Module 9- Variation in Drug response Flashcards
A client is prescribed a new medication. Which area should the nurse include when completing a psychosocial history for this client? (Select all that apply.)
A. Sexual practices
B. Lifestyle preferences
C. Alcohol intake
D. Financial resources
E. Religious beliefs
A. Sexual practices
B. Lifestyle preferences
C. Alcohol intake
E. Religious beliefs
A client with depression is being started on new medication. Which psychosocial intervention should the nurse anticipate being prescribed for this client? (Select all that apply.)
A. Physical exercise
B. Occupational therapy
C. Sleep hygiene interventions
D. Psychotherapy
E. Self-help instruction
A. Physical exercise
C. Sleep hygiene interventions
D. Psychotherapy
E. Self-help instruction
An adolescent client with type 1 diabetes mellitus has several admissions for inadequate blood glucose control. Which psychosocial issue should the nurse consider that may be impacting this client’s adherence with prescribed medications? (Select all that apply.)
A. Viewed as being unhealthy
B. Seen as a drug addict
C. Viewed as being weak
D.Viewed as being dependent
E. Embarrassed for having to take medication
A. Viewed as being unhealthy
C. Viewed as being weak
D.Viewed as being dependent
E. Embarrassed for having to take medication
A client is having difficulty accepting a chronic illness. Which psychosocial issue should be anticipated for this client? (Select all that apply.)
A. Despair
B. Loneliness
C. Death
D. Expenses
E. Suffering
A. Despair
B. Loneliness
C. Death
E. Suffering
A client is starting new medications for a chronic health problem. Which characteristic should the nurse identify that enhances adherence to medication therapy?
A. Medication is beneficial to well-being
B. Side effects can be treated with other medications
C. Changes in diet have to occur for the medication to be effective
D. Medication has to be taken at specific times during the day
A. Medication is beneficial to well-being
The nurse learns that a client is an active member of a specific ethnic group. Which similarity should the nurse recall about ethnicity? (Select all that apply.)
A. Language
B. Rituals
C. Genetic
D. Religious beliefs
E. Biologic
C. Genetic
E. Biologic
A client reports not wanting to take a recently prescribed medication because it contains an animal-based ingredient. Which response should the nurse provide?
A. “It’s important for you to comply with the doctor’s orders.”
B. “The doctor prescribed this drug for you because it’s the best.”
C. “I’ll ask your doctor whether an alternative product can be used.”
D. “The amount of animal product in this medication is minimal.”
C. “I’ll ask your doctor whether an alternative product can be used.”
During a medication teaching session, a client reports using herbs to treat various ailments. Which step should the nurse take next?
A. Instruct the client to stop using herbs to treat ailments
B. Ask the client to give a definition of wellness
C. Compile a list of the herbs commonly used by the client
D. Assess the foods of the client’s culture
C. Compile a list of the herbs commonly used by the client
A client prefers to consult a healer before beginning a prescribed medication. Which response should the nurse make?
A. “Your healthcare provider prescribed this medication for you; you really need to take it.”
B. “I don’t think consulting a healer is really a good idea.”
C. “I understand your need to consult with your healer. Please let me know what the healer says.”
D. “Why do you want to do this? Don’t you trust your healthcare provider?”
C. “I understand your need to consult with your healer. Please let me know what the healer says.”
The nurse is caring for clients in a community clinic. Which variable should the nurse keep in mind when treating clients from different cultural and ethnic groups? (Select all that apply.)
A. Complementary and alternative medicine practices
B. Beliefs about health and disease
C. Cognitive function
D. Financial considerations
E. Dietary considerations
A. Complementary and alternative medicine practices
B. Beliefs about health and disease
E. Dietary considerations
The nurse is discussing genetic polymorphisms with a colleague. Which statement should indicate an understanding of the impact of genetic polymorphisms on drug metabolism?
A. “Whenever a client does not respond well to a drug, it is most likely due to a genetic polymorphism.”
B. “A genetic polymorphism alters the speed of drug metabolism.”
C. “While genetic polymorphisms can impact drug metabolism, the impact is generally minor.”
D. “It’s important to identify clients with genetic polymorphisms since they will consistently need a larger dose of the prescribed drug than others.”
B. “A genetic polymorphism alters the speed of drug metabolism.”
The nurse receives a report indicating that a client has a genetic receptor polymorphism. Which drug action should the nurse expect?
A. Faster uptake and metabolism of drugs
B. Receptors may no longer accept the drug
C. Increased adverse effects will occur in only one gender
D. Drug uptake will be enhanced
B. Receptors may no longer accept the drug
The nurse is discussing the impact of genetic polymorphisms involving receptors on client outcomes. Which statement should the nurse include in the discussion?
