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Pharmacogenetic Testing: A Pharmacy Consultants Case Study #3
A Pharmacy Consultant Case Study on the Utilization of Pharmacogenetics Testing
Garrett Huxall, Pharm.D, CGP, FASCP
Executive Director, PharmCareOK
As a pharmacy consultant and nursing home owner, understanding medications and their side effects is critical to my patient care. I have been utilizing pharmacogenetics testing and it allows me to recommend proper medication therapy more quickly and accurately. The tool from PGx Medical replaces the “trial and error” process consultants cannot afford in a nursing home setting.
I have countless success stories due to pharmacogenetics (PGx) test report, however, what I am finding is the small changes make the biggest impact. I now adjust dosages based on the resident/patient’s PGx test report. Furthermore, I now select medications that can be properly metabolized, where in the past I would have just gone to the next drug and hoped for a better outcome.
Case Study #3 – [Male LTC resident]. This patient was only on Allopurinol and was then prescribed Lipitor and had a reaction. They thought his reaction was more of a psychotic reaction so they prescribed him Geodon. The patient had a severe reaction and tried to strangle his father. He was then admitted to a Psych Hospital and we decided to do a pharmacogenetics test to determine if his body could even metabolize the medications. By the enzymes we found, the Geodon or any of the new atypical drugs weren’t going to work for him. Se we put him on Thorazine and got him calmed down – then we started reducing the Thorazine. Now the patient is back on Allopurinol for gout and that is the only prescription medication he is taking. Great outcome!
Previously, without the testing results to guide us, this change may have taken several different methods and a longer time frame to achieve results. It was very reassuring and validating to me that we were able to intervene with this resident on a much quicker basis, which is a benefit to the clinical team and the medical director.
In this case, the small change with guidance from the test results allowed for a rapid intervention that may have taken months. The small changes can have tremendous benefits to all parties involved. The test results came back in a matter of a day or two and we were able to save thousands of future medicare dollars.
Educating the clinical team and medical directors at the facility on the value this tool provides is crucial, as there is no out of pocket costs for residents with medicare. It’s important to reassure residents and family members that the medications they are taking are the most appropriate and able to provide proper therapy. A less medicated, cognizant, mobile resident allows for the home to be more efficient and profitable.
For more information on pharmacogenetics testing, contact PGx Medical at info@pgxmed.com or 405-509-5112
Pharmacogenetic Testing: A Pharmacy Consultants Case Study #2
A Pharmacy Consultant Case Study on the Utilization of Pharmacogenetics Testing
Garrett Huxall, Pharm.D, CGP, FASCP
Executive Director, PharmCareOK
As a pharmacy consultant with over 20 years of experience and now nursing home owner, I understand that medications and their side effects can critically impact a patients’ care. To aid physicians in their management and choice of medications for various disease states, I have been utilizing pharmacogenetics testing and it allows me to recommend proper medication therapy more quickly and accurately. The tool from PGx Medical replaces the “trial and error” process consultants cannot afford in a nursing home setting.
I have numerous stories on how a pharmacogenetic (PGx) report impacted my dosage recommendation or regimen changes. However, small adjustments in dosage or selection of a new pharmaceutical agent with guidance from the PGx test report, have lead me to now select medications that can be properly metabolized. Where in the past, I would have just gone to the next drug and hoped for a better outcome.
Below is the second in a series of case studies I have written:
Case Study #2 – [Male patient, multiple med, pain regimen not providing therapy] This patient was on Lortab, Asprin and an NSAID for several months. Patient continued to complain of strong pain and medication dosages were increased with no effectiveness in pain reduction. Upon requesting a pharmacogenetic test, patient was placed on Dilaudid. Once we reviewed the test results, we were able to lower his dose of Dilaudid, twice daily while continuing with Asprin. Before the test, he was taking Lortab, Asprin and an NSAID. We reduced the patients’ pain medications by 50% and he is doing much better. In reducing the medications by 50% we are also helping to eliminate many of the complications often associated with heavy dosages and large regimens of pain medications. We were also able to reduce the cost of treatment to medicare for this patient.
Previously, without the testing results to guide us, this change may have taken several different methods and a longer time frame to achieve results. It was very reassuring and validating to me that we were able to intervene with this resident on a much quicker basis and help him avoid falls, which is a benefit to the clinical team and the medical director.
Educating the clinical team and medical directors at the facility on the value this tool provides is crucial, as there is no out of pocket costs to patients on medicare. It’s important to reassure residents and family members that the medications they are taking are the most appropriate and able to provide proper therapy. A less medicated, cognizant, mobile resident allows for the home to be more efficient and profitable.
For more information on pharmacogenetics testing, info@pgxmed.com or 405-509-5112
Pharmacogentic Testing: A Pharmacy Consultants Case Study #1
Pharmacy Consultants Case Study on Pharmacogenetics Testing
Garrett Huxall, Pharm.D, CGP, FASCP
Executive Director, PharmCareOK
As a pharmacy consultant and nursing home owner, understanding medications and their side effects is critical to my patient care. I have been utilizing pharmacogenetics testing and it allows me to recommend proper medication therapy more quickly and accurately. The tool from PGx Medical replaces the “trial and error” process consultants cannot afford in a nursing home setting.
