Lecture - 8.30.23 (in-class by Dr.

Roache)
Wednesday, August 30, 2023 08:52

Special Populations
• Most pharm studies are based on healthy white men in 30-40s
○ Special populations = anyone that are not them^^^

Cultural and Ethnic Influences

• Health disparities = differences in health outcomes and their determinants between s
population as defined by social, demographic, environmental, and geographic attribu
○ Can be caused by
§ Lack of
□ Money
□ Access
□ Food
□ Resources
§ Cost of food
§ Isolation
• Cultural competency
○ Western providers need to understand our own backgrounds but then acknowl
and alternatives of patient backgrounds
• Ethnocentrism = eval of other cultures
• CLAS standards = culturally and linguistically appropriate services
○ Respect the whole individual and respond to the individual's health needs and p
• Many people don’t seek western medicine
○ Appalachian people don’t really see HCPs if they can avoid it
○ Medical mistrust seen in AAs
○ Chattanooga and its surrounding 8 counties = considered underserved populati
• Ethnopharmacology
• Family dynamics
• Health status variables
• Health beliefs and practice

Social Determinants of Health

• Economic stability
○ Employment
○ Income
○ Expenses
 segments o the
utes

ledge the cultures

preferences

ion
Social Determinants of Health
• Economic stability
○ Employment
○ Income
○ Expenses
§ Can you afford prescription?
○ Debt
○ Medical bills
§ #1 cause of bankruptcy
○ Support
• Neighborhood and physical environment
○ Housing
○ Transportation
○ Safety
§ Can they walk around safely?
○ Parks
○ Playgrounds
○ Walkability
○ Zip code/geography
• Education
○ Literacy
§ Can they read?
§ Most people have a 3rd grade reading level
○ Language
○ Early childhood education
○ Vocational training
○ Higher education
• Food
○ Hunger
○ Access to healthy options
§ Are they in a food desert?
• Community and social context
○ Social integration
○ Support systems
○ Community engagement
○ Discrimination
○ Stress
• Health care system
○ Health coverage
○ Provider availability
○ Provider linguistic and cultural competency
○ Quality of care
 ○ Health coverage
○ Provider availability
○ Provider linguistic and cultural competency
○ Quality of care

In-Class Cultural Examples

• #5
• AA = salt sensitive - why more sensitive?
○ AHA, 1996
§ Correlation of salt sensitivity and HTN d/t a genetic factor that AAs have t
little evidence of this
○ AHA, 1999
§ Variant of ACE gene found in AA --> increased salt sensitivity
□ Gene variant screening is not recommended
§ Study found that AAs with HTN, DM, kidney disease, and obesity = most li
gene variant
○ Myth? (Cerdeña, 2021)
§ Increased HTN rates d/t salt sensitivity d/t idea that enslaved Africans wh
middle passage had a selective advantage for salt retention
□ Aka slavery hypothesis
□ Part of scientific racism that has shaped beliefs of pathophysiology i
□ Thiazide diuretics gives better benefits than ACE inhibitors
® ACE inhibitors don’t work for AAs really bc of lower renin stat
increased peripheral resistance--contradicts ACE gene variant
• Relates to presence of HTN and effectiveness of diuretics

Older Adults
• Demographics
• Physical changes affecting medications
• BEERS criteria
○ Polypharmacy is huge for older adults
• Adverse drug reactions

State Law on Prescription Writing

• Federal govt decides what is a prescription drug
• States decide who can prescribe
○ Prescriptive authority varies from state to state
○ States determine how independent an NP is in prescribing
• DEA # is obtained from the DEA but states determine scope of practice of controlled s
prescribing
○ Good for 3 years
○ Make sure to negotiate that employer pays for it
○ DEA = $850
○ Looks at controlled meds and allowing you to write those
thought but there is

ikely to have ACE

ho survived the

in AAs

te and lower CO with

t theory (2005)

substance
 • DEA # is obtained from the DEA but states determine scope of practice of controlled s
prescribing
○ Good for 3 years
○ Make sure to negotiate that employer pays for it
○ DEA = $850
○ Looks at controlled meds and allowing you to write those
• Generic vs brand-name
Generic Brand-name
Usually cheaper More expensive
○ Drug might vary 20% with brand name 100% drug
Some formularies are not covered with health Some formularies are not cov
insurance insurance

Writing a Prescription: Tips

• Dispense as written = giving brand name only
• 90 day supply is usually cheaper than 30 day supply
substance

vered with health