Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.

Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Upper Saddle River, NewJ ersey07458
All rights reserved.
Chapter 10
Psychosocial,
Gender, and
Cultural Influences
on Pharmacotherapy
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Holistic Approach
Established risk factors influence
pharmacotherapeutic outcomes
Age
Genetics
Biologic characteristics
Personal habits
Lifestyle
Environment
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Holistic Approach
Each person: integrated biological,
psychosocial, cultural, communicating
whole person
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Human Integration Pyramid
Framework of human functional
environment and interrelationships
Impacts success of pharmacotherapy
These dimensions often overlooked
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Figure 10.1 The humanintegration pyramidcare model.
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Six Categories of Human-
Integration Pyramid
Age
Gender
Genetic predisposition
Community-environment factors
Culture and ethnicity
Psychological-social-spiritual needs
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Strong Spiritual or Religious Beliefs
Affect Pharmacotherapy Outcomes
Suffering
Loneliness
Despair
Death
Hope
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Better Drug Compliance
If client believes treatment is important
and beneficial
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Outcomes of Pharmacotherapy
Influenced by
Past experiences with medications
Acceptability of taking medication in social
environment
Certain drugs carry social stigma
Clients attitude toward personal health
Clients expectations of pharmacotherapy
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Ethnicity
Biologic and genetic similarities
Shared social and cultural traditions
Shared perception of health and illness
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Figure 10.2 A nurse communicates withher non-English-speakingclient throughandinterpreter. Source: Pearson
Education/PH college
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Structural Variants in
Metabolic Enzymes
Appear more frequently in certain ethnic
groups
Impact pharmacotherapeutics
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Variables of Culture and Ethnicity
That Impact Pharmacotherapy
Diet
Alternative therapies
Beliefs of health and illness
Genetic differences
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Cultural Diet Can Affect
Pharmacotherapeutics
Foods
Spices
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Cultures May Use Herbs and
Alternative Therapies
Along with modern medicines
In place of modern medicines
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Health Care Is Affected by
Population growth
Complex technology advances
Evolving globalization patterns
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Community Factors That Affect
Pharmacotherapy
Urbanization levels
Age distributions
Socioeconomic levels
Occupational patterns
Industrial growth
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
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 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
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
Prevents understanding of importance of pharmacotherapy
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Genetic Polymorphisms Created
Single-base mutation in DNA
Amino acid change in enzyme
Enzyme function changes
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Enzyme Change
Increases metabolism of certain drugs
Decreases metabolism of certain drugs
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Enzyme Polymorphisms
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
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 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
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 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
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 womens health