NSC2500: Assignment 1 Essay Answer

Abstract

Depression is the most prevalent psychiatric disorder in the world that is affecting 4.4% of the global population. Signs and symptoms include sadness and sudden loss of interest and take away the hope of living. The main points of discussion are the pathophysiology of depression and its impact on hemostasis. Secondly, it will discuss the pharmacology of the drug class: Serotonin–dopamine reuptake inhibitor (SDRI) or selective serotonin reuptake inhibitors (SSRI). The class of drugs acts on the receptor that leads to the restoration of the balance of hormones by which depression can be managed. The class of drugs is an effective one with fewer side effects and relieves the condition within 3-4 weeks of administration. Having an understanding of the pharmacology of a drug and its contraindication will lead to safe practices. It allows the nurses to deliver person-centred care. The essay will be presenting information in different sections where the primary sections give facts about pathophysiology followed by a discussion of the pharmacology of drugs. Lastly, it will discuss person-centred care.

Introduction

Depression is a common and serious medical illness that adversely affects how you feel, the way you think and how you act. Signs and symptoms include a feeling of sadness or loss of interest in activities once anyone is enjoying them (Spellman & Liston 2020). A drop in oestrogen and progesterone triggers depressive disorders. The fluctuation in the level of hormones will result in depressive episodes that will make an individual suffer. Depression affects one in 15 adults and one in 6 people experiences depression once in a lifetime. The essay will discuss depression and its pathophysiology that impacts the normal physiology and homeostasis of the system. Followed by a discussion of medication (Fluoxetine) that is used for the treatment of diseases. Lastly, it will cover the important aspects of clinical practices by which person-centred care is delivered.

Depression: its Pathophysiology

The pathophysiology of depression consists of serotonergic, noradrenergic and dopaminergic neurons that are situated in the midbrain and brain stem nuclei and project into the entire brain. The anatomy suggests that monoaminergic systems are involved in regulatory activities of brain function that include mood, attention, reward processing, sleep and appetite. In the brain, every compound secretion will direct the inhibition of the reuptake of monoamines and lead to an increase in the concentration of monoamine in the synaptic cleft. Inhibition of enzyme monoamine oxidases and their increasing concentration will lead to the inhibition of antidepressant effects. To better understand the pathophysiology of depression, the monoamine-deficiency theory that is the basis of depression. It is found that serotonin is a major neurotransmitter in depression. The reported abnormalities of serotonin receptors will be acting in the condition. Serotonin 1A receptor is involved in the regulation of the functioning of serotonin and decreasing the availability of receptors will lead to multiple areas of the brain getting affected (Delhaye & Bardoni, 2021). The high rate of monoamine oxidase by which the metabolism of serotonin is taking place causes the deficiency of serotonin. It will result in the loss of the production of serotonin which is a risk factor for depression. On the other hand, studies show that the reduction in total gamma-aminobutyric acid (GABA) in the prefrontal and occipital cortex is triggering acute depression (Yang et al., 2020). The declining rate of neurotransmitters will make a change in the neuroactive steroid synthesis. It will making an individual experience depressive symptoms that includes diurnal variations (mood, psychomotor and accessing positive and negative memory. Receptors' unavailability, production of enzymes and inactivation of active sites will outcomes in depression in an individual.

Pharmacology of Drug (SDRI)

Serotonin–dopamine reuptake inhibitor (SDRI) or selective serotonin reuptake inhibitors (SSRI) is the category of drug that acts as a reuptake inhibitor of monoamine neurotransmitters and dopamine by blocking the action of serotonin transporters (Mathew et al., 2023). Fluoxetine is commonly used to treat depression and is the first line of pharmacotherapy used for treating psychiatric disorders (Mathew et al., 2023). The action is based on the increasing deficient serotonin that is causing the depression and found a potential cause in the monoamine hypothesis. Fluoxetine belongs to the class of medication that is used for the treatment of depression. SSRI (Fluoxetine) holds the ability to block serotonin transporters that are increasing the extracellular levels of serotonin within the synaptic cleft. 5HT2A, 5-HT3 and 5HT2C are the main receptors of serotonin and make the initial activation of postsynaptic clefts (Correia et al., 2023). The receptors make the downregulation post lag 2-3 weeks that makes the flowing down of the level of serotonin in the presynaptic neuron and neuron firing. It is a short-term action of drugs that makes the management of signs and symptoms.

