Pharmacology TEST 1 Chapter 1,2,3,4,5,7
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Questions and Answers

What is the purpose of a nursing diagnosis?

  • To list clues, cues, evidence, and/or data that support the nurse’s claim about the patient's health status
  • To identify factors related to the patient's response to illness, injury, medications, or significant change (correct)
  • To provide a cause-and-effect link between illness, injury, and medications
  • To state adverse effects to report to the prescriber
  • What does 'Altered safety needs, risk for injury' represent in a human needs statement?

  • Factors related to the patient's response
  • An increased risk or an opportunity to improve the patient’s health status
  • An actual response of the patient to illness, injury, medications, or significant change (correct)
  • Clues, cues, evidence, and/or data that support the nurse’s claim about the patient's health status
  • What does the third part of a human need statement list?

  • An increased risk or an opportunity to improve the patient’s health status
  • Factors related to the patient's response
  • Clues, cues, evidence, and/or data that support the nurse’s claim about the patient's health status (correct)
  • Adverse effects to report to the prescriber
  • What does the second part of a human need statement identify?

    <p>Factors related to the patient's response</p> Signup and view all the answers

    What is the significance of the statement 'As evidenced by inability to perform a return demonstration and inability to state adverse effects' in a human need statement?

    <p>It lists clues, cues, evidence, and/or data that support the nurse’s claim about the patient's health status</p> Signup and view all the answers

    What is the term used to express the extent of drug absorption?

    <p>Bioavailability</p> Signup and view all the answers

    Which therapy is used for the treatment of chronic illnesses such as hypertension?

    <p>Maintenance therapy</p> Signup and view all the answers

    What is the time required for half (50%) of a given drug to be removed from the body called?

    <p>Half-life</p> Signup and view all the answers

    What occurs if the peak blood level of the drug is too high?

    <p>Toxicity</p> Signup and view all the answers

    What is the physiologic or psychological need for a drug called?

    <p>Dependence</p> Signup and view all the answers

    What is the ratio between the toxic and therapeutic concentrations of a drug called?

    <p>Therapeutic index</p> Signup and view all the answers

    What is an extension of the drug’s normal effects in the body called?

    <p>Pharmacologic reaction</p> Signup and view all the answers

    What are permanent changes in the genetic composition of living organisms called?

    <p>Mutagenic effects</p> Signup and view all the answers

    What is provided to prevent illness or other undesirable outcome during planned events?

    <p>Prophylactic therapy</p> Signup and view all the answers

    What are unpredictable reactions that occur in only a small percentage of patients receiving the drug and which do not involve known pharmacological properties of the drug called?

    <p>Idiosyncratic reaction</p> Signup and view all the answers

    What is the goal of palliative therapy?

    <p>To make the patient as comfortable as possible</p> Signup and view all the answers

    What is the term used to describe an alteration in the pharmacologic or pharmacokinetic activity of a given drug caused by the presence of one or more additional drugs?

    <p>Drug interaction</p> Signup and view all the answers

    What is the goal of Interprofessional Education Collaboration (IPEC)?

    <p>To improve health outcomes through interprofessional education</p> Signup and view all the answers

    Which of the following is an example of objective data in nursing assessment?

    <p>Patient's height, weight, and allergies</p> Signup and view all the answers

    What is the purpose of formulating human need statements in the nursing process?

    <p>To fulfill/alter human needs based on objective and subjective data</p> Signup and view all the answers

    Which step of the nursing process includes independent nursing actions, collaborative activities, and implementation of medical orders?

    <p>Implementation</p> Signup and view all the answers

    What is the main focus of the evaluation phase in the nursing process?

    <p>Monitoring whether patient outcomes are met as related to the human need statements</p> Signup and view all the answers

    What is the definition of a medication error?

    <p>Any preventable event that may cause or lead to inappropriate medication use or patient harm</p> Signup and view all the answers

    What is a key component of the planning phase in the nursing process?

    <p>Identifying outcomes that are patient-oriented and provide time frames</p> Signup and view all the answers

    What is the main goal of the nursing process?

    <p>To deliver thorough, individualized, and quality nursing care to patients</p> Signup and view all the answers

    In which step of the nursing process does the nurse analyze objective and subjective data about the patient and the drug?

