Could Pharmacogenetics Help Reduce Accidental Overdose?

With an increase in drug and opioid overdose deaths, could pharmacogenetics help reduce this epidemic?alt = "opioids"

According to the CDC, since 2000, the rate of deaths from drug overdoses has increased 137%, including 200% increase in the rate of overdose deaths involving opioids.  More persons died from drug overdoses in the United States in 2014 than during any previous year on record.

In an online article by vox.com, in 2016 alone, drug overdoses likely killed more Americans in one year than the entire Vietnam War.  It is estimated that more than 140 people are estimated to die from drug overdoses every day in the U.S.  About two-thirds of these drug overdoses deaths are linked to opioids

The opioid epidemic could kill hundreds of thousands in the next decade.

But how do we stop it?

In 2015, the amount of opioids prescribed was enough for every American to be medicated around the clock for 3 weeks.

So how can pharmacogenetics help in decreasing drug overdose?
When a doctor prescribes a standard dosage of a medication, they are frequently confronted with each patient responding differently.  Many patients are taking multiple medications simultaneously and they counteract with each other.

Your genetics can play a part in your risk for overdose.
Oral opioids, such as oxycodone, hydrocodone and codeine, are metabolized by an enzyme which makes the user have a “high” feeling. Some genes are highly variable, leading to a completely inactive enzyme. Individuals who inherit these  alleles are referred to as “poor metabolizers” and are less likely to become dependent.

Individuals who are poor metabolizers of these drugs are more prone to toxicity and overdose at standard doses. But individuals who are fast metabolizers, or “ultra rapid” metabolizers are more predisposed to addiction.

Pharmacogenetic testing eventually can lead to an overall decrease in adverse drug reactions, a decrease in health care costs because of the number of failed drug trials; the time it takes to get a drug approved; the length of time patients are on medication and the number of medications patients must take to find an effective therapy.

Pharmacogenetics has the potential to change the way medicine is practiced, by eliminating the “one size fits all prescribing” with a more personalized approach that takes into account both clinical factors and the patient’s genetics. Healthcare professionals can use pharmacogenetic testing along with traditional clinical practices to predict which drugs are more or less likely to work, achieve therapeutic repose based on appropriate dosage, and know the drugs to be avoided on basis of associated adverse events.

For more information or to schedule a free educational webinar on pharmacogenetic testing for medication management, contact:  PGx Medical, info@pgxmed.com, 405-509-5112.  Or go to www.pgxmed.com.

 

Implementing Pharmacogenetics In Long Term Care

Pharmacogenetics can play an important role in effective use of medications by optimizing drug dose, identifying responders and non-responders to medications, and avoiding adverse events by aligning medications with personal DNA.

Learn how to effectively implement a pharmacogenetics program into your community to help improve quality of life, quality of care, reduce medication costs, and optimize medication usage.

 

To request more information, or to schedule a webinar or phone call, contact PGx Medical at info@pgxmed.com or 405-509-5112.

 

Polypharmacy: A growing concern in older adults

Polypharmacy is defined simply as the use of multiple medications by a patient. The precise minimum number of medications used to define “polypharmacy” is variable, but generally ranges from 5 to 10. 

Polypharmacy is a growing concern in the elderly population

The issue of polypharmacy is of particular concern in older people who, compared with younger individuals, tend to have more disease conditions for which therapies are prescribed. It has been estimated that 20 percent of Medicare beneficiaries have five or more chronic conditions and 50 percent receive five or more medications.

The use of greater numbers of drug therapies has been independently associated with an increased risk for an adverse drug event (ADE), irrespective of age, and increased risk of hospital admission.

There are multiple reasons why older adults are especially impacted by polypharmacy:

Older individuals are at greater risk for ADEs due to metabolic changes and decreased drug clearance associated with aging; this risk is compounded by increasing numbers of drugs used.

Polypharmacy increases the potential for drug-drug interactions and for prescription of potentially inappropriate medications.

Polypharmacy was an independent risk factor for hip fractures in older adults in one case-control study, although the number of drugs may have been an indicator of higher likelihood of exposure to specific types of drugs associated with falls (eg, central nervous system [CNS]-active drugs).

Polypharmacy increases the possibility of “prescribing cascades”. A prescribing cascade develops when an ADE is misinterpreted as a new medical condition and additional drug therapy is then prescribed to treat this medical condition.

Use of multiple medications can lead to problems with medication adherence, compounded by visual or cognitive compromise in many older adults.

A balance is required between over- and under-prescribing. Multiple medications are often required to manage clinically complex older adults. Clinicians are often challenged with the need to match the complex needs of their older patients with those of disease-specific clinical practice guidelines.

