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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.
