ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER

For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorder on the following:

  • Prevalence and Neurobiology of your chosen disorder
  • Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria
  • Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category:  legal considerations, ethical considerations, cultural considerations, social determinants of health
  • Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder
  • Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings.  What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
  • Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.

Week 4 Dec 20 by 10:59pm

  • Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
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  • Review this week’s Learning Resources, including the Medication Resources indicated for this week.
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of vulnerable patient populations requiring antidepressant therapy.

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your patient guide, include discussion on the following:

  • Depressive disorder causes and symptoms
  • How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
  • Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
  • Medication considerations of medication examples prescribed (see last bullet item)
  • What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
  • Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
  • Where to follow up in your local community for further information
  • Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.

Response 2

Respond to your peers post: 

 

Reginald

The agonist-to-antagonist spectrum of action of psychopharmacologic agents

In psychopharmacology, the agonist-antagonist spectrum describes the various ways in which medications affect neurotransmitter receptors and, by extension, brain transmission and behavior. In the same way that neurotransmitters work by activating receptors, antagonists work by inhibiting receptor activity. Situated in the middle of the spectrum, partial agonists are able to activate receptors, although they are not as effective as full agonists. Rarer still are the inverse agonists, which have the opposite effect of agonists and lower baseline receptor activity. The use of partial agonists, such as aripiprazole, in antipsychotic medication, brings a more sophisticated strategy (Jacobson et al., 2023). They have the ability to customize responses due to their intermediate efficacy, which could reduce the negative effects that come with full agonists. This quality comes in handy when maintaining a steady equilibrium of neurotransmitter activity is of the utmost importance. In diseases where increased baseline activity is a pathogenic factor, an interesting new route has opened up with the advent of inverse agonists, which work by decreasing constitutive receptor activity.

When looking to optimize psychopharmacologic therapy, it is crucial to consider the agonist-to-antagonist spectrum. It paves the way for an individualized strategy in which pharmacological choices are in harmony with individual neurobiological diversity. Clinicians can optimize therapy techniques by utilizing partial agonists and inverse agonists, with the goal of maximizing therapeutic advantages while minimizing undesirable effects (Jacobsonet al.,2023). The spectrum highlights the intricate nature of brain regulation, highlighting the necessity for a deep comprehension to traverse the complexities of psychopharmacologic treatments in the field of mental health.

Compare and contrast the actions of g couple proteins and ion gated channels.

Ion-gated channels and G-protein-coupled receptors (GPCRs) both play important roles in cellular signaling, but they do it in different ways. Upon attaching to ligands, GPCRs—transmembrane proteins—activate G proteins, setting in motion signaling cascades. Multiple cellular responses are affected by the activation-induced regulation of second messenger systems. Proteins called ion-gated channels create holes in cell membranes and allow ions to pass through in reaction to signals like ligand binding or voltage changes.

Rapid and temporary reactions are mediated by ion-gated channels, which allow the quick passage of ions across membranes, in contrast to GPCRs, which elicit slower and protracted cellular responses through complex signaling pathways. While ion-gated channels mainly affect membrane potential and electrical nervousness, they play an important role in activities like potential for action propagation; GPCRs control respiration and gene expression, among many other things (Duncan et al., 2020). In order to orchestrate different physiological reactions with variable temporal dynamics, GPCRs and ion-gated channels represent separate techniques in cellular communication.

Contribution of the role of epigenetics in pharmacologic action.

The field of epigenetics, which researches heritable changes in gene expression that do not involve modifications to the DNA sequence, has a substantial impact on the pharmacologic effects. The regulations of gene expression patterns are influenced by epigenetic alterations, which include DNA methylation, histone modifications, and non-coding RNA. These changes have an effect on the results and effectiveness of pharmacologic treatments. Drug pharmacokinetics and pharmacodynamics are shaped by epigenetic control, which directly affects the expression of genes involved in drug metabolism, transport, and target receptors. When it comes to medication responses, there is a lot of diversity between individuals that isn’t just due to genetics. Epigenetic differences add another degree of complexity to this. A complex comprehension of epigenetic effects is required in precision medicine due to the individuality of pharmacological reactions, which is facilitated by this variation.