    <p>Diagnosis / Human Need Statements</p> Signup and view all the answers

    What does the term 'human need statement' refer to in the nursing process?

    <p>A statement of human response to illness, injury, medications, or significant change</p> Signup and view all the answers

    What does the planning phase of the nursing process focus on?

    <p>Identifying outcomes that are patient-oriented and provide time frames</p> Signup and view all the answers

    What is the main reason for altered absorption in neonates and pediatric patients?

    <p>Immature liver leading to reduced first-pass elimination</p> Signup and view all the answers

    Why is distribution altered in neonates and pediatric patients?

    <p>Greater total body water and lower fat content</p> Signup and view all the answers

    How does the metabolism differ in older children compared to infants?

    <p>Older children require higher doses of drugs compared to infants</p> Signup and view all the answers

    What contributes to the decreased excretion of drugs in neonates and pediatric patients?

    <p>Decreased glomerular filtration rate</p> Signup and view all the answers

    What factor contributes to the decline in organ function with advancing age in older adults?

    <p>Reduced blood flow to the liver</p> Signup and view all the answers

    Which statement accurately describes drug therapy in older adults?

    <p>Older adults have decreased protein binding of drugs leading to higher circulation of free drugs</p> Signup and view all the answers

    What does ethnopharmacology refer to?

    <p>Body of knowledge for understanding cultural factors on patient drug response</p> Signup and view all the answers

    What is the purpose of phase I studies in investigational drug studies?

    <p>To determine the optimal dosage range and pharmacokinetics of the drug</p> Signup and view all the answers

    What is required for obtaining informed consent from a patient?

    <p>Voluntary agreement by the patient and at least one witness</p> Signup and view all the answers

    What is essential for new drugs before any testing in human subjects can be done?

    <p>Laboratory testing using both in vitro and animal studies</p> Signup and view all the answers

    Which study involves small numbers of healthy subjects rather than those who have the disease that the new drug is intended to treat?

    <p>Phase I studies</p> Signup and view all the answers

    What does pharmacogenomics study focus on?

    <p>Specific genetic traits affecting drug response</p> Signup and view all the answers

    What is the purpose of conducting postmarketing studies (Phase IV)?

    <p>To gather data for at least 2 years after the drug’s release</p> Signup and view all the answers

    What is the purpose of a black box warning from the FDA?

    <p>To indicate that serious adverse effects have been reported with the drug</p> Signup and view all the answers

    In the context of drug recalls, what does a Class II recall indicate?

    <p>The use of the drug product may result in temporary or medically reversible health effects</p> Signup and view all the answers

    What is an example of a legal consideration related to nursing practice?

    <p>State and federal legislation</p> Signup and view all the answers

    Which ethical principle involves promoting a patient’s decision making and supporting informed consent?

    <p>Autonomy</p> Signup and view all the answers

    What is meant by 'negligence' in the context of nursing practice?

    <p>The failure to act in a reasonable and prudent manner</p> Signup and view all the answers

    What is the purpose of reporting near miss events in healthcare?

    <p>To address safety issues and prevent future incidents</p> Signup and view all the answers

    Which strategy is aimed at minimizing medication errors by focusing on the therapeutic effects and possible interactions among drugs?

    <p>'T.A.C.I.T.' mnemonic</p> Signup and view all the answers

    What does damage refer to in the context of legal and ethical principles?

    <p>Extensive skin and nerve damage resulting from negligence</p> Signup and view all the answers

    'Scope of nursing practice' is an example of a legal consideration related to:

    <p>'Legal and ethical principles'</p> Signup and view all the answers

    A Class III drug recall signifies that:

    <p>The use of the drug product is not likely to result in any significant health problems.</p> Signup and view all the answers

    What does 'breach of duty' refer to in nursing practice?

    <p>The failure to notice signs and symptoms that require immediate attention.</p> Signup and view all the answers

    Which term refers to the study of how various drug forms influence the way in which the drug affects the body?

    <p>Pharmaceutics</p> Signup and view all the answers

    What is the term for any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient?

    <p>Idiosyncratic reaction</p> Signup and view all the answers

    What is the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body?

