The Psychiatric Mental Health Nurse Practitioner (PMHNP) will have to prescribe psychotropic drugs when treating the client with mental health disorders or even for chemical dependency. The clinician must be knowledgeable about how these medications work so that safe and effective treatment can be given to the client. According to Stahl (2013), thirty percent of psychotropic drugs impact the G-protein linked cascade, and twenty percent of psychotropic drugs target the ligand-gated ion channel. Understanding these systems give the practitioner clarity on how these drugs can be useful.

Agonist to Antagonist Spectrum

            Receptors are specialized proteins found in the cells or on the surface of neurons. (Nutt et al., 2007). Post-synaptic receptors generally regulate the actions of the released neurotransmitter (Nutt et al., 2007). Drugs may be referred to as agonists, partial agonists, antagonists, or inverse agonists, which means that they affect the level of neurotransmission at the post-synaptic neuron (Stahl, 2013). An agonist imitates the action of endogenous neurotransmitters.  Agonists may directly bind to the neurotransmitter site (which may cause a change in the shape of the receptor) or may indirectly cause an increase in the level of neurotransmitters released. A partial agonist also causes an increase in neurotransmission effects but does not have as high and effect as a full agonist would. An antagonist, on the other hand, may either block normal neurotransmission or cause a reversal in the shape of the receptor so that the effects are opposite to the agonist (Stahl, 2013). For example, in schizophrenia, it is believed that overactive or high levels of dopamine contribute to the illness; hence a D2 antagonist (such as Haldol) may be given to inhibit dopamine release (Guzman, 2019). An agonist will increase neurotransmitter signals or levels by a significant amount; partial agonist with also increase levels but not to the extent of the full agonist, while an antagonist will inhibit signals or reverse what an agonist has done.

G couple proteins and Ion Gated channels

            As stated earlier, G couple proteins and Ion gated channels are molecular targets for psychotropic drugs. Both G couple proteins and Ion- gated channels are activated by neurotransmitters which then activate genes in the cell nucleus (Stahl, 2013). G couple protein works have a cascade involving cAMP (cyclic adenosine monophosphate) and protein kinase A. On the other hand, the ion gated channel works through calcium, and it activates different kinase called calcium-dependent protein kinase (Stahl, 2013). Both systems affect gene expression; however they do so at via separate systems.

Epigenetics

            Neurotransmission seeks to modify the cell function of gene expression, meaning, turning some genes on and others off. When the cell nucleus changes, it is because the structure of chromatin is modified; hence, gene expression is modified. Epigenetics speaks to changes in the genes that lead to long term changes in how the gene is expressed. This is important in pharmacology as some illnesses such as cancer may have several mutations and, as such, may be challenging to treat (Stefanksa and MacEwan, 2015). However, if the changes in the genes that lead to cancer are studied, then drugs that target those genetic changes can be developed, hence, solving the root of the problem rather than trying to eradicate cancer. Simply put, change gene expression so that it does not lead to cancer (Stefanksa and Mac Ewan, 2015).

How It Impacts the Way Medications are Prescribed

As previously mentioned, prescribers/ clinicians need to know this information for safe, effective, and efficient treatment. Understanding the neuroscience can reduce prescriber error. Stahl (2013) discusses the fact that twenty percent of Asians are poor metabolizers of the Cytochrome CYP 2C19. Hence, the practitioner needs to know that psychotropic drugs metabolized by this enzyme need to be closely monitored as the drug can quickly build up in the patient’s bloodstream. Watching dosing strengths, as well as other medications that may further inhibit this enzyme, could cause an increase in drug levels in the body.

References

Andrade, C., & Sathyanarayana Rao, T. (2016, June). Classification of psychotropic drugs: Problems, solutions, and more problems. Indian Journal of Psychiatry, 58(2), 111-113. doi:10.4103/0019-5545.183771

Guzman, F. (2019, June 27). First-Generation Antipsychotics: An Introduction. In Psychopharmacology Institute. Retrieved from https://psychopharmacologyinstitute.com/publication/first-generation-antipsychotics-an-introduction-2110?canonical=/publication/first-generation-antipsychotics-an-introduction-2110

Guzman, F. (2019, June 27). D2 Receptors in Psychopharmacology. In Psychopharmacology Institute. Retrieved from https://psychopharmacologyinstitute.com/publication/d2-receptors-in-psychopharmacology-2116

Nutt, D., & Lingford-Hughes, A. Key concepts in Psychopharmacology. Psychiatry, 263-267. doi: 10.1016/j.mppsy.2007.05.00

