by brant bullard | Mar 22, 2016 | Journal articles
MTM and Pharmacogenomic Testing…a perfect fit
Blair Green Thielemier, PharmD
Pharmacy Times
Genetic testing has come a long way since completion of the project. Now pharmacists and physicians can use pharmacogenomic test results to help choose safer and more effective medications for their patients. An article posted on Crain’s Chicago Business website featured a physician clinic in Illinois that is doing preemptive genotyping: NorthShore University’s HealthSystems clinic is building a program that will screen patients and use DNA test results to guide therapies.
Another recent study, this one published in the Journal of Medical Economics and conducted at the University of Utah, used cytochrome P450 pharmacogenetic profiling in clinical decision making for elderly patients. The study results found that the hospitalization rate of the genotype-tested group was 6.3 percentage points lower than the untested cohort: 9.8% versus 16.1%, respectively. The estimated potential cost savings was $218 (mean) in the genotype-tested group.2 The study also found that among the health care providers of the genotype-tested group, 95% of providers found the test “helpful” and 46% followed the clinical decision support tool recommendations for therapy changes. The Mayo Clinic is conducting similar studies on the effectiveness of preemptive genotyping, developing clinical decision-making support tools of its own and planning integration of test results into its electronic medical record (EMR).
No one understands medication management better than a pharmacist. So why not help guide them by determining upfront which medications a patient can actually metabolize? A simple swab of the cheek can help lower healthcare costs and improve the quality of life for our seniors.
Read entire article at: pharmacytimes.com
For more information on pharmacogenomic testing, or how you can implement pharmacogenomics, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
by brant bullard | Jan 25, 2016 | Journal articles
CYP2D6 copy number distribution in the US population
Recently published in Pharmacogenetics and Genomics, the attached article reviews the clinical experience with CYP2D6 mutation rates in a random subset of patients. The reseach points to substantial variation in 2D6 mutations by race. Surprisingly, they found that 20% of African Americans may have aberrant 2D6 activity and as many as 1:300 may be completely missing copies of this gene. 70% of this same group were on a drug metabolized by 2D6.
Pharmacogenetic and Genomics article
This data point underscores the value of pharmacogenetic testing based on personal genetic variation.
For more information on pharmacogenetic testing, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
by brant bullard | Dec 20, 2015 | Journal articles
Personalized medicine is an area of medicine that is only moving in one direction, forward. The more we know the better our care will be.
What works for one person does not always work the same way for someone else. So it should not be a surprise that people and their prescription drug outcomes are not created equal.
In a recent article in prescriptionintelligence.com, they discuss our genes and how they can impact a drug’s effectiveness and its potential side effects. Before DNA testing became widespread in forensics, and crime shows blanketed over primetime broadcast television, distinguishing bloodtypes was the most effective forensic tool. In the mid 20th Century, if a common blood type was found at a crime scene it would be little help to the investigation, but if a rare blood type was discovered the forensic science would be significant. DNA profiling has completely changed every aspect of forensic science. Genetic mapping and pharmacology are having a similarly ascendant moment in medicine. Everyday brings a new discovery and there is plenty of work remaining, but the importance of these advances are indisputable. Genetics will only prove to be more and more important in individual patient care.
Full genetic mapping for every patient is currently impractical and unaffordable. Even if doctors had every patient’s genome mapped, not all information is relevant when considering drug interactions and effectiveness. However there are certain genes and genetic expressions where current science has a depth of knowledge. In these areas, genetics and drugs have fostered gene-specific treatments, and further advancements will only broaden the understanding of genetic differences when prescribing medication. As the science and expense of genomic mapping improves, prescription drug outcomes guided by pharmacogenetics will improve and costs should be lowered across all areas.
Specific genes impact liver function, and different people have different outcomes with medications based on certain genetic predispositions. These variations in genetic expression are called polymorphisms. Many drugs are broken down by the liver and they can be separated into two categories: drugs that enter the body in an active or inactive form.
For drugs that are already in an active form — which means that the drug has immediate effect on the body — enzymes in the liver break the drug down to make it inactive, so the body can then discard it.
Genetic variations within liver metabolism can cause some patients to have decreased metabolism or increased metabolism of the drug, resulting in increased or decreased efficacy, and effecting variation in side effects or interactions with other drugs.
The other category of drugs enter our bodies in an inactive state as a pro-drug, and are activated when they are broken down in the liver. The liver enzymes that break the drug down are critical to making it work. For drugs that are converted into an active [form] in the liver, genetic variations can mean that a person needs to take a different kind of drug entirely.
In this scenario it has been discovered that some drugs are significantly more effective than others in reducing negative outcomes. The way the body absorbs a medication impacts not just the proper dose for optimal care, but the prescribed medication itself. Genetic information can lead to better outcomes and the applications are very real in many areas of pharmacological science.
The public sector is invested in personalized and genomic medicine. President Obama’s 2015 State of the Union Address called for the launch of the Precision Medicine Initiative. Just recently the NIH announced it “has committed up to $72 million in preliminary funding opportunities for the [PMI] in 2016.”
With a public policy backing and a clear economic initiative, personalized medicine will be a major component of future health science. The medical and financial benefits will be hard to predict, but the impact will be enormous. With the rate of scientific discovery and advancement of big-data in every area of healthcare, it is easy to foresee genomic mapping improving the outcomes of medical treatment while reducing the costs once benefits are mainstreamed. The future may already be here, but it is far from being fully explored:
It is easier to imagine a future where one hundred would seem like a small number of drugs with pharmacogenetic labels. Genetic data will soon become ubiquitous in every element of care. New genetic discoveries and market forces will increase efficiency and lower costs, hastening the advent of mainstream precision medicine.