    <p>Pharmacokinetics</p> Signup and view all the answers

    Which drugs do not interact with receptors or enzymes and instead target cell membranes and various cellular processes?

    <p>Cancer drugs</p> Signup and view all the answers

    Which organ is primarily responsible for the metabolism of drugs?

    <p>Liver</p> Signup and view all the answers

    What do drugs exert when they produce actions (therapeutic effects) through receptors, enzymes, and nonselective interactions?

    <p>Pharmacologic responses</p> Signup and view all the answers

    What determines the degree to which a drug attaches to and binds with a receptor?

    <p>Affinity</p> Signup and view all the answers

    Which term refers to the clinical use of drugs to prevent and treat diseases?

    <p>Pharmacotherapeutics</p> Signup and view all the answers

    What is the primary focus of pharmacognosy?

    <p>The study of drug sources in nature</p> Signup and view all the answers

    Which process involves maintaining an accurate and up-to-date list of medications for all patients between all phases of health care delivery?

    <p>Medication reconciliation</p> Signup and view all the answers

    What does selective interaction refer to?

    <p>Interacting with enzymes only</p> Signup and view all the answers

    Match

    <p>Part 1 &quot;Altered Safety Needs, risk for injury&quot; = is the statement of the human response of the patient to illness, injury, medications, or significant change. This can be an actual response, an increased risk, or an opportunity to improve the patient’s health status. Part 2 related to = This portion of the statement identifies factors related to the response; it often includes multiple factors with some degree of connection between them. The human need statement does not necessarily claim that there is a cause-and-effect link between these factors and the response, only that there is a connection. Part 3 as evidenced by = This statement lists clues, cues, evidence, and/or data that support the nurse’s claim that the human need statement is accurate. A human needs statement = is the same as a Nursing Diagnosis</p> Signup and view all the answers

    The nursing process is: -A research-supported organizational framework for professional nursing practice -Ensures the delivery of thorough, individualized, and quality nursing care to patients -Requires critical thinking -Ongoing and constantly evolving process

    <p>True</p> Signup and view all the answers

    The Assessment includes all objective and subjective data, review and analysis and the medication profile is updated with all drug use, prescriptions, OTC medications, Vitamins, herbs, supplements and compliance and adherence.

    <p>True</p> Signup and view all the answers

    Human need statements are prioritized in order of criticality based on patient needs or problems. The ABCs of care (airway, breathing, and circulation) are often used as a basis for prioritization. Prioritizing always begins with the most important, significant, or critical need of the patient. Human need statements that involve actual responses are always ranked above statements that involve only risks.

    <p>True</p> Signup and view all the answers

    the client came in with a pain level of 9/10 on a numeric pain scale. The nurse administered an analgesic. The nurse came back 30 minutes later to observe the therapeutic effects by taking vital signs. The student nurse recognizes this as what part of the nursing process?

    <p>evaluation</p> Signup and view all the answers

    match

    <p>Adverse drug event = Any undesirable occurrence related to administration of or failure to administer a prescribed medication. Adverse drug reaction = Unexpected, unintended, or excessive responses to medications given at therapeutic dosages (as opposed to overdose); one type of adverse drug event. Allergic reaction = An immunologic reaction resulting from an unusual sensitivity of a patient to a certain medication; a type of adverse drug event and a subtype of adverse drug reactions. Idiosyncratic reaction = Any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.</p> Signup and view all the answers

    match

    <p>Medical errors = A broad term used to refer to any errors at any point in patient care that cause or have the potential to cause patient harm. Medication errors = Any preventable adverse drug events involving inappropriate medication use by a patient or health care professional; they may or may not cause the patient harm. Medication reconciliation = A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. Pharmaceutics = The study of how various drug forms influence the way in which the drug affects the body.</p> Signup and view all the answers

    The organ most responsible for metabolism is the liver and the primary organ responsible for excretion is the kidney

