NURS 3210 Active Learning Guide - Module 1 - Foundational Principles-Revised Completed.docx

Active Learning Guide- Module 1- Foundational Principles in Pharmacology Purpose/Overview Active learning guides help students to focus their study time. They include knowledge level questions as well as those focusing on the application and analysis of information to provide greater context in rela...

Active Learning Guide- Module 1- Foundational Principles in Pharmacology Purpose/Overview Active learning guides help students to focus their study time. They include knowledge level questions as well as those focusing on the application and analysis of information to provide greater context in relation to the course and career skills. Students should review the active learning guide before beginning to engage with the module content, then work to complete the guide during and after engaging with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate course or module content. Instructions Quickly review the active learning guide (ALG) before you begin reading and engaging with other content in the module. Looking at the questions beforehand will provide a preview of the information you should be alert to as your work through your reading or module resources. As you work through the module content, complete the active learning guide, topic-by-topic. You should use the resources provided and linked on the “Prepare” page in Canvas as the primary source for answering the questions in the active learning guide.  Reading- Chapter 2- Pharmacology Fundamentals: Define, in your own words, pharmacokinetics: 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. Pharmacokinetics represent the drug absorption into, distribution and metabolism within, and excretion from the body. Complete the table by listing the 4 pharmacokinetic processes, providing a brief description of each, and giving 4 examples of circumstances that might alter each of the processes. Pharmacokinetic Processes Definition List situational factors (3 or 4 for each process) potentially impacting that process. (Example: presence of food in the patient’s stomach) Absorption is the first stage of pharmacokinetics and occurs after medications enter the body and travel from the site of administration into the body’s circulation. Route of administration. Food in GI tract. Motility of GI tract 2.Distribution is the second stage of pharmacokinetics. It is the process by which medication is spread throughout the body. Rapid distribution areas, liver, heart, kidneys, brain. Slow distribution areas, skin, fat, muscle. Blood flow to different orgings. 3.Metabolism is the third stage of pharmacokinetics and involves the breakdown of a drug molecule. Type of medication, enzyme inhibitors, enzyme induceres, slow metabolization. 4.Excretion is the final stage of pharmacokinetics and refers to the process in which the body eliminates waste. Liver function, kidney function genetic factors. Write, in your own words, a definition for first-pass effect: First Pass Effect → The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream. Indicate next to the drug orders below whether: A. The ordered drug route is parenteral, enteral, or topical. Enteral → Tablets, capsules, oral soluble wafers, pills, timed-release capsules, timed-release tablets, elixirs, suspensions, syrups, emulsions, solutions, lozenges or troches, rectal suppositories, sublingual or buccal tablets. Parenteral → Injectable forms, solutions, suspensions, emulsions, powders for reconstitution Topical → Aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, rectal and vaginal suppositories B. The ordered drug will be affected by the “first-pass effect”: Acetaminophen 1000mg po q 4-6 hrs prn headache: enteral Hydrocortisone 1% cream, apply to affected area BID x 7 days: topical Albuterol 0.083% 2.5mg per 3 ml, Administer 3 ml updraft (nebulized) q 6 hrs prn wheezing: topical Fluticasone 50mcg 2 sprays each nostril qd: topical Nitroglycerin 0.3mg sl q 5 min x 3 doses prn chest pain: enteral Cefazolin 2g IV q8 hrs x 7 days: parenteral Promethazine 12.5mg supp PR q 6hrs prn N/V: enteral Scopolamine transdermal 1mg, apply behind ear 4 hrs before event, change q 72hrs: topical Fentanyl 2mcg/1ml with Bupivacaine 0.1% 5ml/hr intrathecally: enteral A patient is complaining of severe pain and has prn orders for PO, IM, and IV pain medications. Which of these routes would provide the most rapid relief for the patient? Explain. Intravenous injection would be the fastest route for pain relief. IV injection go directly into the bloodstream. The IV route avoids the GI Tract and does not need to be absorbed by the tissue (epidermis). Which of the routes would you expect to provide relief for the longest duration? Explain. The enteral route or po would provide the longest duration due to the slow metabolization and abosorbtion of tables through the GI Tract along with some medication being available in extended release. Write, in your own words, a