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NBME 20 Answers

nbme20/Block 2/Question#27

A 38-year-old African American man with recently ...

It should play a role because the efficacy of certain classes of medications varies among different ethnicities

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submitted by drw(3),

According to UTD, it is said that for the young patient, ACEI, ARB, beta-blocker are of better efficacy for primary hypertension as a monotherapy, however, CCB and thiazide are better for the elderly and the black patients.

dulxy071  A stronger factor though is diet and other habits. no matter who it is, if you eat more high sodium food you're going to need a treatment which targets ridding the body of sodium more than anything else and so on so forth. This is something that the world medicine needs to understand better +1  
neovanilla  Maybe, but this is NBME, and while diet can play a role in different pharmacological responses, what they might be emphasizing here is that no one drug affects all people the same way. There's an incredible bias in medicine towards white males because older drug clinical studies only recruited these patients. It was only once the drug was in the market that doctors and patients realized that certain drugs didn't work as well for them. That's just a fact, and is what NBME is testing us on +1  




"only pharmacokinetic processes which are biologically or biochemically mediated have the potential to exhibit differences between racial or ethnic groups. Thus, the pharmacokinetic factors which can be expected to potentially exhibit racial differences are (1) bioavailability for drugs which undergo gut or hepatic first-pass metabolism, (2) protein binding, (3) volume of distribution, (4) hepatic metabolism, and (5) renal tubular secretion. Absorption (unless active), filtration at the glomerulus, and passive tubular reabsorption would not be expected to exhibit racial differences. "

via: https://www.ncbi.nlm.nih.gov/pubmed/9423140