 Secondly, the Fluoxetine acts on noradrenaline and dopamine which enhances the 5-HT transmission in the locus of coeruleus. The activation of 5-HT leads to the 5-HT2A receptors on GABA neurons that are exerting inhibitory action on neurons (Edinoff et al., 2021). It will increase the rate of gamma-aminobutyric acid. Reduction of NA in the amygdala leads to emotional blunting in depression. In addition, the reduction of frontal dopamine is contributing to the pathogenesis of depression. The intake of drugs will make a positive shift in the brain by which the emotionally valenced information is going to be promoted. It will allow treatment to occur in early phases. Lastly, the BDNF receptor (the transmembrane of the tyrosine kinase receptor) facilitates the expression and signalling of brain-derived neurotrophic factors (Lochmann & Richardson, 2019). It will act in synergy by which the synaptic plasticity and neurogenesis in areas of the brain that are involved in depression. The treatment will be effective within 4-5 weeks of initiating the drugs with fewer side effects.

Important Aspects of DrugInteractions and Other Factors

Fluoxetine can be administered orally in multiple forms including tablets, capsules, and liquid suspensions. It is once in a day medication that is taken in the morning and at night time. It is important to take care of the schedule like Vilazodone needs to be administered after food. Food and drug administration issued a black box warning for the medication that is possible due to the risk factor like suicide among pediatric and young adults (Protti et al., 2020). It is potentially having a prolonged QT interval that can result in fatal arrhythmia. More than the usual level of the drug will increase the serotonin activity and lead to the risk of serotonin syndrome that is due to the intake of multiple medications that cause serotonergic effects. In addition, the metabolism impacts the cytochrome P450 system. It will restrict the biotransformation of drugs and lead to poor interaction with the system (Edinoff et al., 2021). Taking care of the contraindication while prescribing the drug will lead to regulated functioning and less of adverse effects.

Before the administration of selective serotonin reuptake inhibitors (Fluoxetine), pregnancy and breastfeeding needs to be checked. Any individual below the age of 18 years need not be prescribed medication. Taking the consideration of chronic conditions like diabetes, epilepsy and kidney diseases (Nichols et al., 2023). It will lead to the contraindication of Fluoxetine that is reporting a high number of side effects. Following are the points that need to be assured before prescribing the medication, and intake of alcohol. Heavy drinking creates a harder situation to treat depression. Discontinuation syndrome will consist of suddenly stopping taking medication that is dangerous and might lead to the appearance of signs and symptoms. In addition, taking care of the cardiac risk factor and monitoring the QT prolongation and that is resulting in serious arrhythmias (Demir et al., 2019). Anxiety, insomnia and dysfunction require regular assessment that makes the comorbidities. Polypharmacy restricts the action of drugs and limits the action toward the condition. In this, it is crucial to managing the time, route of drugs and concentration at which it is prescribed (Jia & Bartlett, 2020). Addressing the contraindication and taking into consideration physical parameters allow effective drug action.

Relevance to Clinical Practice in Dealing with the Disorder

Understanding the pharmacology of drugs will help efficient nursing practices. Tricyclic antidepressants, the nursing consideration involves the side effects of antidepressants on anticholinergic. It leads to tachycardia, retention of the urinary system, constipation, dry mouth and confusion that will impact the central nervous system. SSRI is a second-generation antidepressant and has fewer side effects than TCA. Getting an understanding of the SSRI medication will help in the safe prescription of medication (Escrivá Gracia et al., 2019). Patients who will be taking CNS medication and have dysfunction of the liver need to be careful while having medication. Pharmacology (Fluoxetine)makes nurses monitor the ideation of suicide in the population and lowers the chances of serotonin syndrome. In addition, it will help the nurses to ensure that the dosage adjustment is performed for patients with renal and liver diseases. Gained knowledge can be applied in the field of psychiatry and psychology that allows drug toxicity to get limited and increase the outcomes for patients. It will cover vast aspects of drugs by which the side effects can be controlled.