brief definition for half-life and steady state. Half-life→ In pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50% (also called elimination half-life). Steady state→ The physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose. A. Calculate the expected time it would take for an individual to clear a drug from the body based on the drug’s half-life (assuming no additional doses). Drug A has an expected half-life of 30 minutes→ 2.50 hrs Drug B has an expected half-life of 8 hours→ 1.67 days Drug C has an expected half-life of 3 days→ 15 days Calculate the expected time frame for the drug to reach a steady state (assuming a regular dosing schedule). Drug A has an expected half-life of 30 minutes→ 2.50 hrs Drug B has an expected half-life of 8 hours→ 1.67 days Drug C has an expected half-life of 3 days→ 15 days If acetaminophen 500mg po is administered at 0600, and has an expected half-life of 2 hours, how much of the original dose would you expect to be circulating 4 hours later @1000? (See Table 2.7) 125mg What is the difference between hydrophilic and lipophilic medications, and of the two which is more likely to cause toxicity and why? Hydrophilic → Typically a drug that is highly water-soluble (hydrophilic) will have a smaller volume of distribution and high blood concentrations. Medications with water-soluble (hydrophilic [“water loving”]) molecules may be more easily metabolized by simpler chemical reactions such as hydrolysis. Lipophilic → In contrast, fat-soluble drugs (lipophilic) have a larger volume of distribution and low blood concentrations. There are some sites in the body into which it may be very difficult to distribute a drug. These sites typically either have a poor blood supply (e.g., bone) or have physiologic barriers that make it difficult for drugs to pass through (e.g., the brain due to the blood-brain barrier). They target lipid-soluble drugs (also known as lipophilic [“fat loving”]) that are typically very difficult to eliminate. Causing a build up of the medication in the fat, leading to toxicity. Serum albumin levels can affect drug distribution. Why might you be concerned about giving a drug that is highly protein bound to a patient with low albumin levels? Albumin is the most common blood protein and carries the majority of protein-bound drug molecules. If a given drug binds to albumin, then there is only a limited amount of drug that is not bound. This unbound portion is pharmacologically active and is considered “free” drug, whereas “bound” drug is pharmacologically inactive. Certain conditions that cause low albumin levels, such as extensive burns and malnourished states, result in a larger fraction of free (unbound and active) drug. This can raise the risk for drug toxicity. When an individual is taking two medications that are highly protein bound, the medications may compete for binding sites on the albumin molecule. Because of this competition, there is more free or unbound drug. Protein binding may lead to an unpredictable drug response called a drug-drug interaction. A drug-drug interaction occurs when the presence of one drug decreases or increases the actions of another drug that is administered concurrently (i.e., given at the same time). Differentiate between the terms pharmacokinetics and pharmacodynamics: Pharmacokinetics → 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. Pharmacokinetics represent the drug absorption into, distribution and metabolism within, and excretion from the body. Pharmacodynamics → The study of the biochemical and physiologic interactions of drugs at their sites of activity. It examines the effect of the drug on the body. What are the 3 primary pharmacodynamic processes by which drugs exert their therapeutic effect? List them below. 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 (Fig. 2.7). The degree to which a drug attaches to and binds with a receptor is called its affinity. The drug with the best “fit” and strongest affinity for the receptor will elicit the greatest response. A drug becomes bound to the receptor through the formation of chemical bonds between the receptor on the cell and the active site on the drug molecule. Drugs interact with receptors in different ways either to elicit or to block a physiologic response. 