- Learning Center
As healthcare costs continue to climb in the United States, drug costs are responsible for a disproportionate percentage of the overall healthcare spend. Pharmacogenetic testing has been scientifically validated as an option to help lower drug costs, yet little data exists on the testing's potential to improve patient care while also lowering health plans' costs. This presentation will provide the premise of pharmacogenetic testing then share how one self-insured company implemented pharmacogenetic screening of its high-risk populations as part of a collaborative laboratory/pharmacy stewardship program. Lessons learned and an examination of the financial and quality impacts of pharmacogentic panel testing will also be discussed.
After decades have past in the field of Pharmacogenetics, overcoming barriers to adoption by providers utilizing pharmacogenetic testing (PGx) is gaining maturity. Readily available resources, including technology advances, reduction in costs, and insurer reimbursements are accelerating PGx testing as a new standard. In this article, they describe preemptive genotyping to optimize medications. In the back of a patients mind when facing a medication change, spoken or not, is "will this prescription change be my best med?" From common maintenance, multiple or high risk medications, standard genotyping results prior to prescribing decisions including genetics should be considered in the plan of a patient's care. This review describes common elements for RX Alerts utilizing genotyping and presents key process applications including clinical decision guidance.
Severe depression patients? The first line from the study found in the Journal of Psychiatric Research in 2019 reading "Current prescribing practices for major depressive disorder (MDD) produce limited treatment success." is a large patient- and rater-blinded, randomized, controlled study worth reviewing. Guided care improves response and remission rates and reduces economic burden among patients with very severe depression.
This article discusses the genetics behind schizophrenia and pharmacogenomics of antipsychotic drugs. According to the article, in developed countries, disorders of the Central nervous system (CNS) are the third greatest problem in healthcare. This places a socio-economic burden, psychological and family burden on the population. Thus, further insight into the pathogenesis of schizophrenia is needed. Additionally, the role of genetics on metabolism can contribute to the decrease of polypharmacy and relapse for patients who do not experience optimal treatment. The article discusses genes associated with the drug action, genes potentially associated with pathogenesis of CNS diseases, pleiotropic (multiple effects from one gene) genes and genetic impact on antipsychotic drugs.
February 20, 2020
Pharmacogenetic tests, along with other information about patients and their disease or condition, can play an important role in drug therapy. When a health care provider is considering prescribing a drug, knowledge of a patient's genotype may be used to aid in determining a therapeutic strategy, determining an appropriate dosage, or assessing the likelihood of benefit or toxicity.
The table below lists pharmacogenetic associations that FDA has evaluated and believes there is sufficient scientific evidence to suggest that subgroups of patients with certain genetic variants, or genetic variant-inferred phenotypes (i.e., affected subgroup in the table below), are likely to have altered drug metabolism, and in certain cases, differential therapeutic effects, including differences in risks of adverse events. The fact that FDA has included a particular genedrug interaction in the table does not necessarily mean FDA advocates using a pharmacogenetic test before prescribing the corresponding medication, unless the test is a companion diagnostic. Tests that are essential for the safe and effective use of a therapeutic product, including those that identify patients for which the drug is contraindicated, are companion diagnostics. This table is not intended to affect current regulatory requirements or policies, including FDA's policy regarding companion diagnostics. Nor is the table intended to make an assessment on the safe and effective use of, or regulatory requirements for, tests that detect variants in the referenced genes, or to provide comprehensive information on the described gene-drug interactions.
Tramadol is becoming a safety concern, especially in long term facilities. It is widely used to relieve moderate to serve pain. In the year of 1995, tramadol was introduced to the US and marked as safer than opioids. Tramadol has become one of the second most prescribed narcotic drugs. An overdose of tramadol can lead to the following depression, respiratory depression, and death. There are severe withdrawal symptoms including insomnia, rigors, pain, nausea, tremors, diarrhea, and respiratory problems that can occur. Furthermore, seizures have been seen in patients who have received the recommended dosage of tramadol. Patients taking tramadol are also watched for serotonin syndrome symptoms. Regarding hypoglycemia, a study was performed in 2012 using the French pharmacovigilance database to see the correlation between the risk of hypoglycemia and tramadol. Despite the correlation, studies do not prove a positive relationship.
Over the years, moving to nursing homes has improved because the rooms are large, family and pet visits. However, the thought of a nursing home being somewhere people go to die may lead to depression. Depression is treated as a normal part of aging. This has biological and psychological causes. Here are multiple ways that caregivers can help their loved ones cope with depression: encourage social interaction, help them find hobbies, talk openly, enhance the environment, encourage exercise, make sure all medications are taken as instructed, and advocate for loved ones.