    <p>True</p> Signup and view all the answers

    match

    <p>absorption = is the movement of a drug from its site of administration into the bloodstream for distribution to the tissues. distribution = Refers to the transport of a drug by the bloodstream to its site of action. (Keep in mind: drugs are distributed first to those areas with extensive blood supply. Areas of rapid distribution include the heart, liver, kidneys, and brain. Areas of slower distribution include muscle, skin, and fat metabolism = The organ most responsible for the metabolism of drugs is the liver. Other metabolic tissues include skeletal muscle, kidneys, lungs, plasma, and intestinal mucosa excretion = is the elimination of drugs from the body. The primary organ responsible for this elimination is the kidney.</p> Signup and view all the answers

    match

    <p>pharmaceutics = The study of how various drug forms influence the way in which the drug affects the body. pharmacokinetics = Is the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. pharmacodynamics = The study of what the drug does to the body pharmacogenomics = is the study of how certain genetic traits affect drug response</p> Signup and view all the answers

    In which ways can drugs produce actions (therapeutic effects)?

    <p>all of the above</p> Signup and view all the answers

    match

    <p> Receptor Interactions- = A receptor can be defined as a reactive site on the surface or inside of a cell. If the mechanism of action of a drug involves a receptor interaction, then the molecular structure of the drug is critical. Drug-receptor interaction is the joining of the drug molecule with a reactive site on the surface of a cell or tissue. Most commonly, this site is a protein structure within the cell membrane. Once a drug binds to and interacts with the receptor, a pharmacologic response is produced.  Enzyme Interactions- = Enzymes are the substances that catalyze nearly every biochemical reaction in a cell. Drugs can produce effects by interacting with these enzyme systems. For a drug to alter a physiologic response in this way, it may either inhibit (more common) or enhance (less common) the action of a specific enzyme. This process is called selective interaction.  Nonselective Interactions- = Drugs with nonspecific mechanisms of action do not interact with receptors or enzymes. Instead, their main targets are cell membranes N/A = N/A</p> Signup and view all the answers

    match

    <p>Pharmacotherapeutics = The clinical use of drugs to prevent and treat diseases. Defines principles of drug actions—the cellular processes that change in response to the presence of drug molecules. Drugs are organized into pharmacologic classes. Pharmacognosy = The source of all early drugs was nature, and the study of these natural drug sources (plants and animals) is called pharmacognosy. Pharmacoeconomics = Study of the economic factors influencing the cost of drug therapy. Example: is performing a cost-benefit analysis of one antibiotic versus another when competing drugs are considered for inclusion in a hospital formulary n/a = n/a</p> Signup and view all the answers

    match

    <p>steady state = Physiologic state in which the amount of drug removed via elimination is equal to amount of drug absorbed with each dose. bioavailability = Is the term used to express the extent of drug absorption available. first-pass effect = occurs when a large proportion of a drug is chemically changed into inactive metabolites by the liver. half-life = is the time required for half (50%) of a given drug to be removed from the body. Measures the rate at which the drug is eliminated from the body. After approximately five half-lives, most drugs are considered to be effectively removed from the body.</p> Signup and view all the answers

     Peak level: highest blood level of a drug  Trough level: lowest blood level of a drug  Toxicity: occurs if the peak blood level of the drug is too high

    <p>True</p> Signup and view all the answers

    match

    <p>acute therapy = often involves more intensive drug treatment and is implemented in the acutely ill or the critically ill. It is often needed to sustain life or treat disease. Examples are the administration of vasopressors to maintain blood pressure, the use of volume expanders for a patient who is in shock, and intensive chemotherapy for a patient with newly diagnosed cancer. maintenance therapy = It is used for the treatment of chronic illnesses such as hypertension. supplemental/replacement therapy = supplies the body with a substance needed to maintain normal function. Examples are the administration of insulin to diabetic patients and of iron to patients with iron-deficiency anemia. palliative therapy = to make the patient as comfortable as possible. Palliative therapy focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. It is typically used in the end stages of an illness when attempts at curative therapy have failed;</p> Signup and view all the answers

    Supportive therapy maintains the integrity of body functions while the patient is recovering from illness or trauma. Examples are the provision of fluids and electrolytes to prevent dehydration in a patient who is vomiting and has diarrhea, the administration of fluids, volume expanders, or blood products to a patient who has lost blood during surgery.

    <p>True</p> Signup and view all the answers

    Prophylactic/Empirical therapy: drug therapy provided to prevent illness or other undesirable outcome during planned events. A common example is the use of preoperative antibiotic therapy for surgical procedures.