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. Drug-enzyme interaction occurs when the drug chemically binds to an enzyme molecule in such a way that it alters (inhibits or enhances) the enzyme’s interaction with its normal target molecules in the body. Nonselective Interactions Drugs with nonspecific mechanisms of action do not interact with receptors or enzymes. Instead, their main targets are cell membranes and various cellular processes such as metabolic activities. These drugs can either physically interfere with or chemically alter cellular structures or processes. Some cancer drugs and antibiotics have this mechanism of action. By incorporating themselves into the normal metabolic process, they cause a defect in the final product or state. This defect may be an improperly formed cell wall that results in cell death through cell lysis, or it may be the lack of a necessary energy substrate, which leads to cell starvation and death. If a medication is an agonist what is the expected response of the receptor? Agonist → A drug that binds to and stimulates the activity of one or more receptors in the body. Drug binds to the receptor; there is a response. If a medication is an antagonist what is the expected response of the receptor? Antagonist → A drug that binds to and inhibits the activity of one or more receptors in the body. Antagonists are also called inhibitors. Drug binds to the receptor; there is no response. Drug prevents binding of agonists. Give an example of a non-selective interaction: Antibiotic medications are non-selective. They are used to cause the cell death of bacteria. By incorporating themselves into the normal metabolic process, they cause a defect in the final product or state. This defect may be an improperly formed cell wall that results in cell death through cell lysis, or it may be the lack of a necessary energy substrate, which leads to cell starvation and death. Using your own words, define the following terms: Pharmacotherapeutics → The treatment of pathologic conditions through the use of drugs. Contraindication → Any condition, especially one related to a disease state or patient characteristic, including current or recent drug therapy, which renders a particular form of treatment improper or undesirable. Adverse Drugs Effects → Any undesirable occurrence related to administering or failing to administer a prescribed medication. Toxicity → The condition of producing adverse bodily effects because of poisonous qualities. A. Write, in your own words, the definition of therapeutic index. The ratio between the toxic and therapeutic concentrations of a drug. B. If a nurse is administering a drug with a narrow (low) therapeutic index, what general nursing actions would be prudent? Name two. Vital sign assessment before/after. Neurological assessment before/after. Distinguish between tolerance and dependence. Tolerance → Reduced response to a drug after prolonged use. Dependence → A state in which there is a compulsive or chronic need, as for a drug. Explain two types of potential drug-drug interactions, and provide an example of how they might affect the patient. When an individual is taking two medications that are highly protein bound, the medications may compete for binding sites on the albumin molecule. Because of this competition, there is more free or unbound drug. Protein binding may lead to an unpredictable drug response called a drug-drug interaction. A drug-drug interaction occurs when the presence of one drug decreases or increases the actions of another drug that is administered concurrently (i.e., given at the same time). Table 2.10 Pharmacokinetic Phase Drug Combination Mechanism Result Absorption antacid with levofloxacin Antacids bind to the levofloxacin, preventing adequate absorption. Decreased effectiveness of levofloxacin, resulting from decreased blood levels (harmful) Distribution warfarin with amiodarone Both drugs compete for protein-binding sites. Higher levels of free (unbound) warfarin and amiodarone, which increases actions of both drugs (harmful) Metabolism erythromycin with cyclosporine Both drugs compete for the same hepatic enzymes. Decreased metabolism of cyclosporine, possibly resulting in toxic levels of cyclosporine (harmful) Excretion amoxicillin with probenecid Inhibits the secretion of amoxicillin into the kidneys. Elevation and prolongation of plasma levels of amoxicillin (can be beneficial) Video- Pharmacology and the Nursing Process (Ch.1) List the six primary patient rights, and at what phase (step) of the nursing process do they most often occur. Right Drug, Right Dose, Right Time, Right Route, Right Patient, Right Documentation, Right Reason. A. What are the six essential elements of a medication order? Once assessment of the patient and the drug has been completed, the specific prescription or medication order (from any prescriber) must be checked for the following seven elements: (1) patient’s name, (2) date the drug order was written, (3) name of drug(s), (4) drug dosage amount, (5) drug dosage frequency, (6) route of administration, and (7) prescriber’s signature. B. What must you do if an element is missing? That element must be clarified with the prescriber. Never assume an element of a medication order. Besides prescribed medications, what other types of medications or substances should the nurse ask the patient about when conducting a medication history or medication reconciliation? Medication History includes, Rx, OTC, Herbal/Homeopathic/Folk Medicine, Dietary Supplements, Street Drugs/Illicit Drugs/Recreational Drugs. Also Patient Allergies. Give 3 examples of information you would want to gather from your patient before administering ANY