Stahl’s Essential Psychopharmacology Homework Help

Use these two (2) references
• Stahl’s Essential Psychopharmacology, 3rd Edition
and  Basic and Clinical Pharmacology, 12th Edition

Stahl’s Psychopharmacotherapy – Chapter 9 (Psychosis and Schizophrenia) – Neurotransmitters and Circuits in Schizophrenia
Stahl’s Psychopharmacotherapy – Chapter 10 (Antipsychotics) – What makes an antipsychotic typical, What makes an antipsychotic atypical,
Stahl’s Psychopharmacotherapy – Chapter 12 (Antidepressants) – Antidepressant classes
Basic and Clinical Pharmacology – Chapter 29 (Antipsychotics and Lithium)
Basic and Clinical Pharmacology – Chapter 30 (Antidepressant agents) – Basic Pharmacology of Antidepressants

However, you could also use other references.

NOTE: ANSWER ALL QUESTIONS THOROUGHLY!!! And fill in all the spaces in the box.
The references above do not pertain to the nurse practitioner top 2 “go to” drug references. The references should be different and cited/

A) Drug References

QUESTIONS
1a. As a nurse practitioner, what are your top 2 “go to” drug references for figuring out information about medications, doses, dosage forms, routes, frequencies, etc.? If you use the resource electronically, please post the link in your reply.
b. What do you find to be the advantages and disadvantages to these resources? If you use the resource electronically, please post the link in your reply.

 

Dopamine
B) Medications and Dopamine

1a) List the 8 types of medications which can affect dopamine

 

 
1b) List the mechanisms (4) by which dopamine is broke down Increase Dopamine Decrease Dopamine
Dopamine agonist

5HT-2C

 

 

 

 
Monoamine Oxide A or B

Pre-synaptic stimulation of D2

C) Dopamine (DA) and schizophrenia

2a) Identify tracts in the brain which require dopamine stimulation

2b) Described the ADRs (or lack thereof) when there is an increase stimulation of dopamine on the various tracts

2c) Described the action of a potent dopamine antagonists Dopamine Tract Function Normal Dopamine Increased Dopamine Effect (Schizophrenia) Pure DA Antaognist Effect
Mesolimbic Arousal, memory, stimulus processing, motivational behavior
Mesocortical Causes negative symptoms and worsen cognitive and affective symptoms
Nigrostriatal tract No abnormal movements EPS / inappropriate movement
Tuberoinfundibular

D) Dopamine and depression

2a) Which specific symptoms of depression do DRI’s work best on?

2b) Which specific symptoms of depression DRI’s work worse on?

2c) Which specific side effects do DRI’s cause in the short-term? In the long term?

2d) What percentage of DA occupancy is needed to have an antidepressant effect? Mania effect?
Norepinephrine
E) Medications and Norepinephrine

1a) List the 1 types of medications which can affect NE

 

 

 
1b) List the receptors NE can agonize and the resulting action (8 total)

 

 

 

 
1c) List the mechanisms (4) by which dopamine is broke down Increase Norepinephrine
Serotonin/Norepinephrine Reuptake Inhibitors (SNRI)

 

 

 

 

 

Receptor Action
Alpha 1 Increase BP
Post-synaptic alpha 2A
Post-synaptic alpha 2B
Post-synaptic alpha 2C
Pre-synaptic alpha 2 Prevents further release of NE
Beta-1 Bronchodilator
Beta-2 Tachycardia
Beta-3 Reduce urination

 

 

 

 

 
Catechol-o-methyl transferase (COMT)
F) Norepinephrine (NE) and depression

2a) Which specific symptoms of depression do SNRI’s work best on?

2b) Which specific symptoms of depression SNRI’s work worse on?

2c) Which specific side effects do SNRI’s cause in the short-term? In the long term?
Serotonin
G) Serotonin and medications

1a) List the 2 types of medications which can affect serotonin

 

 

 
1b) List the receptors serotonin can agonize and the resulting action

 

 

 

 
1c) List the mechanisms (3) by which serotonin is broken down Increase Serotonin
Selective Serotonin-reuptake inhibitor (SSRI)

 

 

 

 
Receptor Action
5HT-1A
5HT-1B/D (post-synaptic)
5HT-1B/D (post-synaptic)
5HT-2A
5HT-2C
5HT-3 Anxiety, N/V, increase risk for seizures
5HT-4 Stimulates GI motility
5HT-5 Sleep-Wake cycle (no current meds)
5HT-6 Treatment of depression, anxiety, OCD (no current meds)
5HT-7 Autism (no current meds)

Serotonin Transporter
H) Serotonin and depression

2a) How long does it take for a serotonin reuptake inhibitor to have an effect on depression? Why does it take this duration?

2b) How long does it take for serotonin reuptake inhibitor to cause side effect? Why does it take this duration?

2c) Which specific symptoms of depression do SSRI’s work best on?

2d) Which specific symptoms of depression SSRI’s work worse on?

2e) Which specific side effects do SSRI’s cause in the short-term? In the long term?

Serotonin reuptake inhibitors typically 4-6 weeks to have an effect on depressive symptoms. Although there is an initial increase in serotonin once the medication is started, it takes several weeks for the somatodendritic 5HT-1a2 autoreceptors to become desensitized.
I) Serotonin and other effects

What are effects on the following receptors in terms of increasing and decreasing symptoms:

5HT1A:
5HT2A:
5HT2C:
5HT3:

5HT1A: Improved cognition, reduction in anxiety, reduction in depression

5HT2A:

5HT2C:

5HT3:
Glutamate
J) Glutamate and medications

1) List medications (prescription or illicit) which can either positively affect glutamate for schizophrenia

Positive Effects Negative Effects
None

K) Glutamate and schizophrenia

2a) Identify tracts in the brain which require glutamate stimulation

2b) Described the ADRs (or lack thereof) when there is an increase and decrease stimulation of glutamate on the various tracts
Glutamate Tract
On NMDA Function Glutamate Hypostimulation Glutamate Antagonism
Mesolimbic Reduces dopamine stimulation No effect Psychosis / hallucinations (schizophrenia-like)
Mesocortical
Corticostriatal
Cortical Pyramidal Neurocognitive processing

Other Receptors
L) Other Receptors
What are effects on the following receptors in terms of increasing and decreasing symptoms:

Alpha-1
Histamine (H1)
Muscarinic (M1)
Alpha-1:

Histamine: Increase in sleep, decrease in anxiety, increase in drowsiness, increase in weight

Muscarinic: