by PGx Medical | Jan 20, 2017 | Uncategorized
Welcome to our Friday FOCUS on Pharmacogenetics
Each Friday we will post new and relevant information regarding Pharmacogenetics. We hope you will find this useful and pass along to colleagues. If you should have any questions regarding pharmacogenetics, please feel free to reach out to us at PGx Medical, info@pgxmed.com or 405-509-5112.
One question we get asked a lot when we travel around the country educating healthcare professionals on pharmacogenetics is…
Who should be tested?
Even though our pharmacogenetic program is a once in a lifetime test and reimbursed by medicare and in some states medicaid…it isn’t for everyone.
If you have a resident at your LTC facility who isn’t taking any medications, there is no need to test that resident. The following are a few reasons why I resident would benefit from pharmacogenetic testing.
- Taking multiple medications. You are having problems that you write-off as side effects from your medication. It may be that your drugs are interacting. How would you know without a pharmacogenetic test? Drug interactions may make your drug less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. The PGx Medical test result highlights potential drug-on-drug reactions so healthcare professionals can dose accordingly.
- You’ve been taking your medication but your condition is not improving. Have you ever heard the phrase, “let’s try it for a few weeks and see if you improve.” That is called trial and error and honestly, how physicians prescribed medicine because they didn’t know the genetic make-up of each patient. Now, pharmacogenetic testing can help guide healthcare professionals in proper prescribing by aligning medications with each person’s unique genetic profile. And the test report will show them more effective options.
- Your physician has prescribed an anticoagulant. The FDA recommends individuals be aware of pharmacogenetics prior to starting certain anticoagulants such as Plavix and Warfarin. Patients who are poor metabolizers of these medications may be at risk – or may not be receiving the full benefit of these drugs.
Pharmacogenetics can help identify genetic markers and can assist in individualization of treatment.
PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services. Contact us for more information, or let us know if you would like to be part of a Patient-Centered Care Pharmacogenetic Pilot Program. In conjunction with Dr. Linda Shell, PGx Medical is presently enrolling provider organizations and communities. To see if you qualify, go to: www.pgxmed.com/pilotprogram.
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
by PGx Medical | Jan 17, 2017 | News
Doctors look for clues when trying to determine if a patient might become addicted to opioid painkillers. Clinical risk factors such as medical history, family history, and other environmental or social clues can help.
Addiction is estimated to be about 40% to 60% heritable, meaning genetics likely account for about half of a person’s risk.
Overdose deaths continue to climb with 19,000 deaths related to prescription opioid painkillers
While pharmacogenetics is not the end all be all, it is a tool used by many healthcare professionals across the country to help guide them in proper prescribing. It can help physicians and pharmacist determine if a patient has the ability to metabolize a pain medication, therefore alerting them if a patient says they are not receiving therapy and need more.
“There might actually be something to that,” said Clay Bullard, president of PGx Medical. “We’ve had physicians tell us they had patients who would complain their pain medication wasn’t working and they needed more. After performing a pharmacogenetic test, they realized the patient wasn’t able to metabolize the medication – or they were a ultra-rapid metabolizer of their pain medication so they needed to adjust their dosage accordingly. On the other hand, we’ve had physicians tell us their concern was validated after performing a pharmacogenetic test. The patient did have the ability to metabolize the medication.” Bullard went on to say with opioids, one concern is with a poor metabolizer. The body doesn’t metabolize the medication the way the manufacturer intended so the drug sits in their body and can build up toxins which can be deadly.
Cytochrome P450 2D6 (CYP2D6) is a gene product responsible for the metabolism of many major drug groups, including opioids. “A pharmacogenetic (PGx) test, approved by the FDA, is available, which looks for specific changes in the gene and interprets whether you have a ‘good copy’ or a ‘bad copy. A good copy would be a functional allele, while a bad copy is a non-functional allele. These changes and their combinations help predict how well a person will metabolize a drug.
An individual’s genotype can help predict the CYP450 activity, which classifies them into one of the four metabolizer types. The incidence of poor and ultrarapid metabolizers varies greatly among various populations. For example, approximately 10% of Caucasians are PMs for CYP2D6.
The CYP450 testing is a once-in-a-lifetime test. The result will be part of your medical record and denotes your genetic capability of handling these drugs. This not only applies to pain medications but also to other medications such as anti-convulsive medications, cardiac medications and psychotropic drugs that are used for depression and anxiety control.
