Discussion_Board_Rubricking Discussion Board Rubric E.docx

Discussion_Board_Rubric/king
Discussion Board Rubric
Element Superior
(90 – 100%)
Exceeds
Expectations (80 –
89%)
Meets
Expectations (70
– 79%)
Needs
Improvement
(60 – 69%)
Unsatisfactory
(0 – 59%)
Focused

Content
70 points
Student
addresses all
content areas in
detail and adds
value to the
content by
integrating
other academic
resources.
Student does not
address all content
areas and lacks
support for exploring
the topic.
Student is off
topic and does

not engage the
topic by
providing any
support for the
content areas.
Student does
not provide any
topic
knowledge or
support for
shared ideas.
Student does
not provide
content that
explores the
topic.
Format/
Citations

and
References
to Support
Position
10 points
follows APA
format well
and
spelling/
grammatical
errors are
minimal. The
formatting
of this
assignment

is
exceptional.
properly
cites,
references,
and
organizes
information
to present a
clear and
succinct
illustration of
ideas and
facts.
few minor APA,
spelling or

grammatical
errors.
comprehensively
reference ideas
or clarify
illustrations of
ideas or facts.
several APA
and spelling
and/or
grammatical
errors.
submits work
and does
not properly

reference or
cite sources
of used
information.
does not
follow APA
guidelines
and has
significant
spelling
and/or
grammatical
errors.
does not
reference or
cites

sources.
Student fails
to follow any
writing
format.
Student
“copies”
work from
other sources
(see
Academic
Honesty)
Participation
20 points
Student posts
one scholarly
original post

and posts at
least 1 robust
scholarly
response.
Due dates are
met.
Student only posts
one initial post. Due
dates are met.
Student does
not satisfy the
minimum
paragraph
requirements.
Due dates are
met.
Student does
not satisfy the

minimum
paragraph
requirements
and due dates
are not met.
The student
did not post
for the week.
Lippincott Williams & Wilkins and Wolters Kluwer Health,
Inc. are collaborating with JSTOR to digitize, preserve and
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Wolters Kluwer Health, Inc.
CE Credit: Ethnopharmacology
Author(s): Cora Muñoz and Cheryl Hilgenberg
Source: The American Journal of Nursing, Vol. 105, No. 8
(Aug., 2005), pp. 40-49
Published by: Lippincott Williams & Wilkins
Stable URL: http://www.jstor.org/stable/29745831
Accessed: 25-06-2015 15:29 UTC

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?Continuing
ce 3a Education ?_^
By Cora Mu?oz, PhD, RN, and Cheryl Hilgenberg, EdD, RN,
CTN
thnopharmaco ogy
Understanding how ethnicity can affect drug response is
essential to providing culturally competent care.
AJN
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Overview: Ethnopharmacologic research has revealed that
ethnicity significantly affects drug
response. Genetic or cultural factors, or both, may influence a
given drug's pharmacokinetics
(its absorption, metabolism, distribution, and elimination) arid
pharmacodynamics (its mecha?
nism of action and effects at the target site), as well as patient
adherence and education. In

addition, the tremendous variation within each of the broader
racial and ethnic categories
? defined by the U.S. Census Bureau (categories often used by
researchers) must be consid- -?---?---?-----?-?
ered. Nurses need to become knowledgeable about drugs that
are likely to elicit varied
responses in people with different ethnic backgrounds, as well
as the potential for adverse
effects. The existing ethnopharmacologic research focuses
primarily on psychotropic and anti
hypertensive agents, as does this article. Cultural assessment of
every patient is vital; thus
Leininger's Sunrise Model and Giger and
Davidhizar'sTrans?ultural Assessment Models are
brief ly described as well.
The relatively new field of ethnopharmacology
is hampered by a lack of clarity caused, in
part, by the fact that some researchers use the
words race, ethnicity, and culture synony?
mously, even though they have quite distinct
meanings. For example, the term Hispanic can refer
to Puerto Ricans, Mexicans, Peruvians, and
Chileans, among many others, and describes more
than 38 million Americans.1 But some researchers
have used the term to denote a racial category,
despite the fact that Hispanics can be of any race.

Such imprecision has raised quite valid questions
about the accuracy of some data.
This imprecision also reflects a scientific uncer?
tainty: it's impossible to know a person's genotype
simply by looking at her, or the degree to which
environment affects someone's genes merely by
knowing his nationality. Nurses have made signifi?
cant efforts to clear the confusion, but an important
question remains: how is a "culturally competent"
nurse to understand the ways in which drug
response is affected by ethnicity?that amalgam of
genetic and cultural influences that makes up a
human life?
As the U.S. population becomes more diverse
ethnically, such questions have become more press?
ing. Cultural competence, defined as the process of
Cora Mu?oz is a professor at Capital University School of
Nursing,
Columbus, OH. Cheryl Hilgenberg is a professor at the Millikin
University School of Nursing, Decatur, IL. Mu?oz discloses that
she
received an honorarium and expenses for participating in an
invita?
tional session for physicians, pharmacists, and psychiatric
nurses held
in Miami, PL, and sponsored by AstraZeneca, which
manufactures
Inderal, a drug mentioned in this article. Contact author, Cora

Mu?oz:
[email protected] The authors of this article have no other
signifi?
cant ties, financial or otherwise, to any company that might
have an
interest in the publication of this educational activity.
learning to "work within the cultural context" of the
patient,2 involves knowledge not only of patients'
beliefs and values about health and illness, but also
of their responses to treatment, including drug ther?
apies. Ethnopharmacology is the study of the effect
of ethnicity on responses to prescribed medication,
especially drug absorption, metabolism, distribution,
and excretion. The field incorporates pharmacoge
netics, the study of genetic variations in responses to
drugs.
The value of cultural competence has been well
documented, and the need for it is becoming increas?
ingly urgent. In 2000, according to the U.S. Census
Bureau, the national population stood at about
281,422,000; of this total, 12.5% self-identified as
Hispanic or Latino; 12.3%, as black or African
American; 3.6%, as Asian; and almost 1% as
American Indian or Alaskan native.3 The most recent
data show that some population groups are continu?

