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Pharmacogenetics Testing: Smart Medication Management
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) test 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 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 are three case studies I have written:
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.
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.
Case Study #3 – [Male LTC resident on multiple medications]. 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. We then ordered 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. So we put him on Thorazine and got him calmed down. We then started reducing the Thorazine and now the patient is back on Allopurinol for gout and that is the only prescription medication he is taking. Great outcome!
Previously, without the PGx 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 on a much quicker basis and helped, 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 for residents covered by medicare (and medicaid in select states). 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
Pharmacogenetics and Mental Health
Today is World Mental Health Day. The goal is to raise awareness about mental health around the world.
In the U.S. about 1 in 5 adults experience mental illness annually.
Approximately 300 million people suffer from depression
According to the National Alliance on Mental Health, about 1 in 25 struggle with a serious mental illness.
Below are statistics on how mental health issues affect Americans:
- 1 in 5 (or 43.8 million) adults experience mental illness in a given year.
- 1 in 25 (or 10 million) adults experience a serious mental illness.
- 1 in 100 (or 2.4 million) live with schizophrenia.
- 2.6% (or 6.1 million) of Americans have bipolar disorder.
- 6.9% (or 16 million) suffer from severe depression.
- 18.1% (or 42 million) live with an anxiety disorder.
- 90% of those who die by suicide have an underlying mental illness.
And yet:
- Only 41% of adults with a mental health condition received help and less than 50% of children 8-15 received mental health services.
- Only 36.9% of those suffering from anxiety receive treatment.
- Less than 20% of Americans with moderate depressive symptoms sought help from a medical professional.
- And 4% of young adults with self-reported mental health needs forego care.
While the statistics might seem discouraging, there are a number of ways to get help if you or a loved one is struggling with a mental health condition.
Medication can be an important part of the treatment of a mental illness, but finding the right medication at the right dose, for each individual, can take time and may cause harmful side effects.
In The Mental Health Clinician, it states over the past 3 decades, new psychotropic medications have been developed in hopes of improving outcomes such as medication adherence, tolerability, safety, and efficacy. A motivating factor for this has been consistently low reported remission rates in mood disorders with first-line treatment options.
According to the online publication, approximately 40% of treated patients will experience complete remission. In an effort to improve outcomes, mental health pharmacogenomics may play a role in improving outcomes by enhancing decision making in medication selection and treatment strategy. With improved access to genetic testing, future goals within mental health should include providers maintaining a well-rounded understanding of pharmacodynamic and pharmacokinetic properties.
Pharmacogenetics and Mental Health:
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. We know pharmacogenetics isn’t the “end all, be all” but it is another tool that can be used to help clinicians know the right drug, at the right dose, for the right person.
According to the NIMH (National Institute of Mental Health), less than 30% of depressed patients responded adequately to their initial antidepressant.
One thing a patient with mental health can’t afford, is “trial and error” prescribing. Pharmacogenetics testing allows healthcare professionals to identify patients who might experience adverse effects from antidepressant or antipsychotic medications and help to improve adherence.
One benefit from pharmacogenetic testing is to identify patients who rapidly metabolize medications, also known as ultra-rapid metabolizers. Test results will guide prescribing letting providers know what kind of dose that individual should be taking.
PGx Medical travels the country educating and implementing pharmacogenetics in the field of aging services. Despite the FDA’s “black box warning” of the potentially fatal side effects of antipsychotics for people suffering from dementia, these powerful drugs are too often used as a means of sedating elderly nursing home residents with dementia, as a substitute for appropriate care
Mental Health Illness has no limits. An estimated 1 in 4 Americans over the age of 18 suffers from a diagnosable mental disorder each year.
Today as we bring awareness to these statistics all over the world, let’s stop and think about the available ways to help, support and treat those affected.
For more information on pharmacogenetics, contact: PGx Medical, info@pgxmed.com or 405-509-5112.
Unique Patients Require Unique Treatment Plans
Each of us have our own unique genetic profile. So why aren’t our treatment plans tailored to fit us?
Personalized Medicine Is Unique To Each Individual
Twenty years ago the “one size fits all” approach was pretty standard when it came to prescribing medications. But today with the advances in science, healthcare professionals are able to predict your medication response. This information allows doctors to treat each patient as a unique person and tailor treatment to fit.
Many things influence how our bodies respond to medications. Nutrition, drug interactions, environment and yes, genetics. Knowing our genetics can help create an effective treatment plan customized for each individual.
It has been estimated that genetics can account for 20% to 95% of variability in drug disposition and effects as much as 40-60% of adverse drug reactions.
Pharmacogenetic testing can assist in determining if a particular medication will be effective for you, or potentially harmful.
It can improve your quality of life by helping your provider determine the right drug, at the right dose, for your genetic profile. This helps lower costs on unnecessary medications and reduce the risk of possible side effects. This is important for all patients, but particularly in the long term care setting where elderly adults on average take 8 to 10 medications per day.
Now, more than 130 of the most commonly-prescribed drugs include pharmacogenetic guidance, with many including black box warnings.
PGx Medical focuses on educating and implementing pharmacogenetics in the field of aging services. For more information on pharmacogenetics, contact PGx Medical, info@pgxmed.com or 405-509-5112.
Pharmacogenetics Could Save Your Life
Have you ever heard the phrase, “You don’t know, what you don’t know?” That is certainly the case with pharmacogenetics testing.