I have countless success stories due to pharmacogenetics test reports, however, what I am finding is the small changes make the biggest impact. I now adjust dosages based on the resident/patient’s metabolic report. Furthermore, I now select medications that can be properly metabolized, where in the past I would have just gone to the next drug and hoped for a better outcome.
Case Study #1 – [88 year old female Alzheimer patient that was on Aricept, Namenda and Zyprexa because she was frequently falling]. After getting the pharmacogenetics (PGx) test report, we determined she needed a few med changes based upon her genetic profile. There were certain mutations within her system that were not allowing the medication to provide therapy. With the physician’s approval, we immediately transitioned her to a different drug, Geodon. She responded very well to this medication. Now, we have even been able to reduce her dosage of Geodon and she has not fallen since. This is a great outcome as she is on a lower dosage of medication than she was prior to us using the pharmacogenetics test results.
Previously, without the testing results to guide us, this change may have taken several different methods and a longer time frame to achieve results. It was very reassuring and validating to me that we were able to intervene with this resident on a much quicker basis and help her avoid falls, which is a benefit to the clinical team and the medical director.
In this case, the small change with guidance from the test results allowed for a rapid intervention that may have taken months. The small changes can have tremendous benefits to all parties involved. The test results came back in a matter of a day or two and we were able to save thousands of future medicare dollars as a result of avoiding possible injuries due to her falls.
Educating the clinical team and medical directors at the facility on the value this tool provides is crucial, as there is no out of pocket costs to residents covered by medicare. It’s important to reassure residents and family members that the medications they are taking are the most appropriate and able to provide proper therapy. A less medicated, cognizant, mobile resident allows for the home to be more efficient and profitable.
For more information on pharmacogenetics testing, contact PGx Medical, info@pgxmed.com or 405-509-5112.
Pharmacogenomics and Pain
The pain was too intense to ignore. Sixteen years later, Tony Cirrincione still remembers it. He was on a weekend ski trip, and he staggered into the ski lodge, leaving his wife in charge of their son and the five other Cub Scouts they’d brought along. Wincing at the dull ache in his back, he tried to stretch away what had to a muscle cramp. But the bursts of pain grew only more intense, erupting at more frequent intervals. Soon he was in the emergency room in Chicago. Kidney stones that had him doubled over the triage station. Waiting for the prescription opioid Dilaudid (hydromorphone) to take hold. But it never did. read more…
Pharmacogenetics And Drug Effectiveness
In October 2013, the Food and Drug Administration cited a study on the percentages of patients for whom drugs are ineffective. The study explained that some of that ineffectiveness could be attributed to errors in dosing, drug-interactions, or non-compliance, researchers estimated that up to 50 percent of those inappropriate responses were likely related to genetic factors.
- Depression 38%
- Asthma 40%
- Cardiac Arrhythmias 40%
- Diabetes 43%
- Migraine 48%
- Arthritis 50%
- Osteoporosis 52%
- Alzheimer’s 70%
- Cancer 75%
For more information on pharmacogenetic testing, contact PGx Medical. Specializing in Aging Services medication management.
Drug-Related Problems Among Our Elderly
An elderly person often takes many drugs (polypharmacy). They also have age-related changes that increase the risk of adverse effects.
Many drugs have adverse effects that resemble symptoms of disorders common among the elderly or changes due to aging.
Antipsychotics may cause symptoms that resemble Parkinson disease. In elderly patients, these symptoms may be diagnosed as Parkinson disease and treated, possibly leading to adverse effects from the antiparkinson drugs (eg, orthostatic hypotension, delirium, nausea).
A drug-drug interaction may increase or decrease the effects of one or both drugs. Clinically significant interactions are often predictable and usually undesired. Adverse effects or therapeutic failure may result. Rarely, clinicians can use predictable drug-drug interactions to produce a desired therapeutic effect.
Adverse effects of inappropriate drugs account for about 7% of emergency hospitalizations for patients ≥ 65 yr, and 67% of these hospitalizations are due to 4 drugs or drug classes—warfarin, insulin, oral antiplatelet drugs, and oral hypoglycemic drugs.
Despite the Beers and other criteria, inappropriate drugs are still being prescribed for the elderly; typically, about 20% of community-dwelling elderly received at least one inappropriate drug. In such patients, risk of adverse effects is increased. In nursing home patients, inappropriate use also increases risk of hospitalization and death. In one study of hospitalized patients, 27.5% received an inappropriate drug.
Tools to help reduce adverse events:
Pharmacogenetics is a simple test (swab of the cheek) that can help physicians and other healthcare professionals determine if a drug is appropriate for that individual. Does the drug have the ability, based on that person’s genetic make-up to give them therapy? Are there drug-on-drug interactions that you aren’t aware of? This test can guide clinicians in making actionable clinically based decisions to provide a better quality of life. Making the “guessing game” a thing of the past.
For more information on pharmacogenetics in the aging services industry, contact: PGx Medical, info@pgxmed.com or 405-509-5112.