Study Notes NURS 6630: Psychopharmacology for Advanced Practice Nursing
1. Introduction
NURS 6630 is a graduate‑level course designed for advanced practice nurses, particularly psychiatric mental health nurse practitioners (PMHNPs).
Focus: Pharmacological management of psychiatric disorders across the lifespan.
Emphasizes:
Mechanisms of action of psychotropic drugs.
Clinical decision‑making in prescribing.
Monitoring efficacy and side effects.
Ethical and legal considerations.
Goal: Prepare nurses to safely prescribe and manage psychiatric medications in diverse populations.
2. Foundations of Psychopharmacology
Neurobiology of Mental Illness:
Imbalances in neurotransmitters (serotonin, dopamine, norepinephrine, GABA, glutamate).
Structural and functional brain changes.
Pharmacokinetics:
Absorption, distribution, metabolism, excretion.
Factors: age, liver/kidney function, drug interactions.
Pharmacodynamics:
Drug‑receptor interactions.
Dose‑response relationships.
3. Antidepressants
SSRIs (Selective Serotonin Reuptake Inhibitors): fluoxetine, sertraline, citalopram.
Indications: depression, anxiety, OCD.
Side effects: GI upset, sexual dysfunction, insomnia.
SNRIs (Serotonin‑Norepinephrine Reuptake Inhibitors): venlafaxine, duloxetine.
Indications: depression, neuropathic pain.
Side effects: hypertension, nausea.
Atypical Antidepressants: bupropion, mirtazapine.
Bupropion: smoking cessation, less sexual side effects.
Mirtazapine: sedation, weight gain.
Tricyclic Antidepressants (TCAs): amitriptyline, nortriptyline.
Side effects: anticholinergic, cardiac toxicity.
MAOIs (Monoamine Oxidase Inhibitors): phenelzine, tranylcypromine.
Dietary restrictions (tyramine → hypertensive crisis).
4. Antipsychotics
Typical (First‑Generation): haloperidol, chlorpromazine.
Mechanism: dopamine D2 receptor antagonists.
Side effects: extrapyramidal symptoms (EPS), tardive dyskinesia.
Atypical (Second‑Generation): risperidone, olanzapine, quetiapine, clozapine.
Mechanism: serotonin‑dopamine antagonists.
Side effects: metabolic syndrome, weight gain, agranulocytosis (clozapine).
Indications: schizophrenia, bipolar disorder, severe agitation.
5. Mood Stabilizers
Lithium:
Gold standard for bipolar disorder.
Monitor serum levels, renal and thyroid function.
Side effects: tremor, polyuria, hypothyroidism, toxicity.
Anticonvulsants: valproate, carbamazepine, lamotrigine.
Valproate: effective for mania, monitor liver function.
Carbamazepine: risk of agranulocytosis, drug interactions.
Lamotrigine: effective for bipolar depression, risk of Stevens‑Johnson syndrome.
6. Anxiolytics
Benzodiazepines: lorazepam, diazepam, alprazolam.
Indications: acute anxiety, insomnia, seizures.
Risks: dependence, sedation, respiratory depression.
Buspirone:
Non‑sedating, non‑addictive.
Delayed onset, useful for generalized anxiety disorder.
SSRIs/SNRIs: first‑line for chronic anxiety disorders.
7. Stimulants and ADHD Medications
Stimulants: methylphenidate, amphetamines.
Mechanism: increase dopamine/norepinephrine.
Side effects: insomnia, appetite suppression, cardiovascular risks.
Non‑stimulants: atomoxetine, guanfacine, clonidine.
Atomoxetine: norepinephrine reuptake inhibitor.
Guanfacine/clonidine: alpha‑2 agonists, useful for hyperactivity.
8. Special Populations
Children/Adolescents:
Careful dosing, monitor growth and development.
Older Adults:
Polypharmacy risks, altered pharmacokinetics.
Pregnant/Lactating Women:
Risk‑benefit analysis, teratogenicity concerns.
Cultural/Ethnic Considerations:
Genetic variations in drug metabolism (e.g., CYP450 enzymes).
9. Ethical and Legal Considerations
Prescriptive Authority: Varies by state/country.
Informed Consent: Discuss risks, benefits, alternatives.
Confidentiality: HIPAA compliance.
Monitoring for Misuse: Especially with controlled substances.
10. Clinical Decision‑Making
Assessment: Comprehensive psychiatric evaluation.
Diagnosis: DSM‑5 criteria.
Treatment Planning: Integrate pharmacological and non‑pharmacological interventions.
Monitoring: Side effects, adherence, therapeutic response.
Interprofessional Collaboration: Work with physicians, pharmacists, therapists.
11. Case Example
Patient: 35‑year‑old with bipolar disorder.
Treatment: Lithium initiated, regular monitoring of serum levels.
Outcome: Stabilized mood, improved functioning, mild tremor managed with dose adjustment.
12. Summary
NURS 6630 equips advanced practice nurses with knowledge and skills in psychopharmacology.
Covers antidepressants, antipsychotics, mood stabilizers, anxiolytics, stimulants.
Emphasizes safe prescribing, monitoring, and ethical practice.
Prepares nurses to manage psychiatric medications across diverse populations.
Quiz (15 Questions)
Multiple Choice – Select the best answer.
Which neurotransmitter is primarily targeted by SSRIs? a) Dopamine b) Serotonin c) GABA d) Norepinephrine
Which antidepressant requires dietary restrictions due to tyramine interactions? a) SSRI b) SNRI c) MAOI d) TCA
Which antipsychotic carries a risk of agranulocytosis? a) Risperidone b) Clozapine c) Haloperidol d) Olanzapine
Which mood stabilizer requires monitoring of renal and thyroid function? a) Valproate b) Lamotrigine c) Lithium d) Carbamazepine
Which benzodiazepine is commonly used for acute anxiety? a) Buspirone b) Lorazepam c) Atomoxetine d) Fluoxetine
Which non‑benzodiazepine anxiolytic is non‑addictive? a) Diazepam b) Buspirone c) Alprazolam d) Clonazepam
Which stimulant is commonly prescribed for ADHD? a) Methylphenidate b) Lithium c) Risperidone d) Valproate
Which non‑stimulant ADHD medication is a norepinephrine reuptake inhibitor? a) Atomoxetine b) Guanfacine c) Clonidine d) Buspirone
Which antidepressant is associated with sexual dysfunction? a) Bupropion b) Mirtazapine c) SSRI d) Lamotrigine
Which antipsychotic class is associated with extrapyramidal symptoms (EPS)? a) Typical (First‑Generation) b) Atypical (Second‑Generation) c) SSRIs d) SNRIs
Which mood stabilizer carries a risk of Stevens‑Johnson syndrome? a) Lithium b) Lamotrigine c) Valproate d) Carbamazepine
Which population is at higher risk of polypharmacy complications? a) Children b) Adolescents c) Older adults d) Pregnant women
Which law governs confidentiality in prescribing psychiatric medications? a) OSHA b) HIPAA c) FDA d) CMS