Hydrocodone, the most frequently prescribed drug in the U.S., is metabolized differently depending on an individual’s phenotype. An ultra-rapid metabolizer may get some pain control, but their hydromorphone levels are going to increase and they may complain of side effects. Physicians have to be aware of that and they may need to make dosing adjustments accordingly. Poor metabolizers may not get sufficient pain control. If a patient is complaining about a drug not being effective, or about side effects, and the physician is considering a dosing adjustment, genetic testing can guide them.
The potential risks relating to how pain medications are metabolized are exacerbated by drug diversion. Drugs are now one of the leading causes of death in this country. It’s important for physicians to be aware of the impact of genetic variation on metabolizing drugs and try to identify those patients who may be at risk. If someone says they always take a half dose of a drug because of its effect or somebody else says the drug doesn’t really work for them, it’s a warning sign.
Getting the nation’s opioid addiction epidemic under control is a top priority for U.S. public health officials as overdose deaths continue to climb — with nearly 19,000 deaths related to prescription opioid painkillers.
PGx Medical is the trusted and experience resource for the education and implementation of pharmacogenetics.
For more information on pharmacogenetic testing contact:
PGx Medical
info@pgxmed.com
405-509-5112.
source: medpagetoday.com, Dr Leland McClure
by PGx Medical | Jan 11, 2017 | Pilot Program
Here in the West, we live in a culture that loves its medicine—just turn on the TV and you’ll see a drug ad at nearly every commercial break. We’ve become so impatient for a cure to every symptom imaginable, and hope our doctor will just prescribe whatever’s been working for everyone else. But the reality is, even with the great strides we’ve made in pharmaceutics, there isn’t a pill for everything – including old age.
Dr. Linda Shell MA, RN
Polypharmacy, the prescribing of 5+ medications. Polypharmacy is a problem in America and stems from the drastically different reactions each of us can have when taking the same drug. It’s not a new issue—polypharmacy has been a silent killer for years, draining funds from Medicare and dismantling the treatment plans of millions as it becomes a habit ingrained in our culture, especially in eldercare. We’ve become resigned to the falsehood that more drugs mean better treatment, but there’s something putting an end to that.
It’s called
pharmacogenetics: the study of genetic differences in humans that affect how each person responds to drugs. Pharmacogenetics has been studied for over 30 years, but it’s practical applications become most widespread in the medical community in recent years. Identifying precisely which chemicals interact with which genes, medical professionals can map specific drugs to the DNA profiles of individual patients to find the prescription that will work best for them.
This mapping process is critical for patients being prescribed the most consequential and care-intensive classes of drugs, such as cardiovascular, chemotherapy, and neurological drugs. Without pharmacogenetics, doctors may be blindly trying several different drugs in these classes until one seems to work the best, greatly increasing the risk of an adverse drug effect. Not to mention, the circumstances of these drug uses are relatively urgent. Gene-to-drug mapping ensures that a patient is prescribed one that metabolizes at the right speed and delivers the intended effect, avoiding those risks and saving precious time in treatment.
In the long term, we hope to see pharmacogenetics take more of a priority in prescriptions of all drug types as we recognize the financial benefits of pharmacogenetics. Prescribing drugs that more effectively treat a patient’s conditions and the symptoms manifested by them cuts down on ordering multiple prescriptions. Additionally, a drug that achieves its purpose more quickly saves the time and money a less fitting drug would cost in continuing care.
If you were trying on a rock climbing harness in preparation for an ascent up a dangerous cliff, wouldn’t it be common sense to pick a harness that fits you specifically? That’s what pharmacogenetics is finally doing for the drug industry; it’s high time we minimize the risk we’ve been taking with prescription drugs and become intuitive in our medicating.
by PGx Medical | Jan 11, 2017 | Pilot Program
Currently enrolling provider organizations and communities in a Person Centered Care Pharmacogenetics Pilot Program.
Dr. Linda Shell RN (LindaShell.com), in conjunction with PGx Medical (PGxMed.com) are currently enrolling aging services communities in a Person-Centered Care Pharmacogenetic Pilot Program.
Pharmacogenetics, a simple one-time diagnostic lab, covered by Medicare B, assists providers in aligning medications with a person’s DNA.
Genetic testing has been used extensively in patients with arthritis, anticoagulants, and cancer for many years to assist in personalizing medications, reducing costs and minimizing side effects.
The pilot offers long term care communities – including independent, assisted, skilled, memory care, and home health a streamlined program for implementing pharmacogenetics. The pilot goal is to demonstrate the ability to improve quality, reduce costs and maximize care of older adults through the use of pharmacogenetics.