ing to grow much faster than others. For example,
between April 2000 and July 2003, the growth rates
for Hispanic and Asian Americans were reported to
be 13% and 12.5%, respectively, compared with a
growth rate of 3.3% for the total population.4
Although sometimes used interchangeably, the
terms race, culture, and ethnicity have distinct
meanings. Dorland's Illustrated Medical Dictionary
defines race as "a class of persons of a common
lineage; in genetics, races are considered as popula?
tions having different distributions of gene frequen?
cies"; the term generally reflects the geographic
origins of ancestry. Although the usefulness of
the classification has been debated, given the ambi?
guity of even self-defined racial identity,5,6 the term
remains widely used in clinical research. Leininger
has described culture as an integrated system of
[email protected] AJN
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learned beliefs, values, and customs common to a
particular group of people; typically these are
passed down from generation to generation.7
Ethnicity can refer to shared cultural bonds, a com?
mon genetic heritage, or both.
Although varied responses to other treatment
modalities no doubt exist, this article focuses on sim?
ilarities and differences in how people from various
ethnic groups respond to prescribed medications.
(Interactions that may occur between prescribed
drugs and herbal or "folk" remedies are beyond the
scope of this article.)
? A person can be an ultrarapid

metabolizer of some drugs
and a normal or poor
metabolizer of others.
VARIATIONS IN DRUG RESPONSES
Studying how ethnicity affects drug response is
challenging, in part because of the tremendous vari?
ations that exist within each ethnic group. Many
studies have used broad categories when classifying
participants without differentiating among sub?
groups (for example, using the term "Asians" to
refer to people of Korean, Chinese, Japanese,
Indian, Pakistani, and Vietnamese ancestry, among
others). Also, as Burchard and colleagues have
observed, findings of ethnic differences can create
more anxiety than they allay, given the United
States' long history of prejudice and discrimination
against racial and ethnic minorities.8 And some
questions have been raised about the accuracy of
data collected, partly because the definitions of race
and ethnicity are not consistent.5,6
Historically, most clinical drug trials have been
conducted using white men; the results have then
been generalized to all patients receiving the drugs
studied. As Dawkins and Potter point out, this has
been the case even when the targeted disorder or ill?

ness is most prevalent in groups other than white
men.9 Nevertheless, data have been accumulating
that strongly suggest that ethnicity influences
response to certain medications,1011 a fact of which
many clinicians remain largely unaware.
Within the last 15 years, ethnopharmacologic
research has uncovered significant differences in
I how people in diverse ethnic groups metabolize cer?
tain drugs,10 with regard to both pharmacodynam
ics (a drug's mechanisms of action and its effects at
the target site) and pharmacokinetics (the "move?
ment" of drugs, referring to drug absorption,
metabolism, distribution, and elimination).12
Research has shown that genetic variations in cer?
tain enzymes may cause differing drug responses
(although the precise mechanism is unknown); also,
certain ethnic groups have more of these variations
than others do. (See "Medication Selection by
Genotype," May 2004.) Moreover, factors such as
diet and tobacco use can influence a gene's expres?
sion, which can in turn alter a drug's effect.12 Most
ethnopharmacologic research to date has focused
on drugs in two classes: psychotropic agents and
antihypertensive agents. (One possible reason for
the focus on antihypertensives may be the relatively

high incidence of hypertension and cardiovascular
disease in some minority populations. For example,
according to the American Heart Association, the
prevalence of high blood pressure among non
Hispanic blacks is almost 39%, compared with
27% among non-Hispanic whites.13)
PSYCHOTROPIC AGENTS
Most psychotropic drugs are metabolized in the
liver in two phases, an oxidation phase (phase 1)
and a conjugation phase (phase 2). One group of
enzymes, the cytochrome P-450 (CYP) enzymes,
has been the focus of much research because these
enzymes are responsible for the phase 1 metabolism
of many widely prescribed drugs, including most
antipsychotics and antidepressants. There
are many
CYP enzyme subgroups; these are typically identi?
fied by letters and numbers (for example, CYP2).
Many studies have indicated that genetic abnormal?
ities in the CYP enzymes are not only extremely
common but have profound implications for drug
response.12,
14, 15 And as Keltner and Folks have
noted, it appears that the "genetic ability to pro?
duce" these enzymes "will vary by race or ethnic

group."16
For example, genetic changes in certain CYP
enzymes, including CYP2D6, have been shown to
affect the rate of drug metabolism, which in turn
affects drug plasma levels at a given dosage. The
CYP2D6 gene is "unique in that the gene is often
duplicated or multiplied."12 People who have more
than two functional copies of the CYP2D6 gene
have faster than normal enzyme activity and are
known as "ultrarapid metabolizers," whereas those
with two nonfunctional copies of the gene have
slower than normal enzyme activity and are known
as "poor metabolizers."1217 Ultrarapid metabolizers
will metabolize a drug quickly, resulting in lower
serum concentrations, whereas poor metabolizers
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metabolize the drug more slowly, resulting in higher
serum levels at the same dosage. Luo and colleagues
found that the frequency at which genetic abnor?
malities occur in these enzymes varied significantly
among four ethnic groups: 18% of Ethiopian Jews
and 13% of Sephardic Jews had more than two
functional CYP2D6 genes and were predicted to be
ultrarapid metabolizers; only 6% of Yemenite Jews
and 4% of Bedouin Arabs shared the mutation.17

(Depending on which genes have abnormalities, a
person can be an ultrarapid metabolizer of some
drugs and a normal or poor metabolizer of others.)
In an important early study, Lin and Poland
examined the effects of haloperidol in three groups
of healthy volunteers, which they identified as
"Caucasians," "American-born Asian Americans,"
and "foreign-born Asians."18 (More details on the
subjects' nationalities were not reported.) When
administered specified doses of haloperidol, both
Asian groups had significantly higher serum con?
centrations of the drug than the white group did,
even when body surface area was considered.
The same researchers then conducted a second
study in Asian and white patients diagnosed with
schizophrenia, administering haloperidol in fixed
doses for two weeks and then in variable doses
determined by clinical response for 10 weeks.18
They found that when haloperidol was given in
variable doses, Asians required lower doses than
whites did; when it was given at fixed doses, Asians
showed significantly more extrapyramidal symp?
toms than whites given the same dose. A longitudi?
nal study also determined that the dosage of
haloperidol that provided the optimal response