Conclusion

In conclusion, pharmacology is a scientific study of the effects of drugs and chemicals on a living system. It allows the understanding of what the receptors are and how the mechanism of the drug will take place. Gain insight into the disease and relevant drugs will manage the signs and symptoms. Depression is the depletion of neurotransmitters serotonin and dopamine in the central nervous system. It will lead to the management of the level of hormones and manage the signs and symptoms. Serotonin–dopamine reuptake inhibitors (SDRI) or selective serotonin reuptake inhibitors (SSRI) is a class of drugs that regulate the receptor and mediate the signalling. Fluoxetine holds the ability to block serotonin transporters that are increasing the extracellular levels of serotonin within the synaptic cleft. Comprehensive knowledge of medication allows the prescription and side effects to be controlled. It will lead to safe and person-centred practices by which quality and outcomes can be assured.

References

Correia, A. S., Cardoso, A., & Vale, N. (2023). Oxidative Stress in Depression: The Link with the Stress Response, Neuroinflammation, Serotonin, Neurogenesis and Synaptic Plasticity. Antioxidants, 12(2), 470.https://doi.org/10.3390/antiox12020470

Delhaye, S., & Bardoni, B. (2021). Role of phosphodiesterases in the pathophysiology of neurodevelopmental disorders. Molecular Psychiatry, 26(9), 4570-4582.https://doi.org/10.1038/s41380-020-00997-9

Demir, Y., Balcı, N., & Gürbüz, M. (2019). Differential effects of selective serotonin reuptake inhibitors on paraoxonase-1 enzyme activity: An in vitro study. Comparative biochemistry and physiology part C: toxicology & pharmacology, 226, 108608.https://doi.org/10.1016/j.cbpc.2019.108608

Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., ... & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: a narrative review. Neurology International, 13(3), 387-401.https://doi.org/10.3390/neurolint13030038

Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC health services research, 19(1), 1-9.https://doi.org/10.1186/s12913-019-4481-7

Jia, E., & Bartlett, M. G. (2020). Recent advances in liquid chromatographic methods for the determination of selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. Biomedical Chromatography, 34(3), e4760.https://doi.org/10.1002/bmc.4760

Lochmann, D., & Richardson, T. (2019). Selective serotonin reuptake inhibitors. Antidepressants: From biogenic amines to new mechanisms of action, 135-144.https://link.springer.com/chapter/10.1007/164_2018_172

Mathew, S., Orzechowski, N., Teja, N., Thakur, D., Scudder, P., & Albert, D. (2023). An Approach to Psychiatric Illness in Rheumatology Clinics. Current Rheumatology Reviews, 19(1), 7-17.https://doi.org/10.2174/1573397118666220518150230

Nichols, A. L., Blumenfeld, Z., Luebbert, L., Knox, H. J., Muthusamy, A. K., Marvin, J. S., ... & Lester, H. A. (2023). Selective Serotonin Reuptake Inhibitors within Cells: Temporal Resolution in Cytoplasm, Endoplasmic Reticulum, and Membrane. Journal of Neuroscience, 43(13), 2222-2241.https://doi.org/10.1523/JNEUROSCI.1519-22.2022

Protti, M., Mandrioli, R., Marasca, C., Cavalli, A., Serretti, A., & Mercolini, L. (2020). New‐generation, non‐SSRI antidepressants: Drug‐drug interactions and therapeutic drug monitoring. Part 2: NaSSAs, NRIs, SNDRIs, MASSAs, NDRIs, and others. Medicinal Research Reviews, 40(5), 1794-1832.https://doi.org/10.1002/med.21671

Spellman, T., & Liston, C. (2020). Toward circuit mechanisms of pathophysiology in depression. American Journal of Psychiatry, 177(5), 381-390.https://doi.org/10.1176/appi.ajp.2020.20030280

Yang, T., Nie, Z., Shu, H., Kuang, Y., Chen, X., Cheng, J., ... & Liu, H. (2020). The role of BDNF on neural plasticity in depression. Frontiers in cellular neuroscience, 14, 82.https://doi.org/10.3389/fncel.2020.00082

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