Prep for Final Paper

This assignment is designed to guide you as you start your research for the Final Paper. Review the requirements for your Final Paper. Then, use the following guide as you write your assignment for Week Three:

• Final Paper Prep: For the Final Paper, you are to choose an emerging managed care delivery model, Accountable Care Organizations, or Patient-Centered Medical Homes. For this assignment, you will complete section two of your Final Paper – Managed Health Care Quality – to address how the selected emerging managed healthcare delivery model has done to improve quality of care.
• Annotated Bibliography: Provide an annotated bibliography of at least five of the required ten scholarly sources you will be using to write your Final Paper. An annotated bibliography starts with your source that is in APA format and followed by a brief descriptive and/or evaluative paragraph about your source. Follow the guide provided here 

The Prep for Final Paper assignment

• Must be three to five double-spaced pages in length (not including title and references pages) and formatted according to APA style 
• Must include a separate title page with the following:
  • Title of paper
  • Student’s name
  • Course name and number
  • Instructor’s name
  • Date submitted
• Must use at least three scholarly, peer-reviewed, and/or other credible sources in addition to the course text.
  • The Scholarly, Peer Reviewed, and Other Credible Sources (Links to an external site.)Links to an external site. table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment. Be sure to integrate your research (Links to an external site.)Links to an external site. rather than simply inserting it.
• Must document all sources in APA style as outlined here (Links to an external site.)Links to an external site. and here (Links to an external site.)Links to an external site..
• Must include a separate references page (Links to an external site.)Links to an external site. that is formatted according to APA style 

Many patient symptoms can be tied to multiple disorders, which may lead to misdiagnoses. For instance, consider two digestive disorders of the gastrointestinal tract—inflammatory bowel disease and irritable bowel syndrome. These two disorders are commonly confused because they present similar symptoms. As an advanced practice nurse, you must know the differences to properly diagnose and treat the disorders. How does the pathophysiology of inflammatory bowel disease compare to the pathophysiology of irritable bowel syndrome? How do treatments for the two disorders compare?

To Prepare

· Review Chapter 36 in the Huether and McCance text and Chapter 13 in the McPhee and Hammer text.

· Identify the pathophysiological mechanisms of inflammatory bowel disease and irritable bowel syndrome. Think about similarities and differences between the disorders.

· Consider common treatments for inflammatory bowel disease and irritable bowel syndrome. Reflect on whether treatments for one disorder would work for the other disorder.

· Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor you selected might impact the pathophysiology of and treatments for each disorder.

Post an explanation of the pathophysiological mechanisms of inflammatory bowel disorder and irritable bowel syndrome, including similarities and differences. Then describe common treatments, addressing whether treatments for one disorder would work for the other disorder. Finally, explain how the patient factor you selected might impact the pathophysiology of and treatments for each disorder.

https://class.waldenu.edu/bbcswebdav/institution/USW1/201910_27/MS_NURS/NURS_6501/Media/NURS_6501_Week08_media/index.htm

https://www.niddk.nih.gov/health-information/digestive-diseases

Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.

Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3. Consider the discussion and the any insights you gained from it.

4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.

Assignment:

Describe the qualifications to receive Medicare and/or Medicaid. How can this be modified to serve more people who are considered a vulnerable population?

Assignment Description: This assignment will be at least 1000 words or more.

This week you will reflect upon the Medicare and Medicaid programs to answer the following questions:

• How does Medicare affect medical billing?  
• Briefly define the qualifications for Medicare and Medicaid benefits.
• Describe the impact that the ACA has had on Medicare and Medicaid recipients.

Assignment Expectations: 

• Length:
  • 1000-1250 words (4-5 pages); answers must thoroughly address the questions in a clear, concise manner
• Structure:
  • Include a title page and reference page in APA style
• References:
  • Two scholarly references are required; you should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions
• Format:
  • Save your assignment as a Microsoft Word (.doc or .docx), Open Office (.odt) or rich text format (.rtf) file type
• File name:
  • Name your saved file according to your last name, first initial and the week (for example, “jonesb.week1”)
• Submission:
  • Submit your assignment to the Drop Box

“Health Demand, Elasticity, Principle and Agent in Determining Demand for Medical Care”  Please respond to the following:

• Use the   U.S. National Library of Medicine Website   and review the glossary of frequently encountered terms in Health Economics. and compare the primary individual factors that influence demand, and explain the significant ways in which each affects the demand curve. Provide at least one (1) example of these factors to support your rationale.
• Imagine a situation where consumers have incomplete information about their health status and about the productivity of medical care. Examine the roles of the principal and the agent in helping consumers to determine the demand for medical care in the described situation. Provide at least one (1) detailed example of such roles in action to support your response.