with minimal extrapyramidal symptoms was signif?
icantly lower for Asian patients than for whites.19
Differences in clinical responses also occur
within ethnic groups. Researchers have tended to
use broad categories of race and ethnicity based on
those used by the U.S. Census Bureau. (In 2000
these were white, black or African American,
Asian, native Hawaiian and other Pacific Islander,
and American Indian and Alaskan native; people
who identify as Hispanic or Latino may be of any
race.) But a tremendous number of subgroups exist,
and studies have found marked differences in
health status among them. For example, one recent
study found significant differences in risk for hyper?
tension among various Pakistani ethnic groups
(Muhajir, Punjabi, Sindhi, Pashtun, and Baluchi),
even after adjusting for sociodemographic and
other major risk factors (response to pharma
cotherapy was not included in the investigation).20
Systematic investigation of variations in drug
response among specific ethnic subgroups would
lead to improved clinical understanding and thus
better patient care.
Actions for Nurses
? Learn about drugs that are likely to elicit varied
responses in people from different ethnic groups, as
well as the potential for adverse effects.
? Conduct a cultural assessment with each patient.
? Ask the patient direct, specific questions to reveal

the presence or absence of potential adverse effects
of medications.
? Monitor the patient and document findings carefully;
it may be possible to maintain therapeutic benefit at
a lower dosage of a given drug.
?
Keep cultural context in mind when planning educa?
tion for patients and families.
Traditional antipsychotics include chlorpro
mazine (Thorazine), fluphenazine (Prolixin,
Permitil), and haloperidol (Haldol). Research has
suggested that Hispanics may require lower doses
of antipsychotic medications than whites do. A ret?
rospective study by Ruiz and colleagues examined
data from a group of foreign-born Hispanic and
Asian patients diagnosed with schizophrenia.21 The
researchers converted dosages of traditional
antipsychotic agents to "chlorpromazine equiva?
lents," and found that the Hispanic patients
required lower dosages compared with a control
group of "general" patients. (The researchers did
not specify the antipsychotic agents; the general
patient group was "drawn from a large multiethnic
community.") Another study of 398 outpatients
receiving antipsychotic medications, including
haloperidol, fluphenazine, chlorpromazine, and
thioridazine (Mellaril), found that blacks were at

greater risk for developing tardive dyskinesia than
whites were.22 A literature review by Tran and col?
leagues supported this conclusion.23
Newer, "atypical" antipsychotic agents such as
risperidone (Risperdal), clozapine (Clozaril), and
olanzapine (Zyprex, Zydis) have been subjected to
limited ethnopharmacologic study. From anecdotal
and research data available, Frackiewicz and col?
leagues reviewed the effects of both traditional and
newer antipsychotics in Asians, Hispanics, blacks,
and whites.24 They determined that the newer med?
ications "may be preferable in the treatment of eth?
nic minorities" because they caused fewer
extrapyramidal and other adverse effects. In one
study, Korean American and white patients were
given therapeutic doses of clozapine; their
responses were subsequently measured using the
Brief Psychiatric Rating Scale.25 The Korean
American group responded better than the white
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group did, even though they received lower doses
and showed lower serum concentrations of the
drug; however, the Korean Americans also had a
higher incidence of anticholinergic and other
adverse effects. And in reviewing the effectiveness
of olanzapine, Tran and colleagues asserted that the
drug "offers significant advantages over many
existing antipsychotics" in black patients.23 For
example, olanzapine
was associated with fewer
involuntary movements in blacks than was
haloperidol.
It should be noted that, in another review,
Frackiewicz and colleagues cautioned that some
findings suggest that the differences in drug
responses in blacks (and other minority groups)
"may be due to clinician biases and prescribing
practices rather than to pharmacokinetic or phar

macodynamic variability."24 Others have made sim?
ilar observations; future researchers should control
for this possibility.
In one study, blacks appeared
to have a greater risk of
delirium caused by tricyclics
than whites did.
Tricyclic antidepressants. A literature review by
Lawson found that blacks given tricyclics were
likely to have faster therapeutic responses, have
higher serum concentrations, and report more
adverse effects than whites were.26 A review by
Strickland and colleagues reported similar find?
ings.27 For example, blacks appeared to have a
greater risk of delirium caused by tricyclics than
whites did.
Although the research in Hispanic populations
has been limited and much of it was conducted in
the 1980s, there is some evidence that adverse
effects of tricyclics occur at much lower dosages in
Hispanics than in whites. In a literature review,
Mendoza and colleagues describe a retrospective
study conducted in 1982 of Hispanic (primarily

Puerto Rican) and "Anglo" women who were
given tricyclics.28 Dosages given the Hispanic
women were half those given to Anglo women, yet
comparable outcomes were achieved; however, the
Hispanics reported adverse effects more often.
Greater tissue sensitivity in Hispanics and Asians to
tricyclics may explain why these populations
achieve therapeutic responses to these drugs at
lower dosages than those required for whites.29
Newer antidepressants such as the selective sero?
tonin reuptake inhibitors are now being widely pre?
scribed, but as yet very few ethnopharmacologic
studies have been conducted.
Lithium. There is evidence that blacks may
require lower doses of lithium (Eskalith and others)
than white patients do. In one study, Strickland and
colleagues examined the effects of lithium in 12
black and 22 white patients with bipolar disorder.30
All were in remission. Although patients in both
groups received similar daily dosages, blacks
reported more lethargy and dizziness than whites
did. Plasma concentrations of the drug were similar
in the two groups, but erythrocyte lithium concen?
trations were 60% higher in blacks than in whites.30
And in 1980 Okpaku and colleagues found that

serum lithium levels remained higher in healthy
black volunteers than in healthy white volunteers
25 hours after receiving lithium, although the sam?
ple size (N
= 8) was small.31 Given lithium's narrow
therapeutic range and the severity of symptoms of
lithium toxicity, research is needed to examine the
risk of toxicity in populations that demonstrate
lithium sensitivity.
ANTIHYPERTENSIVE DRUGS
The role of CYP enzymes in the metabolism of anti
hypertensives is not yet well understood. But ethnic
variation in drug response has been demonstrated
for many such agents, according to a review by
Burroughs and colleagues in 2002.10 For example,
captopril (Capoten), an angiotensin-converting
enzyme (ACE) inhibitor, has reportedly been found
to be less effective in blacks than in whites.32 The
effectiveness of another ACE inhibitor, enalapril,
was evaluated in white and black patients with left
ventricular dysfunction.33 The patients, who self
identified as white (n = 1,196) or black (n = 800),
were matched for important variables such as age,
sex, and left ventricular ejection fraction and then
randomly assigned to receive enalapril or placebo.
At one year, the white patients showed significant
reductions in blood pressure, and the black patients

