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Respond to two colleagues 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.

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Agonist-to-Antagonist Spectrum

The agonist-to-antagonist spectrum of action refers to  the action that is taken by a neurotransmitter to produces a  conformational change (Stahl, 2013).  The spectrum starts with the  agonist action, which, with the help of a second-messenger, can turn on  the full potential of change (Stahl, 2013). Full agonists can be natural  transmitters used to produce change.  An antagonist blocks the  conformational change of the potential of the transmitter for binding  with the intended agonist (Stahl, 2013).  The role of the antagonist is  to keep the receptors in a baseline state in order to reverse what the  agonist has done (Stahl, 2013). This is the opposite end of the spectrum  and seeks to block agonists.  In the middle, some partial agonists  mimic its agonist partner to a lesser degree, and inverse agonists stop  all activity from occurring on the receptor (Stahl, 2013).  The  conformational change is needed for a receptor to open to the action of  drugs, particularly, psychopharmaceutical medications in this case.

G couple proteins and Ion gated channels

G couple proteins are used at the binding site of a  neurotransmitter to act as a conduit for enzymes (Stahl, 2013). Whereas,  ion gated channels exist as targets to regulate chemical  neurotransmitters (Stahl, 2013).  Ion gated channels consist of channels  and receptors that can only be opened by the neurotransmitters.   Conversely, G couple proteins attach to neurotransmitters and conform to  enzymes to serve as a channel for a second messenger (Stahl, 2013).   Most psychotropic medications aim for the ion gated channels, which open  through chemical neurotransmission and initiate the signal transduction  cascade (Stahl, 2013).  The cascade results in faster uptake of  psychotropic medications into the system.

The Role of Epigenetics

According to DeSocio (2016), epigenetics is the study  of how genomes that undergo changes with certain molecular compounds and  environmental changes can leave the essential DNA unchanged.  It is a  modification of gene expression that is independent of the DNA (DeSocio,  2016).  DNA is the code that determines much of who we are.  Changes in  that code can be seen as a result of heredity, the environment, or  neurotransmission (Stahl, 2013).  These alterations affect individuals  at a physical, emotional, and psychological level.  Stress and adversity  play a significant role in epigenetics by changing the genomes, which  in turn leads to changes in a person’s DNA (Park et al., 2019).  These  alterations influence psychological issues related to many individuals.   It is essential to know how to combat these changes when determining a  plan of care for clients.

Implications of Findings to Prescribing

As nurse practitioners, it is essential to have an  extensive understanding of how the above processes affect the way we  prescribe medications to clients.  It is also essential to take into  consideration how the environment impacts maintaining optimal health and  healing (DeSocio, 2016).  Knowing the mechanisms of action for  medications that we are prescribing is vital to providing competent  care.  For example, a patient with a generalized anxiety disorder (GAD)  is prescribed Venlafaxine.  The PMHNP needs to understand that the  Venlafaxine works by boosting the serotonin, norepinephrine, and  dopamine neurotransmitters (Stahl, 2014).  This action blocks serotonin  reuptake, norepinephrine reuptake, and the dopamine reuptake (Stahl,  2014).  Each of these actions then increases these neurotransmissions in  the brain providing therapeutic results. 

                                          References

DeSocio, J.E. (2016). Epigenetics: An emerging framework for advanced practice psychiatric nursing. Perspectives in Psychiatric Care, 52(3), 201-207. https://doi.org/10.1111/ppc.12118

Park, C.,  Rosenblat, J.D., Brietzke, E.,  Pan, Z., Lee, Y., Cao, B., Zuckerman, H., Kalantarova, A., McIntyre,  R.S. (2019). Stress, epigenetics, and depression: A systematic review. Neuroscience and Biobehavioral Reviews, 102, 139-152. https://doi.org/10.1016/j.neubiorev.2019.04.010

Stahl, S.M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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

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