Transcript N204
N204 Cultural diversity and Medication Safety 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 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 Beliefs about health, illness, medications 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 Interaction with healthcare providers Language barrier Nonverbal communication Trusting relationships Attire, attitude Family involvement Decision maker 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 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 Pharmacology Pharmacokinetics Absorption Metabolism Distribution Elimination Pharmacodynamics Mechanism of action Effects at the target site 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 Medicine examplePsychotropic agents Antipsychotics Typical – thorazine, haldol Atypical – Risperdal, Clozaril, Antidepressants- tricyclic antidepressants Anti-anxiety Mood stabilizer - Lithium Medicine exampleAntihypertension 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 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 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 Prepare for next week Article presentations de Chesnay, Ch. 11- Gigi /Heaven Purnell & Paulanka (2005) – Gigi Munoz, C. & Hilgenberg, C. (2005). -Gigi Ethics