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Pharmacology for Nurses A Pathophysiologic Approach Third Edition

CHAPTER

8

Psychosocial, Gender, and Cultural Influences on Pharmacotherapy

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

Copyright Š2011 by Pearson Education, Inc. All rights reserved.


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

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Holistic Approach (cont'd) • Established risk factors influence pharmacotherapeutic outcomes – Age – Genetics – Biologic characteristics – Personal habits – Lifestyle – Environment Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Human Integration Pyramid • Framework of human functional environment and interrelationships • Impacts success of pharmacotherapy • These dimensions often overlooked • Levels interconnected and interdependent • Holistic approach seems incompatible with Western medicine; nurse must focus on holistic approach Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

Copyright ©2011 by Pearson Education, Inc. All rights reserved.


Figure 8.1 The human integration pyramid care model

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Six Categories of HumanIntegration Pyramid • • • • • •

Age Corollaries Gender Determinants Genetic Predisposition Community-environment factors Cultural and Ethnic Perspectives Psychological-Social-Spiritual Dimension

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Psychological Dimensions • Psychosocial: one’s psychological development in the context of one’s social environment • Spirituality: – Capacity to love – convey compassion and empathy – give and forgive, – to enjoy life, and to find peace of mind and fulfillment in living Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Strong Spiritual or Religious Beliefs Affect Pharmacotherapy Outcomes • • • • • • •

Suffering Loneliness Despair Death Meaning Value Hope Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Better Drug Compliance • If client believes treatment is important and beneficial

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Outcomes of Pharmacotherapy Influenced by • Past experiences with medications • Acceptability of taking medication in social environment • Certain drugs carry social stigma • Client’s attitude toward personal health • Client’s expectations of pharmacotherapy

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Ethnicity and Cutlure • Ethnicity - biologic and genetic similarities • Culture - set of beliefs, values, and norms that provide meaning for an individual or group • Both have profound influence on medication outcomes

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Cultural 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

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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

Diet Alternative therapies Beliefs of health and illness Genetic differences

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Cultural Diet Can Affect Pharmacotherapeutics • Foods • Spices

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Cultures May Use Herbs and Alternative Therapies • Along with modern medicines • In place of modern medicines

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Figure 8.2 A nurse communicates with her non-English-speaking client through and interpreter. Source: Pearson Education/PH college

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

Copyright Š2011 by Pearson Education, Inc. All rights reserved.


Health Care Is Affected by • • • •

Population growth Complex technology advances Evolving globalization patterns Access to health care is perhaps the most obvious community-related influence on pharmacotherapy

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Community Factors That Affect Pharmacotherapy • • • • •

Urbanization levels Age distributions Socioeconomic levels Occupational patterns Industrial growth

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Obstacles to Access to Health-Care • Inadequate health insurance • Cost of treatment and drugs • Limited medical care in rural areas

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Influence of Illiteracy on Health Care • 48% of English-speaking population is functionally illiterate • Prevents client from being able to read drug labels • Prevents understanding of written treatment instructions • Prevents reading of brochures regarding medication or disease Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Influence of Illiteracy on Health Care (cont'd) • Prevents understanding of importance of pharmacotherapy • Nurse may need to make extra effort to educate patients with illiteracy or that speak a foreign language

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Genetic 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

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

Copyright ©2011 by Pearson Education, Inc. All rights reserved.


Structural Variants in Metabolic Enzymes • Genetic polymorphisms appear more frequently in certain ethnic groups • Impact pharmacotherapeutics

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Enzyme Change • Increases metabolism of certain drugs • Decreases metabolism of certain drugs

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Genetic Polymorphisms Identified in Specific Ethnic Groups • Can be amplified in these groups – Stay in same geographical area – Marry within ethnic group for many generations

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Gender Behavior Differences • Can affect success of medication treatment • Example: women seek health care more readily than males • Side effects of medication can be genderspecific and affect compliance

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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FDA Requires Drug Research 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

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

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Gender Equality in Prescription Drug Coverage • Some plans exclude women’s contraceptive medications • Ruled sex discrimination by courts

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams • Holland

Copyright ©2011 by Pearson Education, Inc. All rights reserved.

Chapter 8 PP  

Nursing Pharmacology

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