instead affect channels by the activation of G-proteins. GCPRs contain a neurotransmitter binding site which activates G-proteins. (Purves D, Augustine GJ, Fitzpatrick D, et al., 2001). The G-proteins then separate from the receptor and interact directly to open or close ion gated channels. Ion gated channels regulate the flow of selected ions across plasma membranes. (Purves D, Augustine GJ, Fitzpatrick D, et al., 2001).

Role of epigenetics in pharmacologic action

Pharmacoepigenetics has become a rapidly expanding field that has the potential to personalize treatment. Studies demonstrate how epigenetic patterns of drug carriers, drug-metabolizing enzymes, and nuclear receptors affect the reaction of individuals to a drug. Knowing in advance as to how an individual is going to respond to pharmaceutical treatment could potentially save time and decrease healthcare costs. Ongoing development of therapeutic epidrugs can reduce the cause or symptoms of an individual is experiencing, or even help to identify and prevent certain diseases.

Psychiatric disorders are thought to be due to abnormal brain development resulting in disruptions in the chemical transmission in the brain. (Peedicayil, J. 2011). (Methyltransferase of DNA and inhibitors of histone deacetylase are two classes of drugs being tested to treat idiopathic mental disorders. (Peedicayil, J. 2012). These drugs have shown positive results in the treatment of idiopathic mental disorders. (Peedicayil, J. 2012).

References

Peedicayil, J. (2012). Role of epigenetics in pharmacotherapy, psychotherapy and nutritional

management of mental disorders. Journal of Clinical Pharmacy and Therapeutics.

Volume 37 (5). 499-501.

Peedicayil, J. (2011). Epigenetic management of major psychosis. Clinical Epigenetics, (2), 249-256.

Retrieved from: https://doi.org/10.1007/s13148-011-0038-2

Purves D, Augustine GJ, Fitzpatrick D, et al., editors. (2001). Neuroscience. 2nd edition. Two Families of

Postsynaptic Receptors. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK10855/

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

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