A. “Genetic polymorphisms are the result of diversity in culture.”
B. “Changes in the receptors cause them to metabolize the drug more rapidly, resulting in lower therapeutic effect.”
C. “Changes in the protein of an enzyme results in altered function of the enzyme.”
D. “Small changes in the structure of protein receptors may result in the receptor’s no longer accepting the drug.”
D. “Small changes in the structure of protein receptors may result in the receptor’s no longer accepting the drug.”
An African American client asks why a drug prescribed for hypertension does not seem to be working. Which explanation should the nurse provide?
A. “Genetic polymorphisms are more common in African Americans unfortunately and impact the metabolism of many different drugs including this one.”
B. “No one really knows why certain drugs don’t work for certain people; it is an area still under study.”
C. “Factors such as body composition and gender play significant roles in drug metabolism and are likely the cause in this case.”
D. “Genetically influenced variances can cause decreased effects from certain drugs in your ethnic group.”
D. “Genetically influenced variances can cause decreased effects from certain drugs in your ethnic group.”
The nurse monitors clients for toxic drug effects. For which genetic polymorphism should the nurse perform this monitoring?
A.Fast acetylation
B.Beta Subscript 2-adrenergic
receptor polymorphism
C.Receptor polymorphism
D.Slow acetylation
D.Slow acetylation
The nurse reviews medication adherence with a group of new colleagues. Which description regarding medication adherence in client populations should the nurse include?
A. Not something the nurse can affect
B. A personal issue that the nurse cannot predict
C. The same for both genders for all medications
D. May be due to adverse effects affecting only one gender
D. May be due to adverse effects affecting only one gender
The nurse is discussing gender-based differences in drug response with nursing colleagues. Which statement should the nurse include?
A. Drug response can be different in men and women.
B. Drug research to determine drug response is conducted more often on women than on men.
C. Adverse effects of drugs affect both genders equally.
D. Most drugs are more effective in men than in women.
A. Drug response can be different in men and women.
A male client plans to stop taking an antihypertensive medication because of the side effect of impotence. Which response should the nurse provide?
A. “Take your medications exactly as prescribed. Your doctor is the best judge of what you need.”
B. “Let’s talk to the doctor and see whether an alternative can be prescribed.”
C. “This side effect will go away the longer you take the medication.”
D. “We’ll talk to your doctor to see whether there’s a medication to counteract this side effect.”
B. “Let’s talk to the doctor and see whether an alternative can be prescribed.”
The nurse is evaluating the response of medications provided to assigned clients. Which gender difference should the nurse take into consideration when completing this evaluation? (Select all that apply.)
A. Differences in body composition
B. Cerebral blood flow
C. Polymorphisms
D. Number and type of genes
E. Adherence to medication regimens
A. Differences in body composition
B. Cerebral blood flow
E. Adherence to medication regimens
The nurse reviews gender differences in drug response with a new colleague. Which reason should indicate the colleague needs further teaching?
A. Both genders possess the same genes.
B. Women and men have different fat-to-muscle ratios.
C. Levels of certain enzymes that affect drug response are different in men and women.
D. The different genders have variations in cerebral blood flow.
A. Both genders possess the same genes.
Psychosocial Influences
- Lifestyle preferences
- Religious beliefs
- Sexual practices
- Alcohol/substance use
Ethnic and Cultural influences
- Dietary considerations
- CAM therapies
- Beliefs on health and disease
- Variations in drug response r/t ethnicity (genetic and biologic)
Community and environmental influences
- Healthcare access
- Literacy
- Population density
- Socioeconomics
- Occupational patterns
- Age distribution
- Industrial growth
Gender Influences
- Body composition
- Hormones
- Cerebral blood flow
- Gender-specific side effects
Genetic Influences
- Genetic polymorphism
- Genetic variation in races/ethnic groups
Enzyme CYP450
Impacts hepatic (metabolism) and protein receptors (distribution)
Polymorphism
2+ versions of the same enzyme
Polymorphisms of Acetyltransferase
- Slow acetylation = increased toxicity
- Fast acetylation = decreased drug effect
Ex. Caffeine
Polymorphisms of CYP2A6
Decreased drug metabolism
Ex. Nicotine
Polymorphisms of CYP2B6
Increased or decreased metabolism depending on subtype
Ex. Bupropion (antidepressant being used to treat smoking cessation)
Polymorphisms of CYP2C9
Reduced metabolism
Ex. Warfarin and NSAIDs
Polymorphisms of CYP2C19
Poorly metabolized in Asians and African Americans
Ex. Omeprazole and Warfarin
Polymorphisms of CYP2D6
Poorly metabolized in Asians and African Americans
Ex. Opiods and Morphine
