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.

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

Required Reading

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.  

Neuroanatomy videos http:neuroanatomycalvideos.html

Discussion: Foundational Neuroscience

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.

Photo Credit: Getty Images/Cultura RF

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.

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.

Reply to at least 2 of your peers’ submissions. In your participation responses to your peers, comments must demonstrate thorough analysis of postings and extend meaningful discussion by building on previous postings.

Peer 1

Kolcalba’s Theory of Comfort

            Katherine Kolcaba’s Theory of Comfort recognizes that an important concept that needs to be addressed in a patient’s care is comfort. Comfort is defined by Kolcaba as not only physical, such as pain, but spiritually, socially, and environmentally. According to Peterson and Bredow (2017), nurses traditionally cared for the comfort of the patient, and in the past was one of the sole focuses of the nurse before advancements in medicine. Currently comfort is majorly addressed in both nursing home settings and hospice. 

What is the phenomenon of Concern?

            The main phenomenon of concern when it comes to this theory is comfort. Ensuring that the patient is not only physically comfortable but comfortable in other ways. There are three other areas of comfort that this theory addresses, psychospiritual, social comfort, which later became sociocultural, and environmental comfort (Peterson & Bredow, 2017). Psychospiritual, addresses the patient’s awareness of self, their spirituality, and even sexuality. Sociocultural, addresses the need to address cultural issue that may interfere with care of the patient, and even their relationship with family. Finally, Environmental addresses things such as the amount of noise, light, temperature of where the patient is being given care. In a study by Barreto et al. (2020), they state that hospitalization is “an unpleasant experience for older people and can increase frailty, making them more susceptible to suffering and discomfort and potentially impairing their recovery.” Addressing these needs would allow for an increase in positive outcomes. 

What are the assumptions underpinning this theory?

            There are three distinct assumptions made in this theory that are as follows:

1. Human beings have holistic responses to complex stimuli.
2. Comfort is an immediate and desirable holistic state of human beings that is germane to the discipline of nursing.
3. Human beings strive to meet, or to have met, their basic comfort needs. It is an active endeavor (Peterson & Bredow, 2017).

As a community nurses generally base care on physical needs, and not necessarily needs in any of the other areas of comfort. In the study done by Berreto et al. (2020), they found that out of the 26 nursing diagnoses that they looked at, only four of those nursing diagnoses address a need outside of the physical dimension. 

References

Barreto Cardoso, R., Alfradique de Souza, P., Pereira Caldas, C., & Ribeiro Bitencourt, G. (2020). Nursing diagnoses in hospitalized elderly patients based on Kolcaba’s

           Comfort Theory. Revista de Enfermagem Referência, 4, 1–9. https://doi-org.su.idm.oclc.org/10.12707/RV20066

Peterson, S., & Bredow, T. (2017). Middle range theories: Application to Nursing Research and 

Practice (4th ed.). LWW.

Peer 2

Discussion 3-  Pender’s Health Promotion Model 

In the text author Butts (2017 p.425) describes Nola Pender’s Health Promotion Model as one of four theories “that may be categorized as focusing on goals and functions”.  This classification of Pender’s theory allows it to be qualified and quantified, which has therefore led to a broad spectrum of research.  Butts goes on to describe Pender’s theory as a “multidimensionality of persons interacting with their interpersonal and physical environments as they pursue health…” (2017 p. 445) The understanding of this theory is that it addresses the metaparadigms by acknowledging the patient or client, seeking health which can be determined by an illness, injury, or prevention, being guided, and educated by an advanced practice nurse, in the environment of choice.  The promotion of health is vital to the campaign for better health or fight against chronic disease.  No matter which outcome you seek, this model can provide measurable ways to track efficacy.  

            In one article written by authors Da Silva Santos et al., (2018), the research is described how they utilize “the Pender Health Promotion Model, which provides a simple and clear structure, allows for the planning, intervention and evaluation of actions of Nursing.”  (Da Silva Santos et al 2018, p. 583) This article measured how effectively advanced nursing interventions were in relation to HPV vaccinations and education in schools.  The Health Promotion Model was used to quantify research and understand if the education was productive in lowering incidences of HPV. (Da Silva Santos et al 2018, p. 583) This article along with many others uses a myriad of different health conditions to follow trends and efficacy to better provide health promotion.

            There are assumptions to this model.  To assure the accuracy of the data collected in researching this model, it is typically assumed that participants intend to follow the education and direction of the advanced practitioner, that there is no veering from the plan, and that all other things equal, the data inferred is correct.  These can sometimes be large assumptions, however for the greater good of the population, such assumptions must be made.

References:

Butts, J. B. (2017). Philosophies and Theories for Advanced Nursing Practice. [South 

University]. Retrievedfrom https://digitalbookshelf.southuniversity.edu/#/books/9781284143010/

Da Silva Santos, A., Amaral Viana, M. C., Camelo Chaves, E. M., De Morais Bezerra, A., 

Gonçalves Júnior, J., & Ribeiro Tamboril, A. C. (2018). Educational Technology Based on Nola Pender: Promoting Adolescent Health. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 12(2), 582–588. https://doi-org.su.idm.oclc.org/10.5205/1981-8963-v12i2a22609p582-588-2018

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing

 practice (6th ed.). Pearson.