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Can Pharmacogenetics Identify a Drug Seeker?
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
Pharmacogenetics in Long Term Care
Aligning Rx with DNA
The Pharmacogenetics Program is specifically designed for providers serving older adults in any setting. The program is a simple three-step process that facilitates DNA testing and aligns medications with the resident’s personal DNA. Polypharmacy is an ever-increasing problem in long term care and pharmacogenetics testing is a tool that can be utilized as part of a quality assurance and process improvement (QAPI) program. Additional benefits of pharmacogenetic testing are reduction of medications, reduced trial and error, less med pass time for nurse, and overall medication cost reduction.
Friday FOCUS on Pharmacogenetics
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.
Cardiovascular Disease and Pharmacogenetics
Elevated blood pressure is on the rise around the world, with an increasing impact on mortality, according to a large international study.
Pharmacogenetics can help identify genetic markers of antihypertensive drug responses and can assist in individualization of hypertension treatment.
In October 2016 the American Heart Association released a Scientific Statement on
Enhancing Literacy in Cardiovascular Genetics
Advances in genomics are enhancing our understanding of the genetic basis of cardiovascular diseases, both congenital and acquired, and stroke. These advances include finding genes that cause or increase the risk for childhood and adult-onset diseases, finding genes that influence how patients respond to medications, and the development of genetics-guided therapies for diseases. However, the ability of cardiovascular and stroke clinicians to fully understand and apply this knowledge to the care of their patients has lagged. This statement addresses what the specialist caring for patients with cardiovascular diseases and stroke should know about genetics; how they can gain this knowledge; how they can keep up-to-date with advances in genetics, genomics, and pharmacogenetics; and how they can apply this knowledge to improve the care of patients and families with cardiovascular diseases and stroke.
This is an exciting time in the field of medicine, when the application of genetics and genomics-driven diagnostics, prognostics, and therapeutics is seeing a rapid growth. The federal investment in the Precision Medicine Initiative has energized the field of genomic applications in health care. The applications to cardiovascular diseases and stroke are expected to see similar growth, and the cardiovascular clinician needs to be well informed about this burgeoning field and how to effectively apply it to the care of their patients. This statement provides the current and future state of knowledge in which the clinician needs to be proficient, the public resources available to the clinician to stay abreast of this knowledge, recommendations for increasing genetic awareness and edu- cation among practicing clinicians, and the importance of close collaboration with genetics specialists. Societies such as the American Heart Association should invest in educational tools and resources to increase genetics awareness and knowledge through continuing medical education.
The eventual goal is to empower and enable the cardiovascular clinician to understand, interpret, and apply genetic information to patient care in an effective, responsible, and cost-efficient manner. ~Read entire article at: American Heart Association
Pharmacogenetics can help identify genetic markers of antihypertensive drug responses and can assist in individualization of hypertension treatment. PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services.
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
Source: Mital S, Musunuru K, Garg V, Russell MW, Lanfear DE, Gupta RM; on behalf of the American Heart Association Council on Functional Genomics and Translational Biology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Stroke Council; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Enhancing literacy in cardiovascular genetics: a scientific statement from the American Heart Association [published online ahead of print September 26, 2016]. Circ Cardiovasc Genet. doi: 10.1161/HCG.0000000000000031.
Solutions to Polypharmacy…Pharmacogenetic Testing
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.
Person-Centered Pharmacogenetic 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.
Pharmacogenetics: Can It Help Reduce Readmission Penalties?
Nursing homes hospitalize residents when physicians and nursing staff determine that residents require acute-level care
Nursing homes hospitalize residents when physicians and nursing staff determine that residents require acute-level care.
According to DHHS Office of Inspector General (OIG), in fiscal year 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions, and Medicare spent $14.3 billion on these hospitalizations. Nursing home residents went to hospitals for a wide range of conditions, with septicemia the most common. Annual rates of Medicare resident hospitalizations varied widely across nursing homes.
Nursing homes with the following characteristics had the highest annual rates of resident hospitalizations: homes located in Arkansas, Louisiana, Mississippi, or Oklahoma and homes with one, two, or three stars in the Centers for Medicare & Medicaid Services’ (CMS) Five-Star Quality Rating System.
The OIG recommended to: (1) develop a quality measure that describes nursing home resident hospitalization rates and (2) instruct State survey agencies to review the proposed quality measure as part of the survey and certification process. CMS agreed with both recommendations.
Penalties:
In a recent article in MedPage Today, A new study suggests that financial penalties provide an effective incentive to reduce avoidable readmissions, particularly at low-performing hospitals. Based on 30-day readmission rates after initial hospitalization for acute myocardial infarction, congestive heart failure or pneumonia, researchers found that hospitals with the highest incidences of readmissions also saw the highest reductions in readmissions when the financial penalties started kicking in.
How Pharmacogenetics Can Help:
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. This simple test addresses key clinical concerns such as falls, dementia, sleep, pain and many other areas that effect residents in a nursing home setting on a daily basis. Having evidence-based reports for each individual resident, helps manage medications and in turn, reduces falls, helps residents sleep better, and allows the healthcare team to manage pain based on prescribing medications you know have the ability to give that person therapy.
Person-Centered Care:
CMS is now using person-centered care and care plan in their language when addressing LTC facilities. Pharmacogenetics is “person-centered” care and provides the healthcare team with documentation for each individual when preparing a medical plan of action. These pharmacogenetic reports will help identify problem areas or drug reactions that could be avoided preventing falls and/or readmissions.
PGx Medical in conjunction with Dr. Linda Shell, MA, RN are now accepting community organizations and providers in a Person-Centered Care Pharmacogenetics Pilot Program To see if your community qualifies, go to: Pilot Program, or email info@pgxmed.com, or call 405-509-5112.
Source: MedPageToday.com, oig.hhs.gov