Kelly Burleson, Director of Education, PGx Medical
For many of us, our parents told us we are allergic to a medication. We may have had a reaction to a particular medication as a child, therefore it goes in our medical records and each time we go to the doctor or the pharmacy we remind them of this. And each time they ask, “what happens when you take that medication?” I would always reply the same, “I have no idea. My mom told me I had a reaction when I was a child.”
I work in the field of pharmacogenetics but had never been tested. I’m 54 years old, in good health, eat right, exercise daily and don’t take prescription medications. Until I injured my back recently. Overnight I was prescribed meloxicam for inflammation and hydrocodone for the pain. I’ve never liked taking medication and decided it was time to be tested to see if the medications that were prescribed, even had the ability to give me therapy.
So I went through the simple process of having my PCP order the test and swab my cheek. Within approximately 72 hours my results were ready and everything my mother had told me from a very young age, were validated in this scientific-based test.
Not only am I allergic to codeine, my test results show due to my genetic makeup, that if taken I may experience life threatening or fatal respiratory distress or signs of overdose. See my results for codeine below.
**Avoid use if clinically possible. Avoid codeine use due to potential for toxicity. Individuals who are CYP2D6 ultra-rapid metabolizers may experience life threatening or fatal respiratory distress or signs of overdose (Drug Label; CPIC Guidelines)
This led me to think, how many people have these adverse reactions and are diagnosed with an overdose or some other type of respiratory problems? How would you know if you haven’t been tested? Again, you don’t know, what you don’t know.
So how do doctors and pharmacists know how your body metabolizes medications? Is there a standard “one dose fits all” approach to prescribing? I’ve heard some say they favor one medication over another so that is the drug of choice for their patients. But we all know everyone is uniquely made and medications react differently according to each individuals genetic profile.
As of now, medicare covers the cost of pharmacogenetics testing and in select states, medicaid covers the cost of the test. My hope is that one day soon more private insurance providers will see the benefits of personalized medicine. Not only from a cost savings standpoint – which is huge when you consider the length a patient stays on a medication that doesn’t have the ability to give them therapy, hospitalization from adverse events, falls in the elderly and the list goes on and on.
But to me, the biggest reason is to know from a very young age how “my” body processes medications so I don’t spend a lifetime taking drugs that will do more harm than good. According to an article in aafp.org, drugs cause approximately 20 percent of community-and hospital-acquired episodes of acute renal failure. Among older adults, the incidence of drug-induced nephrotoxicity may be as high as 66 percent. Just think of what a lifetime of drugs — the wrong drugs, is doing to your body.
For now, we will continue our work educating and implementing pharmacogenetics in long term care and hopefully make a difference in the lives of elderly adults across the country. Help give them a better quality of life and peace of mind knowing they are in control of their own health. Don’t we owe that to them?
For more information on pharmacogenetics, contact PGx Medical, info@pgxmed.com or 405-509-5112.
Could Pharmacogenetics Help Reduce Accidental Overdose?
With an increase in drug and opioid overdose deaths, could pharmacogenetics help reduce this epidemic?
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.
Patient Centered Care: CMS Final Ruling
The requirements for LTC Facilities are the health and safety standards LTC facilities must meet in order to participate in medicare or medicaid programs.
What is your Patient Centered Care Plan for your LTC community?
For months now when you walk into a Long Term Care (LTC) facility, you may hear people talking about the CMS Final Ruling. Asking themselves, how they are going to make these changes with more residents then ever before, and less staff then ever before.
A high percentage of residents are admitted to a long term care facility on Friday. This allows them time to get adjusted, move-in over the weekend, and have family and friends available for the first few days. The baseline Care Plan requires facilities to develop a baseline care plan for each resident, within 48 hours of their admission, which includes the instructions needed to provide effective and person-centered care that meets professional standards of quality care. That is tough when you are short staffed to begin with and now it is on a weekend when staff is even more limited.
Below are a few key points in the Final Ruling.
- Person Centered Care: This revolves around information, being involved and allowing the patient to have more choice in their care.
- Facility Assessment, Competency Based Approach: Not a one-size fits all approach. Focus on each resident achieving their highest practicable physical, mental, and psychosocial well-being.
- Align with Current HHS Initiatives: Reducing unnecessary hospital readmissions, reducing the incidences of healthcare acquired infections, improving behavioral healthcare, and safeguarding nursing home residents from the use of unnecessary psychotropic (antipsychotic) medications.
Pharmacogenetics can help decrease, contain and/or give the facility documentation of patient centered care through personalized medicine. It can help with your baseline care plan and give you personalized data for each resident to help develop a personalized medication regime unique to each resident. Documentation on how each resident is on the right medication, at the right dosage for each individual based on their genetic make-up. And it helps in reducing unnecessary medications with scientific based evidence to back it up.
This program is quick, approximately one minute per resident, and there is no out of pocket expense for residents with medicare B and in some states, medicaid.
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. Our proprietary process impacts quality, adds value and enhances the customer experience by addressing top clinical concerns such as falls, dementia, sleep, pain, med management and overall staff efficiencies.
If it isn’t currently part of your patient centered care plan, it should be. What other resource is that easy, quick to implement, and no out of pocket expense to the resident or facility. PGx Medical can be your consultant and educator in the process helping you and your clinical team implement the program.
For more information, contact: PGx Medical, info@pgxmed.com or 405-509-5112. PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services.