Nursing Students' Knowledge of Alcohol - Interactive Medications

In 2018, nearly 57% of American adults reported drinking alcohol in the past month, and 41.5% of current drinkers reported taking alcohol-interactive (AI) medications. Consuming alcohol and medications concurrently may result in adverse effects. The purpose of this study was to determine the effectiveness of a one-hour lecture about AI medications in a class of undergraduate nursing students (N = 48) at a small Midwestern university. The Jarvis Nursing Knowledge of Alcohol-Interactive Medications survey was distributed on August 27, 2018, and again on November 19, 2018. A significant increase was found between pretest and posttest on correct identification of mechanism (27.47 ± 14.18 vs. 37.33 ± 16.60; t =3.15; p < .02). A significant increase was also found between pretest and posttest scores on the ability to discriminate a medication as AI or Non-AI (68.5% ± 6.3 vs 71.5% ± 6.5; t= 2.5; p <. 02). While scores increased significantly, students failed to consistently recognize the correct medicationalcohol interaction. A one-hour lecture emphasizing AI medications in the pre-licensure program enhanced students’ knowledge; however, future research is needed to determine retention of AI medication knowledge. ALCOHOL INTERACTIVE MEDICATIONS 3 Nursing Students' Knowledge of Alcohol Interactive Medications Alcohol is one of the most popular and potentially harmful drugs in the United States. More than 88,000 people die from alcohol related causes each year, making it the third highest cause of preventable death (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2018). Of people aged 18 years or older, 86.4% reported drinking alcohol in their lifetime; 70.1% reported drinking in the past year; and 56.0% reported drinking in the past month (NIAAA, 2018). In 2015, 26.9 % of people ages 18 years or older reported binge drinking in the past month and 7% reported heavy alcohol use in the past month. Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) levels above 0.08 g/dL. Binge drinking is defined as four drinks for women and five drinks for men in about two hours. Heavy drinking is defined as binge drinking on five or more days in the past month (NIAAA, 2018). Alcohol-interactive (AI) medications are any medication with which alcohol interacts on a pharmacokinetic (movement through the body) or pharmacodynamic (interaction in cells) level to produce additive or antagonistic effects. Over a 12-year period (1999–2010), an average of 41.5% of current drinkers 20 years and older reported taking at least one AI prescription medication (Breslow et al., 2015). From 2011-2014, 48.9% of adults over 18 years of age used at least one prescription medication in the last 30 days (Centers for Disease Control [CDC], 2016). People age 65 years and older have a higher prevalence of taking multiple medications, and current drinkers, age 65 and older, have a higher prevalence of taking at least one AI prescription medication (Breslow et al., 2015; National Center for Health Statistics, 2014). In the U.S. people aged 65 years or older ,90.6% reported taking a prescription drug in the last 30 days (CDC, 2016). Due to age related changes, people aged 65 years and older metabolize alcohol more ALCOHOL INTERACTIVE MEDICATIONS 4 slowly and have less body water compared with younger adults, the bioavailability of alcohol increases when consuming the same amount of alcohol as a younger adult (Weathermon & Crabb, 1999). Age-related changes in absorption, distribution, and metabolism of alcohol and medications, place people aged 65 and older at greater risk for adverse effects of combining alcohol and medications (Moore et al., 2007). Central nervous system (CNS) agents are among the most common prescription medications used across all age groups in the United States. Through pharmacokinetic and pharmacodynamic interactions, alcohol interferes with the absorption, distribution, metabolism, and excretion of medications and can have additive or antagonistic effects, particularly in the CNS (Tanaka, 2003). Within the class of CNS agents, pain relievers were involved in 28.4% of the alcohol associated drug interaction emergency department (ED) visits, mainly opioids at 17.4% (Castle, Dong, Haughwout, & White, 2016). Anti-anxiety drugs, sedatives, and sleep medications were involved in 24.7% of the alcohol associated drug interaction ED visits, mainly benzodiazepines at 16.7% (Castle et al., 2016). Within the class of psychotherapeutic agents, antidepressants and antipsychotics were involved in 8.6% and 6.1%, respectively, of alcohol associated drug interaction ED visits (Castle et al., 2016) Education on AI medications is a necessity for nurses, as evidenced by the rise of prescription medications and increased use of alcohol in the U.S. Nurses need to be educated on AI medication because a vital responsibility of nurses is to be vigilant about health risks and to provide health education. In undergraduate nursing schools only 56% of schools offer one to five hours of didactic alcohol education, and 30% of schools offer one to five clinical hours of ALCOHOL INTERACTIVE MEDICATIONS 5 alcohol education (Mollica, Hyman, & Mann, 2011). The education that was identified by (Mollica, Hyman, & Mann, 2011) focused on alcohol withdrawal, abuse, and addiction. As well as undergraduate students lacking AI medication knowledge, professional registered nurses also lack AI medication knowledge. In 2016, professional nurses working at a Midwestern Magnet-designated hospital correctly identified AI medication only 56.3% of the time (Serafico & Jarvis, 2017). A knowledge gap of AI medications was identified in practicing nurses; and therefore important that there is adequate education on AI medication content in undergraduate programs. Including AI medication teaching into the curriculum of undergraduate nursing programs will help future nurses with the critical knowledge they need to deliver safe care to patients. Therefore, the aims of this study are to: 1. Assess nursing students’ baseline level of knowledge of AI medications. 2. Determine if a single lecture in the sophomore year pathophysiology and pharmacology course is effective in increasing knowledge on AI medication content. 3. Determine to what extent the Jarvis Nursing Knowledge of AI Medications (JaNKam) survey is reliable when administered to nursing students.