Steps to Implementing Pharmacogenomics (PGx) in Your Practice

As previously mentioned, proteins (normal or altered) include those used as transporters, enzymes, and receptors. Considering "enzymes," there are many enzymes of importance in the body. Today, let's just look at CYP2C19 metabolizing enzyme as an example.

The normal form for the enzyme allele is *1 and, as we mentioned last week, as new altered alleles or polymorphisms are described, they are numbered with integers of "2" or greater, typically in order of their discovery and validation. The alleles from the parents are separated by a "/" so a normal allele would be *1/*1 (homozygous). So, for the CYP 2C19 metabolizing enzyme, we can look at the following:

Alleles and general maintenance dosing for CYP2C19 metabolizing enzymes is as follows:

Using an example drug as clopidogrel (Plavix), the following might be considered if the PGx patient lab results have any of the genotype examples in column 1:

As can be seen, the *1/*1 and *1/*17 can receive normal dosing. However, the *2/*2 and *2/*3 (and others) are poor metabolizers possibly resulting in treatment failure so alternative antiplatelet therapy should be recommended.

See Table 1 at the website below for more information and should be read for a better understanding. It is a great resource.
https://www.pharmgkb.org/chemical/PA449053

Next week, we will look at a case study involving codeine.

Loyd V. Allen, Jr., PhD, RPh
Editor-in-Chief
International Journal of Pharmaceutical Compounding
Remington: The Science and Practice of Pharmacy Twenty-second edition

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Go to the CompoundingToday.com website; then:

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News

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Barry Cadden, former pharmacy executive and the president of New England Compounding Center, was found guilty of racketeering charges but acquitted of 25 counts of second-degree murder. In all, 732 people were sickened by the meningitis and other infections. Sixty-four people died. Many survivors live with constant pain.
https://www.nytimes.com/2017/03/22/us/meningitis-new-england-compounding-center-barry-cadden.html?_r=1

Best Surgery Days? During Joint Commission Surveys
Overall, patients treated during a Joint Commission survey week had a 1.5% lower risk of dying, on average, within 30 days of admissions compared to the patients treated in the three weeks before or after an inspection. A proposed reason may be due to the fact that clinicians are aware they are under scrutiny and are, therefore, more vigilant, according to a new study published in JAMA Internal Medicine.

Researchers analyzed Medicare admissions at 1,984 surveyed hospitals from 2008 through 2012 in the three-week period before the survey, during the survey, and three weeks after the survey and included approximately 245,000 patients admitted during Joint Commission surveys, and more than 1,462,000 in the three weeks before and after the surveys.

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Did You Know ...

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The HDCS is a joint effort of ACHC/PCAB and IACP, written by a number of experts with extensive experience in the handling of hazardous drugs from a wide range of backgrounds.

They developed the HDCS that:

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The HDCS and several supportive documents such as risk assessment templates and a USP <800> Preparation Checklist, may be downloaded FREE of charge from the Compliance/USP/Other Information Sources section of the Compounding Today website:
CompoundingToday.com.

Looking Back

Passing cars,
When you can't see,
May get you a glimpse,
Of eternity!
     Burma Shave