    <p>True</p> Signup and view all the answers

    a client admitted to the hospital admits to the nurse that he cant stop thinking about cocaine and wants to leave the hospital to get his next fix. the nurse would recognize this as

    <p>psychological dependence</p> Signup and view all the answers

    a recovering drug addict tells the nurse that he would like to put an end to his addiction but does not want to go through any withdrawal symptoms. The nurse administers a medication to help with that. The student nurse recognizes that this is known as:

    <p>physical dependence</p> Signup and view all the answers

    drugs interactions include these effects. match them.

    <p>additive effects = 1+1 is equal to 2 antagonistic effects = 1+1 is less than 2. think antidotes synergistic effects = 1+1 is greater than 2 incompatibility = not compatible</p> Signup and view all the answers

    match the phases of investigational drug studies

    <p>Phase I = studies usually involve small numbers of healthy subjects rather than those who have the disease that the new drug is intended to treat. The purpose of phase I studies is to determine the optimal dosage range and the pharmacokinetics of the drug and to ascertain if further testing is needed. Blood tests, urinalyses, assessments of vital signs, and specific monitoring tests are also performed. Phase II = studies involve small numbers of volunteers who have the disease that the drug is designed to diagnose or treat. Study participants are closely monitored to determine the drug’s effectiveness and identify any adverse effects. Therapeutic dosage ranges are refined during this phase. If no serious adverse effects occur, the study can progress to phase III. Phase III = studies involve large numbers of patients who are followed by medical research centers and other types of health care entities. The purpose of this larger sample size is to provide information about infrequent or rare adverse effects that may not yet have been observed during previous smaller studies. Information obtained during this clinical phase helps identify any risks associated with the new drug. Placebos may be given. Phase IV = studies are postmarketing studies that are voluntarily conducted by pharmaceutical companies to obtain further proof of the therapeutic and adverse effects of the new drug. Data from these studies are gathered for at least 2 years after the drug’s release. Often these studies compare the safety and efficacy of the new drug with that of another drug in the same therapeutic category.</p> Signup and view all the answers

    A black box warning is the strictest warning from the FDA and indicates that serious adverse effects have been reported with the drug. The drug can still be prescribed; however, the prescriber must be aware of the potential risk and the patient must be warned. Black box warnings are included in the prescribing information of the drug, and the text of the warning has a solid black border, thus the name black box.

    <p>True</p> Signup and view all the answers

     Drug recall: The FDA or the manufacturer may issue a drug recall anytime a problem with a drug is noted. There are three classes of recall that may be issued: MATCH the three classes

    <p>Class I = The most serious type of recall—use of the drug product carries a reasonable probability of serious adverse health effects or death. Class II = Less severe—use of the drug product may result in temporary or medically reversible health effects, but the probability of lasting major adverse health effects is low. Class III = Least severe—use of the drug product is not likely to result in any significant health problems. N/A = N/A</p> Signup and view all the answers

    • T.A.C.I.T. – TACIT is a mnemonic. • Therapeutic effect: Does the patient demonstrate therapeutic effects of the drugs? • Are there signs of drug allergies or adverse reactions? • Contraindications: Are there contraindications for giving any of the drugs? • Interactions: Are there possible interactions among the drugs? • Toxicity/overdose: Are there signs of drug toxicity of overdose?

    <p>True</p> Signup and view all the answers

    a nurse who is a part of the immediate team states that she was just about to administer medication to one of her patients but she has an emergency of priority and asks if you can administer the medication, she proceeds to hand you the syringe. what is your response?

    <p>okay, i dont mind helping you out but I will draw up the medication myself</p> Signup and view all the answers

    Drug polymorphism refers to the effect of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs. Factors contributing to drug polymorphism may be categorized into environmental factors (e.g., diet and nutritional status), cultural factors, and genetic (inherited) factors.

    <p>True</p> Signup and view all the answers

    Malnutrition with deficiencies in protein, vitamins, and minerals may modify the functioning of metabolic enzymes, which may alter the body’s ability to absorb or eliminate a medication.

