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Ethnopharmacology by Sue Henderson

Ethnopharmacology by Sue Henderson. Ethnopharmacology. Study of the effect of ethnicity on responses to prescribed medication and incorporates pharmacogenetics, the study of genetic variations in responses to drugs. Ethnicity: Shared cultural bonds, common genetic heritage or both. Race

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Ethnopharmacology by Sue Henderson

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  1. Ethnopharmacology by Sue Henderson

  2. Ethnopharmacology • Study of the effect of ethnicity on responses to prescribed medication and incorporates pharmacogenetics, the study of genetic variations in responses to drugs.

  3. Ethnicity: Shared cultural bonds, common genetic heritage or both Race Common lineage and geographic origin of ancestry (genetics) Culture Common learned beliefs and customs

  4. Effects of ethnicity on drug response • Pharmacokinetics (drugs absorption, metabolism, distribution, and elimination) • Pharmacodynamics (drugs mechanism of action and effects at the target site) • Consumer adherence and education • Wide variation in drug response within each ethnic group

  5. Cultural competence involves: • Working within the consumers cultural context Knowledge of consumers: • Beliefs/values about health/illness • Responses to treatment, including drug therapies.

  6. Assessment • “What do you think caused your health problem?” • “What treatment do you think will help you?”

  7. Metabolism of drugs • Most drugs metabolized by liver enzymes. • Cytochrome P-450 (CYP) is a common group of liver enzymes • Rate of metabolism will affect drug blood levels • Genetic abnormalities in enzymes common • Enzymes vary by race/ethnic group

  8. Genetic abnormalities Ultrarapid metabolizers • > 2 functional copies of CYP2D6 gene faster than normal enzyme activity = lower levels of drug in blood Poor metabolizers • 2 non-functional copies of CYP2D6 gene slower than normal enzyme activity = higher level of drug in blood

  9. Asians: Antipsychotics Asians same dose as whites: • Higher blood levels of typical antipsychotics • Have more EPSE • Need lower doses (Atypicals may be better but few ethno-pharmacologic studies on atypicals)

  10. Tricyclic antidepressants Asians compared whites have: • Faster therapeutic response • Higher blood levels drug • More adverse effects (such as delirium) • Adverse effects occur at much lower dosages. (Few ethno-pharmacologic studies on SSRIs)

  11. Non White: Lithium • Require lower doses • Report more lethargy and dizziness (even when blood levels similar). • Monitor closely for symptoms of toxicity (blood levels may be higher than in white’s given same dosage).

  12. Cultural/Lifestyle • Tobacco/alcohol use (influenced by cultural & genetic factors) affect drug response. • Tobacco/alcohol increase or decrease rate of drug metabolizm & drug clearance. • Smoking decreases blood levels of typical antipsychotics (? caused by effects of smoking on liver enzymes).

  13. Adherence • Adverse effects contribute to non-adherence. • Drug effects may be interpreted as negative or positive depending on the consumers beliefs/expectations. Factors affecting drug adherence: • Language barriers • Clinicians’ beliefs/preconceptions • Consumers distrust of the health care system

  14. References Muñoz, C., & Hilgenberg, C. (2005). Ethnopharmacology American Journal of Nursing, 105(8), 40 - 48.

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