medication? Current medications, allergies, presence/abscence of signs and symptoms. What should you do if your patient is prescribed a medication for which their chart indicates they have an allergy? Hold the medications until after the test is completed. What are two general outcomes you want to assess your patient for during the evaluation phase? Is the patient reaching their goals during the planning phase? Is the patient having a therapeutic response to the medication? Is the patient experiencing any adverse effects/side effects or signs of toxicity. Name two reliable sources for drug information. Reliable nursing drug guides, Pharmacists, scholarly or peer reviewed apps or websites. Video- Pharmacology Across the Lifespan (Ch. 3) In general terms, what is the primary pharmacokinetic issue in the very young? In the young, The alterations are typically secondary to the fact that many body systems continue developing in the first decade of life. Patients 12 and under may need to avoid a drug altogether or may require changes in dosage in order to avoid toxicity. What’s the best parameter for dosing medication in the very young? In many cases, dosing is based on the patient's weight. It may seem counterintuitive, but for those under 12 weight, as a general rule, is a better parameter to use for dosing compared to age. In general terms, what is the primary pharmacokinetic issue in the elderly? Polypharmacy → The practice of prescribing multiple medications for an individual patient, especially excessively, for a single disease. List the four pharmacokinetic processes and then complete the table by telling what expected alterations would be in those processes for elderly and pediatric patients. Pharmacokinetic Process Pediatric Patient Geriatric Patient Absorbtion Increased GI Tract emptying/motility impacts rate/extent of drug absorbtion. Decreased GI Tract emptying/motility impacts rate/extent of drug absorbtion. Distribution Low protein, low binding capacity leading to higher levels of unbound free drug in the plasms. Increased body fat may cause fat-soluable medications to have an increased half life Metabolism Underdeveloped liver enzymes lead to slower metabolism of meds. Decreased liver mass leads to decreased hepatic metabolization leading to an increase in medication concentration in the plasma. Excretion Underdeveloped renal function will impact how tubular secretion and reabsorbtion processes. Reduced renal function capacity due to a reduction in nephrons and a reduction in renal blood flow. Impacting drug clearance of meds that are strictly eliminated by the kidneys. As a result of the alterations, medication dosage will need to be monitored and possibly altered. What is polypharmacy and what concerns are created by polypharmacy in the elderly population? Polypharmacy. One article estimated something like half of all Americans over the age of 65 take at least five medications, and something like one out of ten take ten or more medications. The number of prescription medications per patient in this population is due in part, to an unsurprising increase in the incidence of chronic disease. In other words, as we age, we're more likely to experience diseases of all varieties and therefore we are more likely to be prescribed treatments, frequently medications, for those diseases. Another article suggests that nearly a third of the prescribed medications are inappropriate and a higher percentage still are not taken appropriately by the patient. But polypharmacy represents a real danger to our elderly patients, as they are more likely to fall, more likely to experience adverse reactions, or be hospitalized because of overprescribing. Why is pregnancy of special concern when considering pharmacologic treatments? Drug properties that have an impact on drug transfer to the fetus include the drug’s chemistry, the dosage, and concurrently administered drugs. Examples of relevant chemical properties include molecular weight, protein binding, lipid solubility, and chemical structure. Important drug dosage variables include dose and duration of therapy. Fetal gestational age is an important factor in determining the potential for harmful drug effects to the fetus. The fetus is at greatest risk for drug-induced developmental defects during the first trimester of pregnancy. During this period, the fetus undergoes rapid cell proliferation. Skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate. Self-treatment of minor illness is strongly discouraged at any time during pregnancy, but especially during the first trimester. Gestational age is also important in determining when a drug can most easily cross the placenta to the fetus. During the last trimester, the greatest percentage of maternally absorbed drug gets to the fetus. Although exposure of the fetus to drugs is most detrimental during the first trimester, drug transfer to the fetus is more likely during the last trimester. This is the result of enhanced blood flow to the