did not; the black patients also had higher rates of
hospitalization and death. Another study found
that losar?an, an angiotensin II receptor antagonist,
was less effective in lowering blood pressure in
blacks than in whites, when taken alone.34
Conversely, the thiazide diuretics appear to be
more effective antihypertensives in blacks than in
whites. When used alone, hydrochlorothiazide
(Esidrix and others) has been found to be more
effective in treating hypertension in blacks than in
whites, according to the review by Burroughs and
44 AJN
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colleagues.10 One double-blind study of 1,292 men
with hypertension found that younger black
patients were more responsive to hydrochloroth
iazide and calcium channel blockers than were
white patients.35 And a recent consensus statement

from the Hypertension in African Americans
Working Group of the International Society on
Hypertension in Blacks37 acknowledged that both
thiazide diuretics and calcium channel blockers are
likely to be more effective in treating hypertension
in black patients than in white patients.
Studies on the use of ?-blockers for the treat?
ment of hypertension have also shown ethnic
variation in drug response.35,36 The aforementioned
consensus statement also cautions that monother
apy with ?-blockers is likely to be less effective in
treating hypertension in blacks than in whites.37 In
a recent literature review, Schaefer and colleagues
reported that studies have shown that blacks may
need higher doses of ?-blockers, including propran
olol (Inderal), than those typically prescribed for
whites.38 In contrast, studies have shown that
Asians usually require lower doses of propranolol
than whites do to achieve a therapeutic response.
CULTURAL AND LIFESTYLE FACTORS
Tobacco and alcohol use, both of which may be
influenced by cultural and genetic factors, may
affect an individual's drug response. Strickland and
colleagues noted that the use of tobacco or alcohol

may increase or decrease the rate at which a drug is
metabolized and cleared.27 A review by Frackiewicz
and colleagues stated that smoking has been shown
to decrease serum levels of traditional antipsy
chotics such as chlorpromazine and fluphenazine;
this may be caused by the effects of smoking on
liver enzymes.24 For example, in one man with
schizophrenia the plasma levels of olanzapine
dropped and his condition rapidly worsened when
his smoking increased from 12 to 80 cigarettes a
day.39 The researchers hypothesized that heavy
smoking activated the liver enzyme CYP1A2, the
main enzyme involved in olanzapine metabolism.
And in another study, plasma levels of clozapine in
smokers were approximately 80% of the levels in
nonsmokers.40 A literature search revealed no rele?
vant research on smoking in different populations.
A related concern is adherence to treatment. One
large study of people with hypertension found that
Hispanics were less likely than blacks or whites to
continue taking medication as prescribed, although
the researchers could not account for the differ?
ence.41 Lin and Smith, in discussing how adverse
effects often contribute to nonadherence, point out
that some drug effects "could be interpreted as
either negative or positive" depending on the
patient's beliefs and expectations.12 For example,

Resources
Center for CrossCubural Research
www.ac.wwu.edu/-culture
The Cross Cultural Health Care Program
www.xcubure.org
Diversity Rx
www.diversityrx.org
National Center for Cultural Competence
http://guochd.georgetown.edu/nocc
Transcuhural CAR.E. Associates
www.transcuburalcare.net
Transcuhural Nursing Society
www.tcns.org
discussing one research team's study of Chinese
patients who were bipolar and receiving lithium,
they note the finding that "unlike Western patients,
the Chinese rarely complained of 'missing the
highs' and regarded polydipsia, polyuria, and
weight gain as part of the therapeutic effect." But
the Chinese patients also attributed lethargy and
poor memory to the drug, although the control
group experienced these symptoms at similar rates.

If such issues are not taken into account, clinicians
might misinterpret a pattern of poor compliance by
a particular group as decreased drug efficacy.
Culture-bound syndromes can further compli?
cate evaluation of drug response.28 Culture-bound
syndromes are specific clusters of symptoms or pat?
terns of behavior that are considered abnormal
within a given ethnic group but are much more
common in some groups than others. It's not yet
clear whether culture-bound syndromes overlap
with established psychiatric diagnoses or are dis?
tinct. One example, according to the U.S. surgeon
general, is ataque de nervios (literally, attack of
nerves), specific to Hispanics; its symptoms may
include "screaming uncontrollably, crying, trem?
bling, verbal or physical aggression, dissociative
experiences, seizure-like or fainting episodes, and
suicidal gestures."42 Clinicians' unfamiliarity with a
particular culture-bound syndrome may lead to
inadvertent misdiagnosis, ineffective treatment, and
inappropriate prescribing.
Other factors that may affect drug response and
adherence to treatment include language barriers,
clinicians' beliefs and preconceptions, and patients'

distrust of the health care system. For example, Lin
and Smith report that studies have shown that
black psychiatric patients have been more likely to
be diagnosed with schizophrenia than whites with
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August 2005 ?Vol. 105, No. 8 45
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the same symptoms, and this has been linked to cli?
nician bias.12 Moreover, according to the U.S. sur?
geon general, blacks are more likely than whites are
to receive higher dosages of psychotropic drugs,
even though research indicates that blacks metabo?
lize such drugs more slowly.43 This can lead to more
severe adverse effects and less stringent adherence.
? Some patients will have ther?
apeutic responses at lower
doses than those typically
recommended; careful moni?
toring may help prevent
unnecessary increases in

dosage and adverse effects.
NURSING IMPLICATIONS
Nurses need to be knowledgeable about drugs
that may elicit varied responses in patients from dif?
ferent ethnic groups, especially the variations in
therapeutic dosages and adverse effects. Some
patients will have therapeutic responses at lower
doses than those typically recommended; careful
monitoring may help prevent unnecessary increases
in dosage and adverse effects. For example, among
Hispanic patients receiving traditional antipsy
chotics, symptoms may be managed effectively at
lower doses than those typically prescribed.21 Black
patients on lithium need to be monitored for symp?
toms of drug toxicity, because serum levels of the
drug may be higher than in white patients given
the same dosage.30 For the same reason, Japanese
and Taiwanese patients may require lower dosages
of lithium.44
The practice of making therapeutic substitutions
with medications in the same drug category to con?
tain costs should be approached with caution.
Noting that drugs in the same class may vary in
how they are metabolized, the review by Burroughs
and colleagues called the practice of therapeutic

