NR 546 WEEK 2 NEUROTRANSMITTERS ULTIMATE STUDY GUIDE 2025 | 41 Q&A WITH DETAILED RATIONALES & DRUG MECHANISMS | COVERS DOPAMINE, GABA, GLUTAMATE PATHWAYS & PSYCHOPHARMACOLOGY | GUARANTEED PASS

Which client factor(s) impact the effect of psychotropic medications and should be considered when prescribing psychotropic medications.

age

smoking

caffiene

perscrined medication

over the counter medications

the chemical transmission of information between neurons and their target cells is called ______________

Neurotransmission

The neurotransmitters that most impact mental health can be classified into four major categories:

1.cholinergics (acetylcholine)

2.monoamines (norepinephrine, dopamine, serotonin, and histamine)

3.amino acids (gamma- amino-butyric acid and glutamate), and 4.neuropeptides

Psychotropic medications often impact neurotransmitters by either enhancing or decreasing the neurotransmitters' ability to bind to receptor sites

True

I am the chief inhibitory neurotransmitter (NT). The opposite of Glu. I decrease neuroexcitability across the brain. I bring the “chill” to the party. I say party because people really like me when I take the edge off stress and help them calm down. Some meds use my benefits to help people sleep for medical procedures. I help people relax, destress, and get some sleep.

GABA (gamma-aminobutyric acid.)

When people don't have enough of GABA they may experience

anxiety or even

schizophrenia.

You can see my effects when people drink alcohol. A few drinks and people are super social and up for just about anything. I’m told these are great benefits, but some people abuse alcohol and medications that target me, such as benzodiazepines. I don’t just calm down those emotions, I slow down everything, even breathing, which can be dangerous. I also affect the executive function and motor coordination, making people more at risk for accidents.

GABA (gamma-aminobutyric acid.)

I am your flight, fight, or fright. That's me, in excess. . I can really help with focus and productivity which is why you see me with a cup of coffee. I can put some "pep in your step" for sure when we get you to your sweet spot.

Norepinephrine (NE)

What happens if you have too much NE due to stress, medications, and caffeine or other stimulants? I can make you -------------,------------, and affect your ability to ------------. You see, I'm very primal and I can't tell if you're stressed about a deadline or need to save yourself from a sabertooth tiger, which to me is more important. That executive function? It's on hold until I'm sure you're out of danger. These many roles apply to both physical and mental health, including mood, cognition, cardiac functioning, sleep, and arousal. Knowing about how I function will help you to better understand symptoms and treatments.

antsy, nervous, and affect your ability to focus.

I affect arousal, motivation, attention, learning, and REM sleep. I work within the parasympathetic nervous system too. I can make you sweat and salivate. Increase me, and I can help with symptoms

acetylcholine

Substances that block me can paralyze you because I am the link between the brain and muscles. When there's not enough of me, I can be involved in Alzheimer's and Parkinson's disease.

acetylcholine

I also have a role in addiction. Dr. Stahl refers to me as “the brain’s own nicotine” when he talks about my role in addiction. I’ve got lots of receptor friends; my best friends are nicotinic and muscarinic receptors.

acetylcholine

some people call me 5HT. I help to regulate mood. I’ve been called the “happy hormone,” but actually I am not a hormone at all; I am a monoamine neurotransmitter. Your body synthesizes me naturally from tryptophan. You know that amino acid in turkey that makes you content and happy after a big turkey meal? That’s me, helping you to feel relaxed, comfortable, and less stressed.

Serotonin

I help to regulate sleep, arousal, libido, aggression, and pain perception too! That's how I work in medications too.

Serotonin

I am one of the key monamine neurotransmitters that regulate mood. First of all, I am associated with executive function, your ability to perform well, be organized, and all those good things including emotional intelligence.

dopamine

I'm also essential to your movement and coordination. Being balanced is very important to me; too much or too little can cause problems.

dopamine

When my levels are low you'll lose pleasure, interest, alertness, and even self-confidence. Low levels are also found in clients who have Parkinson's disease. Too much of me is not always a good thing. I can lead to the hallucinations you see in schizophrenia and psychosis.

dopamine

to much DA can lead to

hallucinations

schizophrenia and

psychosis.

Do you know that great feeling you get when you win something? That's me, at work in your reward center. Some people have trouble with me because my reward properties can lead to all types of addictions. These are just a few examples of how I function. Did I mention I even have my own pathways?

Dopamine (DA)

I am an amino acid and THE excitatory neurotransmitter. I’ve been referred to as the workhorse of the brain because I can affect almost every neuron in the brain. I’m quite the firecracker. You’ll find me working hard all over the brain affecting energy, memory, learning, and neural plasticity. I also work to relay sensory information and regulate spinal and motor reflexes.