fetus, increased fetal surface area, and increased amount of free drug in the mother’s circulation. How will you know if a medication is safe to use during pregnancy, childbirth, or lactation? Traditionally, the most widely used index of potential fetal risk of drugs has been the FDA’s pregnancy safety category system. The student will likely encounter both the old categories (A to X) and the new rules throughout his or her career. The new rule requires the use of three subsections in the prescribing information titled “Pregnancy,” “Lactation,” and “Females and Males of Reproductive Potential.” These subsections will include a summary of the risks of using a drug during pregnancy and breastfeeding, as well as data supporting the summary and information to help health care providers make prescribing decisions. The “Pregnancy” section will include information on dosing and potential risks to the developing fetus. The “Lactation” section will provide information regarding breastfeeding, such as the amount of drug in breast milk and the potential effect on the child. The “Females and Males of Reproductive Potential” section will include information about contraception, pregnancy testing, and infertility. Video- Legal & Ethical Considerations in Pharmacology (Ch. 4) What government agency regulates drug development and production in the United States? Once a potentially beneficial drug has been identified, the pharmaceutical company must follow a regulated, systematic process before the drug can be sold on the open market. This highly sophisticated process is regulated and carefully monitored by the FDA. The primary purpose of the FDA is to protect the patient and ensure drug effectiveness. What is a black-box warning? Some medications make it through all phases of clinical trials without causing any problems among study patients. However, when they are used in the larger general population, severe adverse effects may appear for the first time. If a pattern of severe reactions to a newly marketed drug begins to emerge, the FDA may request that the manufacturer of the drug issue a black box warning or a voluntary recall. 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. List and write a brief description of each of the 4 phases of drug development. Phase I 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 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 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. Phase IV 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. What are some of the ethical challenges impacting drug development and availability? Vaccine development? Ebola Vaccines Vaccines distribution is not a priority for diseases that plague the developing world. Eventhough the Ebola vaccine has been in development and available in the developed world for decades. Fast Tracking There are stringent steps, each of which may take years, that must be completed before the drug can be approved. The FDA has made certain lifesaving investigational drug therapies available sooner than usual by offering an expedited drug approval process, also known as “fast-track” approval. Acquired immunodeficiency syndrome (AIDS) was the first major public health crisis for which the FDA began granting expedited drug approval. This process allowed pharmaceutical manufacturers to shorten the approval process and allowed prescribers to give medications that showed promise during early phase I and phase II clinical trials to qualified patients with AIDS. In such cases, when a trial continues to show favorable results, the overall process of drug approval is hastened. The concept of expedited drug approval became controversial after the FDA-initiated manufacturer recall of the antiinflammatory drug rofecoxib (Vioxx) in 2004. This recall followed multiple case reports of severe cardiovascular events, including fatalities, associated with the use of this drug. Medications that require ongoing or extended use in resource-poor settings (HIV drugs/HTN/TB/Insulin, others)? As with new drug development, pharmaceutical companies and drug manufacturers have very little incentive to make generic drugs, when the populations that are most at risk have little money to offer in return. Pharmaceutical companies also have little incentive to supply older, inexpensive, reliable drugs to underdeveloped populations. Vitamins and supplements? Vitamins and supplements do not go through the same scrutiny as other over the counter drugs or prescription medications. Without that scrutiny there is no way to verify the ingredient composition of the supplement or what is a safe dose or what is a therapeutic/effective dose of that ingredient. This lack of scrutiny limits the needed research. These supplements/vitamins can also interact with other medications or cause side effects that can result in harm. Video- Culture and Pharmacology (Ch. 4) Describe four ways that culture may impact pharmacology. Drug polymorphism refers to the effect