For more information on pharmacogenetic testing, contact:
PGx Medical
Individualized Care – Personalized Medicine
Info@pgxmed.com
405-509-5112
source: prescriptionintelligence.com
by brant bullard | Mar 19, 2015 | Journal articles
Dr. Scott Dellinger, MPC Geriatrics
Metabolic Validation has become an integral part of my house call practice for everyday patient care. My practice is in nearly 30 Assisted Living facilities with approximately 1,100 patients and growing. Pharmacogenomic testing allows for tailoring better preventative efforts and finding the best pharmaceutical therapy for each individual patient.
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by brant bullard | Dec 11, 2014 | Journal articles
Medication nonadherence drives the largest avoidable cost
According to an article in IMShealth.com, patients not adhering to their doctors’ medication guidance experienced complications that led to an estimated $105 billion in annual avoidable healthcare costs. While the underlying reasons for nonadherence are varied and longstanding, the growing use of analytics and collaboration among providers, pharmacists and patients appear to be advancing both the understanding and effectiveness of intervention programs.
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by brant bullard | Jun 12, 2014 | Journal articles
What all nurses need to know.
Psychotropic medications are commonly administered to elderly patients to help manage behavior and psychiatric symptoms. These drugs are known to have potentially serious side effects, to which older adults are more vulnerable. Nurses care for older adults in many different practice settings but have varying degrees of knowledge about these kinds of medications. The purpose of this article is to provide information to geriatric nurses in all settings about how the most commonly prescribed psychotropic medications (i.e., anxiolytic, antidepressant, and antipsychotic drugs) differentially affect older adults, and examine recent concerns about the use of psychotropic medications with older adults.
Although much of the literature regarding the use of psychotropic medications among older adults is focused on their use in nursing home settings and in residents with dementia, psychotropic medication use is quite common among older adults with or without dementia in all settings (community, assisted living, acute care medical and psychiatric units, and nursing homes). Psychotropic medications are more prevalent among community-dwelling older adults than other age groups. For example, community-dwelling older adults are 7 to 18 times more likely to use psychotropic drugs than are middle-aged adults. Smith, Buckwalter, Hyunwook, Ellingrod, and Schultz (2008) noted research findings suggesting that between 35% and 53% of assisted living residents receive one or more psychotropic medications, and Voyer and Martin (2003) found that more than half of community-dwelling older adults who are admitted to nursing homes receive psychotropic medications within 2 weeks of their admission. In a study of older adults with dementia in nursing homes and acute care geriatric units, Pitkala, Laurila, Strandberg, and Tilvis (2004) found that 87% of patients were taking one psychotropic medication, 66% were taking two, 36% were taking three, and 11% were taking four or more.
It is well documented that older adults are highly vulnerable to the adverse effects of psychotropic medications. Those older than age 70 are 3.5 times more likely than younger individuals to be admitted to the hospital due to adverse drug reactions associated with psychotropic medications. The risk for adverse reactions increases dramatically with the number of medications used and with increasing age (Brooks & Hoblyn, 2007). Thus, it is imperative that nurses caring for older adults, regardless of the setting, are knowledgeable about these medications and are able to recognize and appropriately respond to side effects and adverse effects. The purposes of this article are to (a) provide geriatric nurses working in all settings with information about how psychotropic medications differentially affect older adults; (b) examine recent concerns about the use of psychotropic medications with older adults; and (c) discuss nursing implications related to potential side effects and adverse effects of these medications.
Because of severe adverse side effects and inappropriate prescribing practices, the use of psychotropic medications first came under scrutiny with nursing home residents. As a result, the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), federal legislation mandating minimum health and care requirements for nursing homes, placed limitations on the use of psychotropic medications with nursing home residents.
Adverse Effects of Psychotropic Medications in Older Adults
Psychotropic medication is a broad term referring to medications that affect mental function, behavior, and experience. Psychotropic medications are typically administered to older adults to manage symptoms of anxiety, depression, psychological distress, and/or insomnia.
Administration of psychotropic medications is potentially hazardous and can result in serious and sometimes fatal consequences for patients of all ages. This is even more evident for high-risk populations such as older adults. Nurses in all practice settings caring for elderly patients should be familiar with this group of medications, their side effects, and the impact of age-related changes on their pharmacodynamics and pharmacokinetics. Careful assessment, close monitoring of potentially serious side effects, and use of nonpharmacological interventions when possible will help prevent potential deleterious or fatal effects on this highly vulnerable group. Read more at: http://www.ncbi.nlm.nih.gov
PGx Medical’s Metabolic Validation Testing helps healthcare professionals administer the Right Drug, Right Dose, Right Patient. And can be your tool for reducing unnecessary medications. This easy buccal swab is a once in a lifetime test that will help you provide your residents with a better quality of life and eliminate the trial and error process.
For more information on the PGx Medical Metabolic Validation Test, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
www.pgxmed.com
Resource: (Usher, Lindsay, Holmes, & Luck, 2003), (NSW Department of Health, 1997), (Bulat, Castle, Rutledge, & Quigley, 2008; Carr, 2005; Grasso, Bates, & Shore, 2007; Mott, Poole, & Kenrick, 2005),(Brooks & Hoblyn, 2007),