Glutamate

When my levels are too high, I've been associated with schizophrenia, epilepsy, and mania. My receptors, NMDA and AMPA, work with me across many regions of the brain. I can really make things happen.

Glutamate

Which neurotransmitter(s) may be responsible for a client's symptoms of depression? Select all that apply.

increased levels of acetylcholine

increased levels of serotonin

increased levels of glutamate

decreased levels of norepinephrine

decreased levels of histamine

Imbalanced levels of acetylcholine, norepinephrine, serotonin, histamine, or glutamate can contribute to symptoms of depression.

true

This enzyme system is responsible for metabolizing many psychotropic medications

cytochrome P450

Drug metabolism is influenced by client factors such as ___________, ___________, ____________, or other ________________. In older adults’ drug metabolization is decreased, so dosages may need to be reduced to prevent toxicity. Other drugs and substances such as nicotine or caffeine can be either inducers, which increase the rate of drug metabolism, or inhibitors, which decrease the rate of drug metabolism. Polypharmacy is another factor which is common in the care of clients with psychiatric disorders. Not only do clients with psychiatric disorders often need more than one medication to control symptoms, particularly in those with the diagnosis of schizophrenia or bipolar illness, but they often need subsequent medications to manage side effects.

age, smoking, caffeine intake, or other medications.

A client who is a poor metabolizer has a lower concentration of the necessary enzyme to metabolize a drug, which results in higher blood concentrations of the drug. Higher concentrations of drugs increase the risk of side effects and adverse reactions.

inhibits the reuptake of serotonin, which can cause nausea, agitation, headache, and sexual dysfunction

Selective Serotonin Reuptake Inhibitors

inhibits the reuptake of serotonin and norepinephrine, which can cause nausea, sweating, insomnia, tremors, sexual dysfunction

Serotonin and Norepinephrine Reuptake Inhibitors

inhibits reuptake of serotonin and norepinephrine, which can cause sexual dysfunction

blocks norepinephrine receptors, which can cause hypotension and tachycardia

blocks histamine receptors, which can cause sedation and weight gain

blocks acetylcholine receptors, which can cause dry mouth, constipation, blurred vision, and urinary retention

Tricyclic Antidepressants

increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it, which can cause sedation, dizziness, sexual dysfunction, and hypertensive crisis

Monoamine Oxidase Inhibitors

increases the receptor affinity for GABA, which can cause dependence and confusion

Benzodiazepines

inhibits the reuptake of norepinephrine and dopamine, which can cause insomnia, dry mouth, tremors, and seizuresX

Bupropion

The most common action of psychotropic drugs is to modify the actions of G-protein-linked receptors, which occurs on a spectrum. The agonist spectrum ranges from antagonist, which blocks the action of a neurotransmitter, to agonists, which fully stimulate G-protein-linked receptors. In the middle of the spectrum are partial agonists, which stimulate receptors to a lesser degree than an agonist or natural neurotransmitter (Stahl, 2021). Watch this video Links to an external site.to learn more about the agonist spectrum.

SSRIs, SNRIs, and tricyclic antidepressants _______________ serotonin levels. Benzodiazepines do not impact serotonin levels.

increase

Joshua presents to the PMHNP with symptoms of schizophrenia. Nicotine stains are noted on his mouth and hands. He confirms that he smokes at least 2 to 3 packs of cigarettes a day. The PMHNP prescribes olanzapine for Joshua. Olanzapine is metabolized via CYP 1A2 and 2D6.

Is nicotine an inducer or an inhibitor of the CYP 1A2 enzyme?

Inducer. Nicotine is an inducer of the CYP 1A2 enzyme.

Nicotine is an inducer of the CYP 1A2 enzyme. Does the PMHNP anticipate Joshua may need a higher or lower dose of olanzapine to achieve a therapeutic response?

Nicotine is an inducer of the CYP 1A2 enzyme, so it lowers the concentration of drugs. Therefore, a higher dose of olanzapine may be needed to control his symptoms.

_______________ is responsible for the regulation of fight or flight responses and can impact mood and sleep.

Norepinephrine (pounding heart beat)

________________ impacts sleep, pain perception, and memory; increased levels result in depression

Acetylcholine

_____________ impacts alertness, pain sensation, and inflammatory responses; increased levels result in depression

Histamine

Increased levels of gamma-aminobutyric acid have a _________________ effect

calming effect.

_____________ is the best medication class for the PMHNP to prescribe for Ernesto to address his elevated norepinephrine levels?

A selective serotonin reuptake inhibitor would block the reuptake of serotonin, leaving a larger amount of serotonin available. Increasing the amount of serotonin would help regulate the feelings of fear and anxiety. Reducing the occurrence of fear would help reduce the release of norepinephrine.