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Optimizing drug therapy based on genetic differences: implications for the clinical setting
1University of Cincinnati Medical College, Department of Environmental Health, Ohio, USA.
Abstract:
Differences in drug responses due to gene alterations are rapidly being identified. Gene alterations may inhibit the function of an enzyme so that an active drug accumulates, causing adverse reactions with normal doses. Alternatively, gene alterations may accelerate enzymatic function so that an active drug is rapidly eliminated, causing subtherapeutic responses to normal doses. Mutations and polymorphisms have been identified that affect a person's response to many currently prescribed medications including cardiovascular, anti-infective, chemotherapeutic, psychiatric, and analgesic drugs. The potential exists for drug therapy to be optimized by selecting medication and doses based on a person's genotype rather than by trial and error. In the near future, advanced practice nurses in the acute care setting may be expected to order, provide patient education about, and explain results of genetic tests before initiating a specific drug therapy. Advanced practice nurses must be knowledgeable about what genetic tests are analyzing and their benefits, limitations, and risks.
Insights
Genetic variations significantly impact how individuals respond to medications, influencing drug efficacy and safety. Understanding these genetic differences allows for personalized medicine, optimizing treatment through genotype-guided drug selection.
Area of Science:
- Pharmacogenomics
- Clinical Genetics
- Drug Metabolism
Background:
- Genetic alterations can significantly alter enzyme function, impacting drug metabolism.
- These alterations lead to either drug accumulation (adverse reactions) or rapid elimination (subtherapeutic response).
- Variations affect responses to cardiovascular, anti-infective, chemotherapeutic, psychiatric, and analgesic drugs.
Purpose of the Study:
- To highlight the impact of genetic variations on drug response.
- To emphasize the potential for genotype-guided drug therapy optimization.
- To inform advanced practice nurses about the role of genetic testing in acute care.
Main Methods:
- Review of identified gene mutations and polymorphisms affecting drug response.
- Analysis of enzymatic inhibition and acceleration due to genetic variations.
- Discussion of clinical implications for various drug classes.
Main Results:
- Gene alterations demonstrably cause adverse or subtherapeutic drug responses.
- Personalized drug therapy based on genotype offers an alternative to trial-and-error.
- Numerous genetic variations influencing common medications have been identified.
Conclusions:
- Genotype-guided drug selection and dosing can optimize therapeutic outcomes.
- Advanced practice nurses will play a key role in ordering and interpreting genetic tests.
- Knowledge of genetic testing's benefits, limitations, and risks is crucial for nurses.