adams ch09 lecture

PHARMACOLOGY FOR NURSESPHARMACOLOGY FOR NURSESA Pathophysiological ApproachA Pathophysiological Approach

FOURTH EDITIONFOURTH EDITION

Copyright © 2014, © 2011, © 2008 by Pearson Education, Inc.All Rights Reserved

CHAPTER

Psychosocial, Gender, and Cultural Influences on Pharmacotherapy

9

Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban

Holistic ApproachHolistic Approach

• Each person: integrated biological, psychosocial, cultural, communicating whole person


Holistic ApproachHolistic Approach

• Established risk factors influence pharmacotherapeutic outcomes:– Age– Genetics– Biologic characteristics– Personal habits– Lifestyle– Environment


Psychological and Spiritual FactorsPsychological and Spiritual Factors

• Psychosocial: one's psychological development in the context of one's social environment

• Spirituality:– Capacity to love– Convey compassion and empathy– Give and forgive– Enjoy life, and to find peace of mind and

fulfillment in living


Strong Spiritual or Religious Beliefs Strong Spiritual or Religious Beliefs Affect Pharmacotherapy OutcomesAffect Pharmacotherapy Outcomes• Suffering• Loneliness• Despair• Death• Meaning• Value• Hope


Better Drug ComplianceBetter Drug Compliance

• If patient believes treatment is important and beneficial, it often is more effective.


Outcomes of PharmacotherapyOutcomes of Pharmacotherapy

• Influenced by:– Past experiences with medications– Acceptability of taking medication in

social environment– Certain drugs carry social stigma– Patient's attitude toward personal health– Patient's expectations of

pharmacotherapy


Ethnicity and CutlureEthnicity and Cutlure

• Ethnicity– Biologic and genetic similarities

• Culture– Set of beliefs, values, and norms that

provide meaning for an individual or group

• Both have influence on medication outcomes.


Cultural CompetenceCultural Competence

• Ability to provide care to people with diverse values, beliefs, and behaviors, including ability to adapt delivery of care to meet needs of these patients– Dietary considerations– Alternative therapies– Beliefs about health and disease


Variables of Culture and Ethnicity That Variables of Culture and Ethnicity That Impact PharmacotherapyImpact Pharmacotherapy

• Diet• Alternative therapies• Beliefs of health and illness• Genetic differences


Figure 9.1 Holistic model of pharmacotherapy: For pharmacotherapy to be successful, the nurse must consider psychosocial, cultural, environmental and biologic variables that could affect drug response.


Health CareHealth Care

• Health care is affected by:– Population growth– Complex technology advances– Evolving globalization patterns– Access to health care


Community Factors That Affect Community Factors That Affect PharmacotherapyPharmacotherapy

• Urbanization levels• Age distributions• Socioeconomic levels• Occupational patterns• Industrial growth


Obstacles to Access to Health Care Obstacles to Access to Health Care

• Inadequate health insurance• Cost of treatment and drugs• Limited medical care in rural areas


Influence of Illiteracy on Health Influence of Illiteracy on Health CareCare

• 48% of English-speaking population is functionally illiterate

• Prevents patient from being able to read drug labels

• Prevents understanding of written treatment instructions

• Prevents reading of brochures regarding medication or disease


Influence of Illiteracy on Health Influence of Illiteracy on Health CareCare

• Prevents understanding of importance of pharmacotherapy

• Nurse may need to make extra effort to educate patients with illiteracy or who speak a foreign language.


Genetic PolymorphismsGenetic Polymorphisms

• Two or more versions of the same enzyme

• Caused by single-base mutation in DNA• Amino acid change in enzyme• Enzyme function changes• Pharmacogenetics—study of genetic

variations that cause differences in the way patients handle medications


Table 9.1 Enzyme Polymorphisms of Importance to Pharmacotherapy


Structural Variants in Metabolic Structural Variants in Metabolic EnzymesEnzymes

• Genetic polymorphisms appear more frequently in certain ethnic groups.

• Impact pharmacotherapeutics


Enzyme ChangeEnzyme Change

• Increases metabolism of certain drugs• Decreases metabolism of certain drugs


Genetic Polymorphisms Identified Genetic Polymorphisms Identified in Specific Ethnic Groupsin Specific Ethnic Groups

• Can be amplified in ethnic groups– Stay in same geographical area– Marry within ethnic group for many

generations


Gender Behavior DifferencesGender Behavior Differences

• Can affect success of medication treatment

• Example: women seek health care more readily than males.

• Side effects of medication can be gender-specific and affect compliance.


Local and Systemic Responses to Local and Systemic Responses to Medications Differ Between GendersMedications Differ Between Genders• Body composition • Cerebral blood flow• Rate of elimination of drug


FDA Requires That Drug Research FDA Requires That Drug Research Studies Include:Studies Include:

• Subjects of both genders• Analysis of clinical data by gender• Assessment of pharmacokinetic and

pharmacodynamic differences• Studies specific to women's health• Changes are result of reforms after

1993.


Gender Equality in Prescription Gender Equality in Prescription Drug CoverageDrug Coverage

• Some plans exclude women's contraceptive medications.

• Ruled sex discrimination by courts