    <p>True</p> Signup and view all the answers

    Study Notes

    Nursing Diagnosis

    • Serves to identify patient needs and guide nursing care.
    • 'Altered safety needs, risk for injury' indicates the potential risks affecting a patient's safety.
    • The second part of a human need statement identifies the specific problem.
    • The third part lists evidence supporting the nursing diagnosis.

    Human Need Statements

    • 'As evidenced by inability to perform a return demonstration and inability to state adverse effects' signifies lack of understanding or skill related to treatment.

    Pharmacokinetics

    • Absorption extent of a drug is termed bioavailability.
    • Half-life is the time for 50% of a drug to be removed from the body.
    • Peak blood levels exceeding therapeutic limits may lead to toxicity.
    • The physiologic or psychological need for a drug is classified as drug dependence.
    • Therapeutic index determines the margin between effective and toxic concentrations.
    • Extended drug effects are termed side effects or adverse effects.
    • Permanent genetic changes in organisms are known as mutations.

    Preventive Measures

    • Preventive health measures are strategies to avoid illness during events, like preoperative antibiotics.

    Drug Reactions and Therapy

    • Unpredictable drug reactions that are not due to known pharmacology are termed idiosyncratic reactions.
    • Palliative therapy aims to provide relief from symptoms and improve quality of life without curing the disease.
    • Drug interactions involve altered pharmacologic activity due to concurrent medications.

    Nursing Collaboration and Assessment

    • Interprofessional Education Collaboration (IPEC) focuses on enhancing teamwork in healthcare.
    • Objective data in nursing assessments include measurable facts like vital signs.
    • Human need statements are essential for identifying and prioritizing patient care concerns.
    • The evaluation phase centers on assessing effectiveness and outcomes of interventions.

    Medication Errors and Nursing Process

    • Medication errors are defined as any preventable event leading to inappropriate medication use.
    • Key planning phase components include setting achievable goals for patient outcomes.
    • The nursing process aims to provide comprehensive, individualized care.

    Data Analysis in Nursing

    • Analyzing objective and subjective data occurs during the assessment phase.

    Drug Absorption and Pediatric Considerations

    • Altered drug absorption in neonates and children is due to physiological differences.
    • Distribution is affected by the body composition variations in pediatric patients.
    • Metabolism speeds increase in older children compared to infants due to developed enzymes.
    • Decreased drug excretion in neonates results from immature renal function.
    • Declining organ function in older adults is primarily due to aging.

    Age and Drug Therapy Considerations

    • Ethnopharmacology studies how cultural factors influence drug response.
    • Phase I studies involve healthy subjects assessing drug safety.
    • Informed consent requires clear communication of risks and benefits prior to participation in research.

    Drug Trials and Regulations

    • Phase IV studies monitor drugs post-marketing for long-term effects.
    • A black box warning from the FDA indicates serious risks associated with the drug.
    • Class II recalls indicate that use may cause temporary or medically reversible health issues.
    • Legal considerations in nursing practice include scope of practice and liability.
    • Promoting patient decision-making relates to the ethical principle of autonomy.
    • Negligence refers to failure to provide the standard of care expected from professionals.

    Reporting and Drug Interaction Strategies

    • Reporting near miss events is crucial for enhancing patient safety and improving care quality.
    • Strategies focusing on therapeutic effects and interactions aim to reduce medication errors.

    Therapeutic Actions of Drugs

    • Peak level is the highest concentration of a drug, while trough level is the lowest.
    • The effects of drugs include therapeutic effects, toxicity, and side effects.
    • Supportive therapy maintains body integrity during recovery phases post-illness.

    Drug Forms and Pharmacology

    • Breach of duty in nursing relates to failing to meet the standard of care.
    • Selective interaction in pharmacology involves specific targeting of cellular processes.

    Drug Pharmacodynamics and Dynamics

    • The liver plays a key role in drug metabolism, while the kidneys are primarily responsible for drug excretion.
    • Drug therapy focuses on disease prevention and treatment.
    • Pharmacognosy is the study of medicinal drugs derived from plants and other natural sources.
    • Maintaining an accurate medication list during health care transitions is critical for preventing error.

    Final Notes

    • Drug polymorphism affects pharmacokinetics based on a patient’s diverse characteristics.
    • Factors influencing drug polymorphism encompass environmental, cultural, and genetic elements.

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