Pharmacogenetics is a tool used in long term care communities across the country to help manage polypharmacy.  Pharmacogenetics is a simple swab of the cheek that allows providers to look at how medications align with each persons unique DNA.  The results help guide providers in proper prescribing eliminating unnecessary medications and guiding them when dosing changes are recommended based on metabolization.

For more information on pharmacogenetics, contact:  PGx Medical at 405-509-5112 or info@pgxmed.com.

source:  uptodate.com

Polypharmacy On The Rise Among Older Adults

Gene mutations that affect drug metabolism may explain higher hospitalization rates in some older adults taking multiple medications, according to researchers from Columbia University.

alt = "pharmacogenetics"

Nearly 40 percent of Americans 65 or older take at least five or more medications.

Polypharmacy (the use of multiple medications), is on the rise among U.S. seniors, according to an article in Sciencedaily.com. The article states, approximately 40 percent of Americans 65 or older take at least five or more medications. Previous studies have shown that older adults with polypharmacy are more prone to adverse events and hospitalizations than those taking fewer medications. However, few studies have investigated individual, genetic risk factors for adverse drug events in this population.

For this small pilot study, the researchers hypothesized that older adults with polypharmacy and increased hospitalization rates would have more genes associated with altered drug metabolism or lack of sensitivity to certain drugs than those with fewer hospitalizations.

The researchers performed pharmacogenetic testing to identify five such genes — CYP2C19, CYP2C9, VKORC1, CYP2D6, CYP3A4/5 — in older adults with polypharmacy. The study included six seniors who had been admitted to the hospital at least three times over the past two years and six age-matched controls who had fewer hospitalizations. Both groups had an average age of 77 years, and were taking an average of 14 medications.

In the higher hospitalization group, each of the participants had at least one of the mutations, and half had more than one. None of the controls had any of the mutations.

“Although this was a very small pilot study, the findings suggest that routine testing for these gene variants could improve health outcomes for older adults taking multiple medications,” according to Joseph Finkelstein, MD, PhD, director of the Center for Bioinformatics and Data Analytics in Oral Health at the Columbia University College of Dental Medicine, associate professor of health informatics in dentistry at Columbia University Medical Center, and lead author of the paper. “In dentistry, for example, pharmacogenetic testing could be part of a personalized approach in which clinicians select pain medications that are most effective and least risky for each patient.”

Pharmacogenetics aligns current and future medications with each persons unique genetic profile.

For more information on pharmacogenetics in the field of aging services, contact: PGx Medical, info@pgxmed.com or 405-509-5112

source:  Sciencedaily.com

 

Over Prescribing Medications for Older Adults

Prescribing for older patients presents unique challenges.

alt = "medications"

Atypical antipsychotic medications, used for the management of the behavioral and psychological symptoms of dementia, are among the drugs most frequently associated with adverse events in long-term care facilities.

Optimizing drug therapy is an essential part of caring for an older person. The process of prescribing a medication is complex and includes: deciding that a drug is indicated, choosing the best drug, determining a dose and schedule appropriate for the patient’s physiologic status, monitoring for effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation.

But how do you know what a person can metabolize, or receive therapy from, and what they can’t?  It’s all kind of a guessing game and you hope that you get it right the first time.  Pre-marketing drug trials often exclude geriatric patients and approved doses may not be appropriate for older adults. Many medications need to be used with special caution because of age-related changes in pharmacokinetics (ie, absorption, distribution, metabolism, and excretion) and pharmacodynamics (the physiologic effects of the drug).

Adverse drug events (ADEs) are the serious consequences of inappropriate drug prescribing. The possibility of an ADE should always be top of mind when evaluating an older adult individual; any new symptom should be considered drug-related until proven otherwise.

Atypical antipsychotics:
Atypical antipsychotic medications, used for the management of the behavioral and psychological symptoms of dementia, are among the drugs most frequently associated with adverse events in long-term care facilities. In particular, psychotropic medications are associated with an increased risk for falls. In one meta-analysis of patients age 60 or older, the odds ratio for any psychotropic use among patients who had one or more falls was 1.73 (95% CI 1.52-1.97).

Use of antipsychotic medications in long-term care facilities is widespread. A study of 19,780 older adults with no history of major psychosis prior to long-term care admission found that antipsychotic therapy was prescribed for 17 percent within 100 days of their long-term care admission and for 24 percent within one year.

Pharmacogenetics is one tool that can help determine the right drug, at the right dose, for the right person.  This one time test is simple to administer and will give clinical caregivers valuable information for each individual resident in a long-term care community.   There is no-cost to the resident and no-cost to the community since it is reimbursed by Medicare B and in select states, Medicaid.

If you would like more information on Pharmacogenetics, or you would like to sign up for an educational webinar, contact: info@pgxmed.com or call 405-509-5112.

Source:  uptodate.com