of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs. Environmental and economic factors (e.g., diet) can contribute to drug response. For example, a diet high in fat has been documented to increase the absorption of some drugs. Medication response depends greatly on the level of the patient’s adherence with the therapy regimen. Yet adherence may vary depending on the patient’s cultural beliefs, experiences with medications, personal expectations, family expectations and influence, and level of education. Historically, most clinical drug trials were conducted using White men, often college students, as research subjects. However, due to data that demonstrate the impact of genetic factors on drug pharmacokinetics and drug pharmacodynamics or drug response, clinical trials now strive to include different ethnicities. Some individuals of European and African descent are known to be slow acetylators. This means that their bodies attach acetyl groups to drug molecules at a relatively slow rate, which results in elevated drug concentrations. This situation may warrant lower drug dosages. Write two questions you might want to ask a patient from a different country about their culture to help you provide the best medication education possible. What type of diet is native to your culture? Does your culture have any events that require you to fast or feast? Are you currently on any “Folk Medicines.” What might you do to help a patient, whose first language is not English, to understand how to take their medications correctly? Therefore, before any medication is administered, complete a thorough cultural assessment. This assessment includes questions regarding the following: Languages spoken, written, and understood; need for an interpreter Health beliefs and practices Past uses of medicine Use of herbal treatments, folk remedies, home remedies, or supplements Use of over-the-counter drugs Usual responses to illness Responsiveness to medical treatment Religious practices and beliefs (e.g., many Christian Scientists believe in taking no medications at all) Support from the patient’s cultural community that may provide resources or assistance as needed, such as religious connections, leaders, family members, or friends Dietary habits Reading & Video- Chapter 8- Pharmacogenetics What is a polymorphism? Drug polymorphism → Variation in response to a drug because of a patient’s age, sex, size, and/or body composition. What pharmacokinetic process is the most studied in relationship to pharmacogenetics? Metabolism Pharmacogenomics → The study of genetics in drug response. For example, why does a Chinese patient require lower dosages of an antianxiety drug than a White patient? Why does an Black patient respond differently to antihypertensives than a White patient? However, due to data that demonstrate the impact of genetic factors on drug pharmacokinetics and drug pharmacodynamics or drug response, clinical trials now strive to include different ethnicities. Some individuals of European and African descent are known to be slow acetylators. This means that their bodies attach acetyl groups to drug molecules at a relatively slow rate, which results in elevated drug concentrations. This situation may warrant lower drug dosages. A classic example of a drug whose metabolism is affected by this characteristic is the antituberculosis drug isoniazid. In contrast, some patients of Japanese descent are more rapid acetylators and metabolize drugs more quickly, which predisposes the patient to subtherapeutic drug concentrations and may require higher drug dosages. What is the CYP450 enzyme system and what is it’s relationship to medications? This has effects on the ability to metabolize many drugs. This can affect plasma drug levels, and therefore the intensity of drug response, at different doses. If a drug is a standard drug (administered formulation is pharmacodynamically active), what would the expected outcome be if the patient was a slow metabolizer? Some individuals of European and African descent are known to be slow acetylators. This means that their bodies attach acetyl groups to drug molecules at a relatively slow rate, which results in elevated drug concentrations. This situation may warrant lower drug dosages. If a patient told you that Codeine, a prodrug, “has never worked for them” when they took it in the past, what conclusion might you draw about their pharmacogenetic profile? Pharmacogenomics → The study of genetics in drug response. I would conclude they are fast metabolizers and their dosage may need to be increased. Give two examples of how enhanced understanding of pharmacogenetics has impacted pharmacotherapeutics. Pharmacogenetics → The study of genetic variation that gives rise to differing responses to drugs. Pharmacotherapeutics → The study of the therapeutic uses and effects of drugs. a. Enhanced safety in medications prescribed to particular/specific ethnicities. b. Enhanced specialization in medication prescription to particular/specific ethnicities.