N204

1. N204 Cultural diversity and Medication Safety

2. 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

3. 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 pt’s beliefs and values about health care and illness, but also of their responses to treatment

4. White Intolerance to pain High expectation to be cured or well managed through technology, powerful drugs Management of microbes > bolster resistance to them Asians Drug’s safety profile > its effectiveness Use lower doses and fewer reported side effects Quick remove of S/S does not equal to a permanent cure Beliefs about health, illness, medications

5. Interaction with healthcare providers • Language barrier • Nonverbal communication • Trusting relationships • Attire, attitude • Family involvement • Decision maker

6. 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

7. 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 gene’s expression, which can in turn alter a drug’s effect

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

9. Culture & lifestyle factors • Preference -Ways of taking the med. ie. Oral, injection, • Rituals ie. Fasting -> affects drug absorption • Fear- Concerns about addictive effects -> cut the dose

10. Medicine example- Psychotropic agents • Antipsychotics • Typical – thorazine, haldol • Atypical – Risperdal, Clozaril, • Antidepressants- tricyclic antidepressants • Anti-anxiety • Mood stabilizer - Lithium

11. 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

12. 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, clinician’s beliefs and preconceptions, and pt’s distrust of the health care system

13. 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

14. Prepare for next week • Article presentations • de Chesnay, Ch. 11- Gigi /Heaven • Purnell & Paulanka (2005) – Gigi • Munoz, C. & Hilgenberg, C. (2005). -Gigi • Ethics