require lower dosages of an antianxiety drug than a white patient? Why does an African-American patient respond differently to antihypertensives than a white patient? 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.

Medication response depends greatly on the level of the patient’s compliance with the therapy regimen. Yet compliance may vary depending on the patient’s cultural beliefs, experiences with medications, personal expectations, family expectations and influence, and level of education. Compliance is not the only issue, however. Prescribers must also be aware that some patients use alternative therapies, such as herbal and homeopathic remedies, that can inhibit or accelerate drug metabolism and therefore alter a drug’s response.

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 the drug griseofulvin (an antifungal drug). 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.

Individuals throughout the world share common views and beliefs regarding health practices and medication use. However, specific cultural influences, beliefs, and practices do exist. Awareness of cultural differences is critical for the care of patients because of the constantly changing U.S. demographics. As a result of these changes, attending to each patient’s cultural background helps to ensure safe and quality nursing care, including medication administration.

For example, some African Americans have health beliefs and practices that include an emphasis on proper diet and rest; the use of herbal teas, laxatives, protective bracelets; and the use of folk medicine, prayer, and the “laying on of hands.” Reliance on various home remedies can also be an important component of their health practices. Some Asian-American patients, especially the Chinese, believe in the concepts of yin and yang. Yin and yang are opposing forces that lead to illness or health, depending on which force is dominant in the individual and whether the forces are balanced. Balance produces healthy states. Other common health practices of Asian Americans include use of acupuncture, herbal remedies, and heat. All such beliefs and practices need to be considered—especially when the patient values their use more highly than the use of medications. Many of these beliefs are strongly grounded in religion. The Asian and Pacific Islander racial/ethnic group also includes Thais, Vietnamese, Filipinos, Koreans, and Japanese, among others.

Some Native Americans believe in preserving harmony with nature or keeping a balance between the body and mind and the environment to maintain health. Ill spirits are seen as the cause of disease. The traditional healer for this culture is the medicine man, and treatments vary from massage and application of heat to acts of purification. Some individuals of Hispanic descent view health as a result of good luck and living right and illness as a result of bad luck or committing a bad deed. To restore health, these individuals seek a balance between the body and mind through the use of cold remedies or foods for “hot” illnesses (of blood or yellow bile) and hot remedies for “cold” illnesses (of phlegm or black bile). Hispanics may use a variety of religious rituals for healing (e.g., lighting of candles), which may also be practiced by adherents of other religions and/or belief systems. It is very important to remember that these beliefs vary from patient to patient; therefore, consult with the patient rather than assume that the patient holds certain beliefs because he or she belongs to a certain ethnic group.