N204

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N204

• Cultural diversity and
• Medication Safety

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Agenda 9/25/07

• Article presentations
• Narayanasamy (2003) - Gina
• de Chesnay, Ch. 8 - Gina
• Chesnay, Ch. 10 - Gina
• Leininger (1993).- Susie
• Salimbene, S. (1999) Susie
• Wheeler (2004) Susie
• Cultural diversity and medication safety

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Assumptions

• Ethnic culture affects beliefs about health,
  illness, medications, interactions with
  healthcare providers, comply with prescribed
  med. as well as response physiologically to med.
• Culturally competent care involves knowledge not
  only of pts beliefs and values about health care
  and illness, but also of their responses to
  treatment

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Beliefs about health, illness, medications

• White
• Intolerance to pain
• High expectation to be cured or well managed
  through technology, powerful drugs
• Management of microbes gt bolster resistance to
  them

• Asians
• Drugs safety profile gt its effectiveness
• Use lower doses and fewer reported side effects
• Quick remove of S/S does not equal to a permanent
  cure

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Interaction with healthcare providers

• Language barrier
• Nonverbal communication
• Trusting relationships
• Attire, attitude
• Family involvement
• Decision maker

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Adherence to prescribed medications

• Beliefs on the medication
• Discontinue the med when symptoms ease
• Thwart the acceptance of drugs with a delayed
  onset of action
• Stop taking the med. esp if the dis is not
  common in their original country

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Physiologic response to medications

• Genetic polymorphisms
• 3-5 of whites compare to 15-20 of Asians are
  poor metabolizers of drugs affected by
  mephenytoin polymorphism ie. Diazepam, imipromine
• Asians and Eskimos need lower doses of
  anxiolytics than white
• Diet and tobacco use can influence a genes
  expression, which can in turn alter a drugs
  effect

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Pharmacology

• Pharmacokinetics
• Absorption
• Metabolism
• Distribution
• Elimination
• Pharmacodynamics
• Mechanism of action
• Effects at the target site

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Culture lifestyle factors

• Preference -Ways of taking the med. ie. Oral,
  injection,
• Rituals ie. Fasting -gt affects drug absorption
• Fear- Concerns about addictive effects -gt cut the
  dose

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Medicine example- Psychotropic agents

• Antipsychotics
• Typical thorazine, haldol
• Atypical Risperdal, Clozaril,
• Antidepressants- tricyclic antidepressants
• Anti-anxiety
• Mood stabilizer - Lithium

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Medicine example- Antihypertension

• ACE (angiotensin-converting enzyme) inhibitor
  work better for whites than blacks
• Captopril (Capoten)
• Enalapril
• Losartan
• Thiazide diuretics better for blacks than
  whites
• Hydrochlorothiazide (Esidrix and others)
• Calcium channel blockers

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Non-adherence to treatment

• Interpretation of the drug effects including side
  effects
• Positive or negative
• Culture-bound syndromes complicate evaluation of
  drug response- inadvertent misdiagnosis,
  ineffective treatment, inappropriate
  prescribing
• Others -language barrier, clinicians beliefs and
  preconceptions, and pts distrust of the health
  care system

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Roles of the care provider

• Therapeutic range of the medication and the risk
  of toxicity serum level of the medication and
  the side effect
• Skill in communication attitude, terminology
• Touchy subject - fear of offending people
• Avoid a we/they attitude
• Respect

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Prepare for next week

• Article presentations
• de Chesnay, Ch. 11- Gigi /Heaven
• Purnell Paulanka (2005) Gigi
• Munoz, C. Hilgenberg, C. (2005). -Gigi
• Ethics