TABLE OF CONTENTS - NR 546 / NR546 Bundle Weeks 1 to 4 Notes Advanc...

Chamberlain University

NR 546 / NR546

Bundle Weeks 1 to 4 Notes Advanced Psychopharmacology

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TABLE OF CONTENTS

Week 1 – Psychopharmacology Founda�ons & Prescribing Principles Week 2 – Neurotransmi�ers & Drug Metabolism Week 3 – An�psycho�cs & Schizophrenia Week 4 – An�depressants & Mood Disorders 2 / 4

Week 1: Psychopharmacology Foundations 

Intro to Psychopharmacology The development of mental health conditions is linked to causes such as genetics, biochemical processes, environment, and lifestyle. Mental illness is common, and treatment often includes the use of psychotropic medications. When prescribing medications, the PMHNP must consider each client’s unique circumstances, including but not limited to their symptoms, age, physical health, previous response to treatment, and lifestyle.Prescribing Psychotropic Medications All medications have a mechanism of action that targets a speci�c process. In psychopharmacology, medications target symptoms related t o speci�c mental health diagnoses.Medications work within speci�c areas of the brain, or on speci�c neurotransmitters, to achieve symptom remission.According to the World Health Organization (WHO), the terms “psychoactive” and “psychotropic” may be used interchangeably and are the most neutral and descriptive terms for medications that a�ect mental processes.  The PMHNP must develop a clear understanding of neuroscience to guide the selection of medications to treat speci�c psychological symptoms. Objective data, such as laboratory results and imaging, are often used by providers to determine a diagnosis and guide treatment.However, the use of objective data is not always feasible when caring for clients with mental illness, making this specialty challenging. A diagnosis is determined based on the presenting symptoms and by utilizing well-developed interview techniques and assessment skills.The PMHNP must recognize that presenting symptoms may r epresent what is happening within the client’s brain. For example, changes or losses in grey matter are associated with numerous psychiatric diagnoses, including Alzheimer's disease, schizophrenia, and major depressive disorder (Stahl, 2021).Psychiatric prescribing has many challenges. Several factors hinder the e�ectiveness of psychiatric drugs making a one-size-�ts-all treatment plan impossible and even harmful. It is important to thoroughly understand the full scope of a client’s presenting symptoms. For example, a client who presents with depressive symptoms such as a lack of energy, somnolence, weight loss, and suicidal thinking may warrant treatment with a more stimulating antidepressant.On the contrary, a client who presents with both depressive and anxiety symptoms together may require a di�erent medication that will not aggravate their anxiety. Even though each of these clients may indeed be clinically depressed, it is imperative to evaluate their speci�c presenting symptoms to guide medication selection. Polypharmacy is common in treating psychiatric disorders, so a client may need more than one psychotropic medication to treat their symptoms.Lifestyle Factors Lifestyle factors such as smoking status, diet, exercise, history of medication adherence, or history of addiction should be considered when prescribing psychotropic medications. For example, a prescriber must be cautious when selecting medications for a client who su�ers from severe anxiety or panic disorder and has a history of abusing anti-anxiety medications such as benzodiazepines. Another consideration is that many psychotropic medications can cause weight gain; therefore, the provider should avoid prescribing these drugs to obese clients.  Lifespan Considerations Downloaded by Benjamin Luca ([email protected]) lOMoARcPSD|51648332 3 / 4

Careful consideration must be given to the client’s age, developmental level, emotional status, health status, and ability to participate in the medication administration process. Attention must also be given to the treatment needs of special populations.Pediatrics

: Pediatric clients have heightened drug sensitivity, show greater individual

variation, and are at increased risk for adverse drug reactions than adults. Dosage selection can be challenging because their brains and bodies are still developing.  Pregnancy/breastfeeding

:  The use of several psychotropic drugs during pregnancy can

result in birth defects, presence of the drug in breastmilk with a�ects to the breastfed child, or a�ect milk production. The potential risks to the fetus or breastfed child and bene�ts to the mother must be considered when prescribing psychotropic therapy.  Older adults

: Physiological changes associated with aging impact the drug processes of

absorption, distribution, metabolism, and excretion of medications, so lower than normal dosages may be needed. The most recent Beers Criteria should be reviewed to avoid prescribing potentially inappropriate medications for older adults. Older adults may also have multiple illnesses or chronic diseases for which other medications are prescribed; therefore, there is an increased risk of drug interactions.Adherence Poor adherence to medication and treatment plans can impact clients’ psychiatric and mental health outcomes. Adherence can be de�ned as persistence or compliance. Persistence is taking the medication over the intended period of time. Compliance is taking the medication as prescribed. The client, clinician, and structural factors all contribute to nonadherence.Client factors that contribute to nonadherence include concern about side e�ects, fear of addiction to medications, and misunderstanding of expected outcomes.Clinician factors that contribute to nonadherence include lack of shared decision-making with the client, providing inadequate education about medications, and lack of follow-up.Structural factors that contribute to nonadherence include medication access, medication cost, and stigma associated with mental illness.Dell’Osso et al. (2020) developed a sequential framework of priorities for providers to address when prescribing antidepressants to treat major depressive disorder. The components of this framework may also be useful to improve medication adherence for any client with mental health illness.  Diagnosis : con�rm diagnosis, explain biological determinants of illness Pharmacological treatment : discuss the need for pharmacological treatment, discuss client expectations and goals Medication Education : mechanism of action, anticipated time to experience e�ects, treatment duration, side e�ects, lifestyle instructions

Monitoring Plan : short-term, long-term

Adherence Reinforcement : family/social support, clinician availability

Ethical and Legal Considerations Ethical principles pertaining to client rights and legal considerations are essential concepts for consideration when prescribing psychotropic drug therapy.Informed consent : Clients have the right to receive enough information to make decisions about treatment. They must also be informed about potential risks associated with medications. Clients have the right to refuse treatment and cannot be forcibly medicated in non-emergencies. However, clients can be forcibly medicated if they are violent toward themselves or others and when less restrictive methods have failed.Downloaded by Benjamin Luca ([email protected]) lOMoARcPSD|51648332

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