According to the NIH 50% of nursing home residents take 9 or more medications per day (2016). Dr. Shell states, “as a gerontological nurse, one of my concerns has been the prevalence of polypharmacy. The risk for side effects increases when a patient has more than nine prescriptions.”. The problem is often related to comorbid conditions such as heart disease, diabetes, chronic obstructive lung disease, and hypertension requiring multiple medication management. In long term care, medication-related problems currently cost $177.4 billion a year (ascp.com). The problem of polypharmacy can lead to interactions between multiple medications resulting in serious harm. Some medications increase the risk of confusion, falls, and behaviors in the cognitively impaired. With over 43.1 million adults 65 and older, research indicates personalized medications play a role in improving the quality of life.
Along with anti-psychotic medication monitoring, updated CMS regulations coming in 2018 increase the scrutiny of medication review. A simple, straightforward solution is needed – one that offers providers an effective tool that aligns prescribed medications to the unique needs of each resident.
Collaborating in this pilot program is PGx Medical, a leading supporter and provider of pharmacogenetic testing in older adults. Their team is knowledgeable and uniquely qualified to assist providers in the process of pharmacogenetic testing. They have spent years educating healthcare professionals on the benefits of pharmacogenetics, how it impacts current medications and is a roadmap for the future.
For more information on this pharmacogenetics pilot program, contact, Bill Shell at bill@legacymarketservices.com or 952-960-0806, or visit www.LindaShell.com/pharmacogenetics.
by PGx Medical | Sep 15, 2016 | Journal articles
If medication is not working for you, could new testing tell you if your genes are to blame?
Up to 99 percent of us may have small variations in our genes that can also impact how we react to common medications. (ISTOCKPHOTO)
By: Mark Dunnenberger
We all know a medication that works well for one person might not work for another – or even cause some people unwanted side effects. These differences in response can be caused by factors such as age, gender or other drugs and supplements that a person might be taking.
However, up to 99 percent of us may have small variations in our genes that can also impact how we react to common medications, including pain relievers, antidepressants and blood thinners.
Now, through a new kind of genetic testing in a field known as pharmacogenomics, some doctors are able to identify a number of these variations to help predict how their patients might respond to a new medication.
These tests are very different than genome sequencing services that provide data on your ancestry, analysis of disease-related genes or information on your risk of developing certain diseases. Instead, the tests look for specific gene variants that can help physicians minimize the trial and error of prescribing certain medications and help narrow down medication choices, especially when it comes to treatments for pain and psychiatric medications.
Understanding the basics of pharmacogenomics:
1. Pharmacogenomics will not tell you why your eyes are blue or predict your risk of cancer. Unlike other genetic tests, pharmacogenomics does not measure disease risk. Instead, it helps doctors identify treatments that are most likely to work by examining how your genes affect your response to medications.
2. The tests cannot give information about how you may respond to every single medication. Currently, research only supports testing for certain drugs, most commonly those for cardiology, pain management and depression/mental illness.
3. A pharmacogenomics test has value throughout your life. By studying a set of your genes, clinical experts can analyze a broad amount of information regarding drug therapy for many conditions, including psychiatric disorders, pain management and cardiology. Because your genes don’t change over time, you only need one test to discover genetic information that could be applied to future care. At some hospital-based testing centers, results can be added to your electronic medical record for easy access and used as a reference for medication and treatment choices throughout your life.
4. Pharmacogenomics is especially helpful for non-responders – people who have tried numerous drugs to find ones that effectively treat their symptoms. For some people, the tests can help explain why they didn’t respond to medications in the past, or provide peace of mind in knowing they are not genetically predisposed to a negative outcome on a new medication.
5. Make sure that the medications covered by the genes being tested are related to your current clinical situations or medications.
6. Pharmacogenetic testing is “not a crystal ball” and will not tell you the perfect drug for your condition. It can, however, narrow down your options and help doctors prescribe the right medicine faster avoiding the “trial and error” process.
7. Is no news good news? No specific feedback from your genomics test means that your suboptimal response to a particular medication is not the result of your genetics, but could be caused by other factors such as diet or age.
Especially when it comes to pain medication and psychiatric medications, pharmacogenomics testing can minimize the trial and error of prescribing medications, plus help a physician to narrow down treatment choices.
PGx Medical specializes in education and implementation of pharmacogenetic testing in the field of aging services. If you are interested in learning more, contact PGx Medical at info@pgxmed.com or 405-509-5112.
Read entire article at: health.usnews.com