Epigenetic alterations play a pivotal role in cancer therapy, and medications that target these alterations change patterns of gene expression, opening up new treatment possibilities (Tomaselli et al., 2020). Furthermore, epigenetic alterations may direct pharmacologic therapies and function as biomarkers for illness diagnosis and prognosis. Epigenetics has a significant role in gene control, and understanding this role can lead to better pharmacological therapies, more effective treatments, and more tailored pharmacologic approaches.

Impact of the prescription of medications to patients.

In my role as a mental health nurse practitioner, my knowledge of epigenetics greatly impacts how I prescribe drugs. It stresses the significance of taking into account the fact that pharmacological responses can vary from patient to patient and of customizing treatments according to each patient’s own genetic and epigenetic profile. As an example of a real-world application, consider the widespread usage of antidepressants, especially SSRIs, which are designed to block the uptake of serotonin.

A person’s reaction to selective serotonin reuptake inhibitors (SSRIs) may vary, for example, depending on their unique methylation status of genes like SLC6A4, which encodes a serotonin transporter. The medication’s effectiveness and the rate of therapeutic effect onset may be affected by epigenetic changes on these genes. Knowing a patient’s epigenetic profile may lead to a reevaluation of therapy options in the event that an SSRI fails to alleviate a patient’s depression (Tomaselli et al., 2020). To maximize results, it may be necessary to make modifications, such as adjusting the dosage or drug, taking into account the specific genetic and epigenetic characteristics of each patient. This tailored strategy improves the efficacy of mental medication in accordance with the tenets of precision medicine.

 

 

Discussion response 1

Respond to your peers discussion post: 

 

 

Anthony Adesina

 

Manage Discussion Entry

Drugs classified as antagonists bind to target receptors with affinity and alter receptor activity to cause a reaction (intrinsic efficacy). There is a connection between antagonist medications and their lack of intrinsic efficacy. Stated differently, antagonists attach themselves to target receptors without causing an action (Seyedabadi et al., 2019). Antagonists decrease the likelihood of agonists occupying a given fraction of the receptor population. An increase in the agonist’s concentration raises the probability of receptor occupancy (Berg & Clarke, 2018).

Two ideas in pharmacology, inverse and functional agonists, greatly influence how drugs are used in medicine and how they evolve and change (Berg & Clarke, 2018). A novel class of ligands known as inverse agonists lowers receptor activity. It has the opposite impact of what an agonist does. The drug’s intrinsic efficacy is unaffected by the system in which it functions. To put it another way, different drugs with single receptors have different intrinsic efficacies based on the measured receptor and response. According to Berg and Clarke (2018), a drug can function as an agonist, antagonist, and inverse agonist simultaneously. When using drugs as medicine, functional selectivity, and inverse agonists need to be taken into account.

G protein-coupled receptors are known as metabotropic receptors and ligand-gated ion channels are known as ionotropic receptors. The movement of inorganic ions is the focus of the ion channel.

G proteins regulate ion channels, transporter proteins, metabolic enzymes, and transcription regulation. According to Stefanska and MacEwan (2015), it controls a variety of systemic processes, including learning and memory, homeostasis, and embryonic development

 Taking into account the patient’s condition, family history, and the genetic implications of the diagnosis and course of treatment, this information influences the medication that a nurse practitioner prescribes. Age significantly affects how well a patient responds to antipsychotic medication for psychotic behavior, such as dementia (McCarty et al., 2018). Sometimes aging affects how drugs are metabolized, rendering a medication ineffective. Antipsychotic changes brought on by aging-related epigenetic modifications impact the pharmacokinetics and pharmacodynamics of drug metabolism. An adequate understanding of the changes will impact the prescriber’s decision to minimize side effects and maximize the medication’s actions (Camprodon & Roffman, 2016).