Chamberlain University
NR 546 / NR546
Bundle
Weeks 1 to 4 Notes
Advanced Psychopharmacology
,TABLE OF CONTENTS
Week 1 – Psychopharmacology Foundations &
Prescribing Principles
Week 2 – Neurotransmitters & Drug Metabolism
Week 3 – Antipsychotics & Schizophrenia
Week 4 – Antidepressants & Mood Disorders
, lOMoARcPSD|51648332
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 specific process. In
psychopharmacology, medications target symptoms related to specific mental health diagnoses.
Medications work within specific areas of the brain, or on specific 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 affect mental processes.
The PMHNP must develop a clear understanding of neuroscience to guide the selection of
medications to treat specific 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 represent 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 effectiveness of
psychiatric drugs making a one-size-fits-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 different medication that will not aggravate their anxiety. Even though each of these
clients may indeed be clinically depressed, it is imperative to evaluate their specific 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 suffers 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 ()
, lOMoARcPSD|51648332
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 affects to the breastfed
child, or affect milk production. The potential risks to the fetus or breastfed child and
benefits 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 defined 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 effects, 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: confirm 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 effects,
treatment duration, side effects, 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 ()
NR 546 / NR546
Bundle
Weeks 1 to 4 Notes
Advanced Psychopharmacology
,TABLE OF CONTENTS
Week 1 – Psychopharmacology Foundations &
Prescribing Principles
Week 2 – Neurotransmitters & Drug Metabolism
Week 3 – Antipsychotics & Schizophrenia
Week 4 – Antidepressants & Mood Disorders
, lOMoARcPSD|51648332
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 specific process. In
psychopharmacology, medications target symptoms related to specific mental health diagnoses.
Medications work within specific areas of the brain, or on specific 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 affect mental processes.
The PMHNP must develop a clear understanding of neuroscience to guide the selection of
medications to treat specific 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 represent 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 effectiveness of
psychiatric drugs making a one-size-fits-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 different medication that will not aggravate their anxiety. Even though each of these
clients may indeed be clinically depressed, it is imperative to evaluate their specific 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 suffers 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 ()
, lOMoARcPSD|51648332
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 affects to the breastfed
child, or affect milk production. The potential risks to the fetus or breastfed child and
benefits 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 defined 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 effects, 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: confirm 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 effects,
treatment duration, side effects, 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 ()