substitution "clinically risky for patients in differ?
ent nonwhite racial and ethnic groups."10 And of
course, no two people are alike. Thus nurses must
also be alert to individual variations in drug
response and be prepared to initiate discussion with
the primary provider and others on the team.
Skill in communicating with patients from vari?
ous cultures is essential. It's best to ask patients spe?
cific questions about possible adverse effects, rather
than asking general questions or waiting for the
patient to voice concerns. For example, Spector
noted that most Asian cultures highly value
patience and modesty, adding that "the typical
Chinese patient rarely complains."45 Pi and Gray
observed that Asians with psychological complaints
"are likely to express their problems in behavioral
or somatic terms rather than in emotional ones."46
Careful observation and specific questions may be
necessary to elicit important information. A nurse
interviewing a Chinese American patient receiving
haloperidol might ask, "Have you noticed any
unusual, involuntary movements?" to determine
the presence or absence of extrapyramidal effects.
The importance of considering culture when
assessing and teaching patients and families is well

recognized. Two useful, basic questions are "What
do you think caused your health problem?" and
"What treatment do you think will help you?"
Several cultural assessment tools have been
developed. Leininger's Sunrise Model focuses on
seven major areas: educational; economic; familial
and social; political; technologic; religious and
philosophic; and cultural values, beliefs, and prac?
tices. It also considers how lay and professional
beliefs and practices affect the patient's experiences
of health and health care. Examples of questions a
nurse might ask include47:
? In what ways have family members or friends
influenced your life, especially regarding your
health? How have they cared for you, and how
would you like them to care for you now?
? How have your spiritual beliefs helped you to
face crises or to heal when you or your loved
ones are ill?
? In your daily life, do you use a lot of "high-tech"
equipment or appliances? How do you think the
equipment used here helps or hinders your care?
Similarly, Giger and Davidhizar's Transcuhural
Assessment Model considers six areas: communica?
tion, space, social organization, time, environmen?

tal control, and biologic variations.48 It too offers
numerous sample questions. For example, an
assessment of a patient's communication style
includes voice quality, pronunciation and enuncia?
tion, use of silence, and use of nonverbal cues; an
assessment of the patient's relationship to space
includes considering his comfort with proximity to
other people and objects and preferred distance
during conversation. (For more on cultural assess?
ment, see Resources, page 45.)
Determining the patient's language preferences
for spoken and written communication is the first
step. A language barrier that impedes a nurse's abil?
ity to obtain an accurate patient history can con?
tribute to misdiagnosis; one that hampers patient
and family teaching can undermine management of
46 AJN
?
August 2005 ?Vol. 105, No. 8 http://www.nursingcenter.com
2015 15:29:16 UTC

the patient's illness. For example, a patient who
can't understand the instructions for his drug regi?
men may not adhere to it; if this isn't recognized,
the drug regimen may be needlessly altered.
Patients and families also need to know how to
identify the major adverse effects of the drugs
they're taking and instructions regarding whom to
contact if such effects occur.
If an interpreter is needed, one should be pro?
vided by the facility. (The Office of Minority
Health's National Standards for Culturally and
Linguistically Appropriate Services in Health Care
[www.omhrc.gov/clas/finalculturalla.htm] states
that using the patient's friends or family members
as interpreters is not recommended; one reason
is that the patient may not be comfortable disclos?
ing certain symptoms or behaviors to them.) In
some cases the patient may be fluent in speaking a
language but not in reading or writing it. Nurses
may also need to become aware of the different
terms patients use to describe their illnesses. In
our experience, for example, African American

patients often refer to hypertension as "high blood"
and anemia as "low blood."
A cultural assessment can yield other important
information such as dietary preferences, customs
related to alcohol and tobacco use, and the use of
herbal products. Finally, to become culturally compe?
tent, nurses also need to explore their
own perspec?
tives, including any assumptions or misconceptions
they may have. ?
Complete the CE test (or this article by
using the mail-in form available ?n this
issue, or visit NursingCenter.com's
"CE Connection" to take the test and find
other CE activities and "My CE Planner/
REFERENCES
1. U.S. Census Bureau. Young, diverse, urban: Hispanic popu?
lation reaches all-time high of 38.8 million, new Census
Bureau estimates show. 2003. http://www.census.gov/
Press-Release/www/releases/archives/hispanic_origin_
population/001130.html.
2. Campinha-Bacote J. A model and instrument for addressing
cultural competence in health care. / Nurs Educ 1999;38(5):
203-7.
3. U.S. Census Bureau. Geographic comparison table. GCT
P6. Race and Hispanic or Latino: 2000. 2000.

http://factfinder.census.gov/servlet/GCTTable?_bm=y&
geo_id=01000US&-_box_head_nbr=GCT-P6&>
ds_name=DEC_2000_SFl_U&-_lang=en&-format=US-9&
_sse=on.
4. U.S. Census Bureau. People: race and ethnicity. 2004.
http://factfinder.census.gov/jsp/saf?/SAFFInfo.jsp?_pageId=tp
9_race_ethnicity.
5. Denberg TD. Questioning race-based hypertension manage?
ment. Arch Intern Med 2003;163(14):1744-5; author reply
1745.
6. Schwartz RS. Racial profiling in medical research. N Engl J
AW2001;344(18):1392-3.
7. Leininger M. The theory of culture care and the ethnonurs
ing research method. In: Leininger M, McFarland MR, edi?
tors. Transcuhural nursing: concepts, theories, research, and
practice. 3rd ed. New York: McGraw-Hill; 2002. p. 71-98.
8. Burchard EG, et al. The importance of race and ethnic
background in biom?dical research and clinical practice.
N EnglJ Med 2003;348(12):1170-5.
9. Dawkins K, Potter WZ. Gender differences in pharmacoki
netics and pharmacodynamics of psychotropics: focus on
women. Psychopharmacol Bull 1991;27(4):417-26.
10. Burroughs VJ, et al. Racial and ethnic differences in

response to medicines: towards individualized pharmaceuti?
cal treatment. / Nati Med Assoc 2002;94(10 Suppl):l-26.
11. Nicol MJ. The variation of response to pharmacotherapy:
pharmacogenetics?a new perspective to "the right drug for
the right person." Medsurg Nurs 2003;12(4):242-9.
12. Lin KM, Smith MW. Psychopharmacotherapy in the con?
text of culture and ethnicity. In: Ruiz P, editor. Ethnicity and
psychopharmacology. Vol. 19, no. 4, Review of Psychiatry,
Oldham JM, Riba MB, editors. Washington, D.C.: Ameri?
can Psychiatric Press; 2000. p. 1-36.
13. American Heart Association. Number of adults in U.S. with
high blood pressure rose in last decade. 2004. http://
www.americanheart.org/presenter.jhtml?identifier=3024254.
14. Lin KM, et al. The evolving science of pharmacogenetics:
clinical and ethnic perspectives. Psychopharmacol Bull
1996;32(2):205-17.
15. Solus JF, et al. Genetic variation in eleven phase I drug
metabolism genes in an ethnically diverse population.
Pharmacogenomics2004;5(7):S95-931.
16. Keltner NL, Folks DG. Psychotropic drugs. 3rd ed. St.
Louis: Mosby; 2001.
17. Luo HR, et al. Polymorphisms of CYP 2C19 and CYP 2D6
in Israeli ethnic groups. Am J Pharmacogenomics 2004;
4(6):395-401.
18. Lin KM, Poland RE. Pharmacotherapy of Asian psychiatric

