利用药物基因组学(PGx)和整合药物诱导的表型转化来指导阿片类药物治疗,可以改善治疗反应,减少药物不良事件的发生。遗传学有助于阿片类药物反应的个体差异。本病例报告的目的强调了PGx知情用药安全审查的影响,在临床决策支持系统的协助下,在减轻药物-基因和药物-药物-基因相互作用(DGI和DDGI,分别)增加了药物反应不足和药物不良事件(ADE)的风险。该病例描述了一名69岁的女性,她因骨关节炎和神经病引起的不受控制的慢性疼痛而接受PGx测试。临床药师回顾了PGx测试结果和用药方案,并确定了几种(DGI和DDGI,分别)在细胞色素P450(CYP)2C19和CYP2D6。建议:(1)将曲马多改为丁丙诺啡透皮贴剂,一种潜在ADE较低的阿片类药物,缓解CYP2D6DDGI;(2)逐渐停止阿米替林,以减轻抗胆碱能副作用的风险,ADEs,和多个DDGI;和(3)优化普瑞巴林。提供者和患者同意实施这些建议。在一个月后的随访中,患者报告生活质量和疼痛控制得到改善.在amitriptyline锥度之后,患者出现上肢和下肢震颤。当犯罪者吸毒时,奥美拉唑,停止了,代谢能力不再受到阻碍;由于阿米替林的快速戒断,患者可能出现阿米替林戒断症状,重新启动并逐渐变慢。该病例报告显示了一个成功的PGx知情药物安全性审查,该审查考虑了药物引起的表型转换并减轻了药物治疗失败的风险。ADEs,和阿片类药物滥用。
Utilizing pharmacogenomics (PGx) and integrating drug-induced phenoconversion to guide opioid therapies could improve the treatment response and decrease the occurrence of adverse drug events. Genetics contribute to the interindividual differences in opioid response. The purpose of this
case report highlights the impact of a PGx-informed medication safety review, assisted by a clinical decision support system, in mitigating the drug-gene and drug-drug-gene interactions (DGI and DDGI, respectively) that increase the risk of an inadequate drug response and adverse drug events (ADEs). This
case describes a 69-year-old female who was referred for PGx testing for uncontrolled chronic pain caused by osteoarthritis and neuropathy. The clinical pharmacist reviewed the PGx test results and medication regimen and identified several (DGIs and DDGIs, respectively) at Cytochrome P450 (CYP) 2C19 and CYP2D6. The recommendations were to: (1) switch tramadol to buprenorphine transdermal patch, an opioid with lower potential for ADEs, to mitigate a CYP2D6 DDGI; (2) gradually discontinue amitriptyline to alleviate the risk of anticholinergic side effects, ADEs, and multiple DDGIs; and (3) optimize the pregabalin. The provider and the patient agreed to implement these recommendations. Upon follow-up one month later, the patient reported an improved quality of life and pain control. Following the
amitriptyline taper, the patient experienced tremors in the upper and lower extremities. When the perpetrator drug, omeprazole, was stopped, the metabolic capacity was no longer impeded; the patient experienced possible amitriptyline withdrawal symptoms due to the rapid withdrawal of
amitriptyline, which was reinitiated and tapered off more slowly. This
case report demonstrates a successful PGx-informed medication safety review that considered drug-induced phenoconversion and mitigated the risks of pharmacotherapy failure, ADEs, and opioid misuse.