patients. Psychiatr Ann 1989;19(12):659-63.
19. Lin KM, et al. A longitudinal assessment of haloperidol
doses and serum concentrations in Asian and Caucasian
schizophrenic patients. Am J Psychiatry 1989;146(10):
1307-11.
20. Jafar TH, et al. Ethnic subgroup differences in hypertension
in Pakistan. / Hypertens 2003;21(5):905-12.
21. Ruiz S, et al. Neuroleptic dosing in Asian and Hispanic out?
patients with schizophrenia. Mt Sinai] Med 1996;63(5
6):306-9.
22. Glazer WM, et al. Race and tardive dyskinesia among out?
patients at a CMHC. Hosp Community Psychiatry 1994;
45(l):38-42.
23. Tran P, et al. Treatment of the African-American patient
with novel antipsychotic agents. In: Herrera JM, et al., edi?
tors. Cross cultural psychiatry. Chichester, England: John
Wiley and Sons; 1999. p. 131-8.
24. Frackiewicz E, et al. Review of neuroleptic dosage in
differ?
ent ethnic groups. In: Herrera JM, et al., editors. Cross cul?
tural psychiatry. Chichester, England: John Wiley and Sons;
1999. p. 107-30.
25. Matsuda KT, et al. Clozapine dosage, serum levels, efficacy,
and side-effect profiles: a comparison of Korean-American
and Caucasian patients. Psychopharmacol Bull 1996;32(2):

253-7.
26. Lawson WB. Clinical issues in the pharmacotherapy of
African-Americans. Psychopharmacol Bull 1996;32(2):275
81.
27. Strickland TL, et al. Psychopharmacologic considerations in
the treatment of black American populations. Psychopharma?
col Bull 1991;27(4):441-8.
28. Mendoza R, et al. Ethnic psychopharmacology: the
Hispanic and Native American perspective. Psychopharma?
col Bull 1991;27 {4) A49-61.
29. Wood AJ, Zhou HH. Ethnic differences in drug disposition
and responsiveness. Clin Pharmacokinet 1991;20(5):350-73.
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30. Strickland TL, et al. Comparison of lithium ratio between
African-American and Caucasian bipolar patients. Biol
Psychiatry 1995;37(5):325-30.
31. Okpaku S, et al. A pilot study of racial differences in ery

throcyte lithium transport. Am J Psychiatry 1980;137(1):
120-1.
32. Kudzma EC. Drug response: all bodies are not created
equal. AmJNurs 1992;92(12):48-50.
33. Exner DV, et al. Lesser response to angiotensin-converting
enzyme inhibitor therapy in black as compared with white
patients with left ventricular dysfunction. N EnglJ Med
2001;344(18):1351-7.
34. Flack JM, et al. Efficacy and tolerability of eplerenone and
losartan in hypertensive black and white patients. / Am Coll
Cardiol 2003;41(7):1148-55.
35. Materson BJ, et al. Single-drug therapy for hypertension in
men?a comparison of six antihypertensive agents with
placebo. The Department of Veterans Affairs Cooperative
Study Group on Antihypertensive Agents. N EnglJ Med
1993;328(13):914-21.
36. Preston RA, et al. Age-race subgroup compared with renin
profile as predictors of blood pressure response to antihy?
pertensive therapy. Department of Veterans Affairs
Cooperative Study Group on Antihypertensive Agents.
JAMA 1998;280(13):1168-72.
37. Douglas JG, et al. Management of high blood pressure in
African Americans: consensus statement of the Hyper?

tension in African Americans Working Group of the
International Society on Hypertension in Blacks. Arch
Intern Med 2003;163(5):525-41.
38. Schaefer BM, et al. Gender, ethnicity, and genes in cardio?
vascular disease. Part 2: implications for pharmacotherapy.
Heart Dis 2003;5(3):202-14.
39. Chiu CC, et al. Heavy smoking, reduced olanzapine levels,
and treatment effects: a case report. Ther Drug Monit
2004;26(5):579-81.
40. Haring C, et al. Dose-related plasma levels of clozapine:
influence of smoking behaviour, sex and age. Psychopharma
cology (Berl) 1989;99 Suppl:S38-40.
41. Sudano JJ, Jr., Baker DW. Antihypertensive medication use
in Hispanic adults: a comparison with black adults and
white adults. Med Care 2001;39(6):575-87.
42. U.S. Public Health Service. Surgeon General's Report. Fact
sheets: Latinos/Hispanic Americans. 2001. http://www.
mentalhealth.samhsa.gov/cre/fact3.asp.
43. U.S. Public Health Service. Surgeon General's Report. Fact
sheets: African Americans. 2001. http://www.mentalhealth.
org/cre/factl.asp.
44. Lin KM, et al. Ethnicity and psychopharmacology. Cult
Med Psychiatry 1986;10(2):151-65.
45. Spector R. Cultural diversity in health and illness. 5th ed.
Upper Saddle River, NJ: Prentice Hall Health; 2000. p. 209

29.
46. Pi EH, Gray GE. Ethnopharmacology for Asians. In: Ruiz P,
editor. Ethnicity and psychopharmacology. Vol. 19, no. 4,
Review of Psychiatry, Oldham JM, Riba MB, editors.
Washington, D.C.: American Psychiatric Press; 2000.
p. 91-113.
47. Leininger M. Culture care assessments for congruent com?
petency practices. In: Leininger M, McFarland MR, editors.
Transcultural nursing: concepts, theories, research, and
practice. 3rd ed. New York: McGraw-Hill; 2002. p. 117-43.
48. Giger JN, Davidhizar RE. Transcultural nursing: assessment
and intervention. 4th ed. St. Louis: Mosby; 2004. p. 3-19.
Continuing Education
GENERAL PURPOSE: To provide registered professional
nurses with current information on ethnopharmacology,
including how ethnicity affects responses to prescribed
medication.
LEARNING OBJECTIVES: After reading this article and tak?
ing the test on the next page, you will be able to:
? discuss the trends and concepts that contribute to
understanding ethnopharmacology. ? describe the effects of
specific drugs on various
racial and ethnic groups as presented in this article. ? outline
the efficacy

of several types of drugs on var?
ious racial and em nie groups, as well as how cul?
ture can affect drug therapy.
To tore conKmndj ?docotiou (CE) croo?, fmow those
1? After reading this article, darken the appropriate boxes
(numbers 1-17) on the answer card between pages 48
and 49 (or a photocopy). Each question has only one
correct answer.
2. Complete the registration information (Box A) and help
us evaluate this offering (Box C).*
3. Send the card with your registration fee to: Continuing
Education Department, Lippincott Williams & Wilkins, 333
Seventh Avenue, 19th Floor, New York, NY 10001.
4. Your registration fee for this offering is $22.75. If you take
two or more tests in any nursing journal published by
Lippincott
Williams & Wilkins and send in your answers to
all tests together, you may deduct $0.75 from the price of
each test.
Within six weeks after Lippincott Williams & Wilkins
receives your answer card, you'll
be notified of your test
results. A passing score for this test is 13 correct answers
(76%). If you pass, Lippincott Williams & Wilkins will
send you a CE certificate indicating the number of contact
hours you've earned. If you fail, Lippincott Williams &
Wilkins gives you the option of taking the test again at no
additional cost. All answer cards for this test on

'Ethnopharmacology" must be received by August 31,
2007.
This continuing education activity for 3.5 contact
hours is provided by Lippincott Williams & Wilkins,
which is accredited as a provider of continuing nursing
education (CNE) by the American Nurses Crederv
tialing Center's Commission on Accreditation and by
the American Association of Critical-Care Nurses
(AACN 00012278, category O). This activity is also
provider approved by the California Board of
Registered Nursing, provider number CEP 11749 for
3.5 contact hours. Lippincott
Williams & Wilkins is also
an approved provider
of CNE in Alabama, Florida,
and Iowa, ana holds the following provider numbers:
AL #ABNP0114, FL #FBN2454, IA W75. All of its
home study activities are classified for Texas nursing
continuing education requirements as Type 1.
*/n accordance with hwa Board of Nursing administrative
rules governing grievances, a copy of your evaluation of mis
CNE offering may be submitted to the hwa Board of Nursing.
48 AJN
?
August 2005
? Vol. 105, No. 8 http://www.nursingcenter.com
2015 15:29:16 UTC

HOURS
Ethnopharmacology
1. The study of generic variations in
responses to drugs is most accu?
rately termed
a.
ethnopharmacology.
b. cultural competence.
c.
pharmacogenetics.
d. transcultural pharmacology.
2? According to Hie article/ between
April 2000 and July 2003 which of
the following groups grew in popu?
lation the fastest?
a. Native Alaskans
b. African Americans
c. Asian Americans
d. Hispanic Americans
3? According to Leininger, an inte?
grated system of learned beliefs/
values, and customs common to a
particular group of people

a.
ethnicity.
b. race.
c.
lineage.
d. culture.
4. The cytochrome P-450 enzymes
a. are responsible for the phase 2
metabolism of many common drugs.
b. can alter drug response
when
genetically abnormal.
c. do not
typically
affect plasma levels
of psychotropic drugs.
d. can be altered by specific lifestyle
practices.
5. When Un and Poland studied the
effects of nolopondol in noolftiy
participants/ mey louna me lowest
serum concentrations of the drug
among
a. whites.
b. American-born Asian Americans.

c. African Americans.
d. foreign-born Asian Americans.
6. According to this article, at least
one study of the use of traditional
antipsyctioncs demonstrated that
a. black patients were at lower risk for
developing tardive dyskinesia than
whites were.
b. black patients required lower doses
than "general" patients (those from a
multiethnic control group) did.
c. Hispanic patients were at greater
risk for developing tardive dyskinesia
than whites were.
d. Hispanic patients required lower
doses than "general" patients did.
7. In a study of clozapine (Glozaril)
use by Korean Americans and
whites, the Korean Americans
a. had a higher incidence of anti
cholinergic effects.
b. received higher doses of the drug.
c. showed a poorer therapeutic
response.
d. showed higher
serum concentra?
tions of the drug.

8. In a study by Tran and col?
leagues, which drug caused fewer
involuntary movements in blacks
man naioponaoi aiar
a. fluphenazine (Prolixin, Permitil)
b. clozapine (Clozaril)
c. olanzapine (Zyprexa)
d. risperidone (Risperdal)
9. Two literature reviews of the use
of tncyclics have indicated that, in
comparison with whites, blacks
have
a. slower
therapeutic
responses.
b. a greater risk of delirium.
c. lower serum concentrations.
d. more reluctance to report adverse
effects.
10? According to a study by
Strickland and colleagues, blacks
taking lithium reported which of
the following adverse effects more
often than whites did?
a. oliguria
b. constipation
c. rapid pulse

d. lethargy
11 ? Which type of antihypertensive
agent has generally been found to
be more effective in bracks than in
whites?
a. thiazide diuretics
b. angiotensin-converting enzyme
(ACE) inhibitors
c. ?-blockers
d. angiotensin II receptor antagonists
12. Whichtype of drug is likely to
be more effective in treating hyper?
tension in blacks than in whites?
a. ?-blockers
b. centrally acting adrenergics
c. calcium channel blockers
d. ACE inhibitors
13. Studies have shown which
group to require lower doses of
propranolol (Inderal) to achieve a
therapeutic response than whiles
do?
a. blacks
b. Hispa nies
c. American Indians
d. Asians

14. A study by Sudano and col?
leagues demonstrated lowest
aanerence 10 a arug r?gimen
among
a. blacks.
b. Hispanics.
c. whites.
d. Asians.
15. According to Spector, cultural
values held by people from which
group make mem less likely to
report adverse effects?
a. blacks
b. Hispanics
c. whites
d. Asians
16. One good way to assess the
neaim oeiiers or a panenr rrom
another culture is to
a. ask the patient, "What treatment do
you think will help you?"
D. research the patient's culture using
the library and Internet.
c. determine, based on the patient's
health status, how self-care can help.
d. discuss with the

family
how culture
shapes the patient's health beliefs.
17? It is recommended that nurses
who encounter a language barrier
when trying to talk with a patient
a. check the chart for a contact per?
son.
b. try to communicate with gestures.
c. use an interpreter provided by the
facility.
d. screen the patient's visitors for an
interpreter. T
ain9hvw.com AJN
?
August 2005
? Vol. 105, No. 8 49
2015 15:29:16 UTC
http://www.jstor.org/page/info/about/policies/terms.jspArticle
Contentsp. 40p. 41p. 42p. 43p. 44p. 45p. 46p. 47p. 48p. 49Issue
Table of ContentsThe American Journal of Nursing, Vol. 105,
No. 8 (Aug., 2005) pp. 1-88Front MatterEditorial: When Nurses
Die of AIDS [pp. 11-11]Viewpoint: Terri Schiavo and the Pope
[pp. 13-13]LettersAPRNs in Texas [pp. 15-15]Who Are You
Calling a Nurse? [pp. 16-16]Malnutrition in Nursing Homes

[with Response] [pp. 16-16]Tattoos in Borneo [pp. 16-16]How
about Nurses Month? [pp. 16-16]Correction: Wound Wise:
Preventing Pressure Ulcers with the Braden Scale [pp. 16-
16]News [pp. 19-22]Drug Watch [pp. 25-26]AJN Reports [pp.
28-29]The Politics of Caring: Medicaid Reform on Tap in
September [pp. 30-30]Wound Wise: Preventing Pressure Ulcers
with Massage? [pp. 31, 33]Practice Errors: Not All Brands Are
Created Equal [pp. 36-37]Reflections: Planting Angelo [pp. 39-
39]CE Credit: Ethnopharmacology [pp. 40-49]Correspondence
from Abroad: Across the Barrier [pp. 50-55]CE Credit: Raynaud
Phenomenon [pp. 56-66]Art of NursingShattered [pp. 67-
67]Emergency: Color Coding to Reduce Errors [pp. 68-
71]Nursing Resources: Health Care Quality Databases [pp. 72-
72]Hospital ExtraFYI [pp. 72A, 72D, 72F-72G]Nursing Nuns
[pp. 72H-72H]Critical Care ExtraFYI [pp. 72CC-72CC]Issues
Update: No Smoking, Please [pp. 75, 77, 79]Profiles: Good
Grief [pp. 86-87]Health &Safety: Protect Your Family [pp. 88-
88]Back Matter
Ethnopharmacology Discussion Board:
Hello Students,
Researchers have identified that genetic and ethnic factors may
effect a drug's pharmacokinetics ... as you read about in Week
1. This week, your assignment is to read the
Ethnopharmacology
article provided in preparation for submitting a scholarly
discussion. It
is expected that a brief literature review will be completed in an

effort to find supporting sources. I look forward to your
findings!
Prompts:
he key concepts
racial groups?
this changed?
setting?
Please respond to at least one classmate from another
Discussion Topic.
Thanks!
“Emergency Preparedness” Discussion:
Hello Students,
ANA considers disaster preparedness and response a part of
nursing practice.
Please research information on this topic and the nurse’s role.
Below are a

few resources, please feel free to include other scholarly
sources! I look
forward to your findings!
Resources:
- Stockpile?
Prompts:

Discussion Topic.
Thanks!
http://www.merckmanuals.com/professional/clinical-
pharmacology/pharmacokinetics/overview-of-pharmacokinetics
https://scf.instructure.com/courses/11902/files/1858639/downlo
ad?wrap=1
ad?wrap=1
•%09http:/www.nursingworld.org/disasterpreparedness)
•%09http:/www.nursingworld.org/MainMenuCategories/Workpl
aceSafety/Healthy-Work-Environment/DPR/Education
http://www.nursingworld.org/MainMenuCategories/WorkplaceS
afety/Healthy-Work-Environment/DPR
https://www.cdc.gov/phpr/stockpile/stockpile.htm
leacain
Highlight
Opioid Crisis! Discussion:
Hello Students,
We have studied about Drugs for pain and substance abuse. Our
nation is in
the midst of an Opioid Crisis! It is troubling for us in this
community and Florida
to see the increase in deaths due to heroin and fentanyl
overdoses.

Many governmental agencies [HHS, CDC, and FDA] have
recognized this as
a very troubling problem in America. Below are a few
resources, please feel
free to include other scholarly sources! I look forward to your
findings!
Resources:
Prompts:

-economic [hospitals,
agencies, families, employers, law
enforcement, etc.]. Impact on the nation? Costs?
Solution
s? short term; long term
Discussion Topic.
Thanks!
Is Marijuana Medicine? Discussion Board:
Hello Students,

This is a very timely topic! What did the voters of Florida have
to say about
this? Please research this topic using scholarly sources to
develop a
discussion posting. I look forward to your findings!
Resources:
IV [Chapter 40]
Prompts:

Discussion Topic.
Thanks!
http://www.hhs.gov/opioids/about-the-epidemic/
http://www.fda.gov/drugs/drugsafety/informationbydrugclass/uc
m337066.htm
http://www.cdc.gov/drugoverdose/
http://www.floridahealth.gov/statistics-and-data/e-
forcse/index.html
https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/drugfact
s_is_marijuana_medicine_july2015.pdf
http://google2.fda.gov/search?q=marijuana+for+medical+use&cl
ient=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&re
quiredfields=-archive%3AYes&output=xml_no_dtd&getfields=*

Pharmacogenetics Discussion Board:
Hello Students,
Researchers have identified that genetic and ethnic factors may
effect a drug's
pharmacokinetics ... as you read about in Week 1. This week,
your assignment is to
watch a short Cultural Health video below and read
the Pharmacogenomics article [written by one of our BSN alum
and was the
beginning of his EBP paper!] provided in preparation for
submitting a scholarly
discussion. It is expected that a brief literature review will be
completed in an effort
to find supporting sources. I look forward to your findings!
Resources:

Medication Adherence
nalized Medicine, Genomics,.PDF
Prompts:
ce?
Discussion Topic.
Thanks!

Prevalence and Nature of Medication Administration Errors in
Health Care Settings Discussion
Board:
Hello Students,
This is always a very timely topic! Please research the stats
related to medication errors
and develop a scholarly discussion post. I look forward to your
findings!
Resources:

Prompts:
learn?
Discussion Topic.
Thanks!
ad?wrap=1
•%09https:/www.youtube.com/watch?v=s1zq2o2ZjJs

ad?wrap=1
https://www.ismp.org/default.asp
http://google2.fda.gov/search?q=Medication+Errors&client=FD
Agov&site=FDAgov&lr=&proxystylesheet=FDAgov&requiredfi
elds=-archive%3AYes&output=xml_no_dtd&getfields=*

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