The Pharmacogenetics of Opioid Pain Management

High rates of interpatient variability in drug metabolism and drug response for nearly all medications lead to the hypothesis that assessment of an individual patient\u27s genotype with respect to their ability metabolize certain drugs can be a useful tool in predicting a patient\u27s responsiveness to certain medications. Evaluating patients using pharmacogenomics as a basis for assessment could allow pharmacists to decide which treatment options would be most efficacious in a given patient and, thereby, have significant impact in the clinical setting. This holds true especially in the case of prodrugs, which require in vivo activation to an active or more active form. Codeine is a prodrug whose clinical efficacy depends greatly on its metabolism to more active forms by both cytochrome P450 enzymes and uridine diphosphate glucuronyltransferase enzymes and is affected by the activity of transporters and the structure of its target receptor. Evaluation of a patient\u27s metabolic capacity concerning these enzymes, as well as any abnormalities in transporter activity or receptor structure, could indicate if the patient will receive adequate pain relief from a given dose of codeine

Genetic Variations in a Cytochrome P450 Enzyme and the Effects on Clopidogrel Bioactivation and Metabolism

Clopidogrel, the top prescribed antiplatelet medication for individuals who have experienced a myocardial infarction or cerebral vascular accident or who have peripheral arterial disease, is administered orally as a prodrug. It relies on hepatic metabolism through cytochrome P450 enzymes for conversion to its active form. Current research shows that allelic variation m the gene coding for CYP2C19 is the main factor contributing to the variability of response associated with clopidogrel treatment. Through the promotion of genetic testing for variability in the CYP2C19 gene and competently interpreting test results, pharmacists have the opportunity to use these findings to significantly impact clopidogrel prescribing and dosing. By tailoring an individual\u27s dosing regimen, pharmacists can maximize the efficacy of clopidogrel for a patient according to his or her genotype

Options for Breast Cancer Prevention in High-Risk Patients

Breast cancer is the most frequently diagnosed non-skin cancer in women, and one in eight women will develop breast cancer within their Iifetimes. Unfortunately, the strongest risk factors for breast cancer (i.e. age, family history, hormonal factors) are not easily modified. There is some evidence that chemopreventative drugs may be able to prevent breast cancer in high-risk patients. Tamoxifen and raloxifene have been shown to reduce the risk of breast cancer in high-risk women but may be associated with several serious adverse events. Clinical trials are currently in progress to determine if aromatase inhibitors are a viable alternative for breast cancer prevention, as they may be considered effective in the early treatment of breast cancer. For patients with BRCA1 and BRCA2 mutations, a bilateral prophylactic mastectomy may be an option. This article discusses the risks and benefits of available treatment options for breast cancer prevention in high-risk patients

Theoretical framework for facilitating young musicians’ learning of expressive performance

Since communication and expression are central aspects of music performance it is important to develop a systematic pedagogy of teaching children and teenagers expressiveness. Although research has been growing in this area a comprehensive literature review that unifies the different approaches to teaching young musicians expressiveness has been lacking. Therefore, the aim of this article is to provide an overview of literature related to teaching and learning of expressiveness from music psychology and music education research in order to build a new theoretical framework for teaching and learning expressive music performance in instrumental music lessons with children and teenagers. The article will start with a brief discussion of interpretation and expression in music performance, before providing an overview of studies that investigated teaching and learning of performance expression in instrumental music education with adults and children. On the foundation of this research a theoretical framework for dialogic teaching and learning of expressive music performance will be proposed and the rationale explained. Dialogic teaching can be useful for scaffolding young musicians’ learning of expressivity as open questions can stimulate thinking about the interpretation and may serve to connect musical ideas to the embodied experience of the learner. A “toolkit” for teaching and learning of expressiveness will be presented for practical application in music lessons. In addition, a theoretical model will be proposed to further our understanding of teaching and learning of expressive music performance as a multifaceted and interactive process that is embedded in the context of tutors’ and learners’ experiences and environment. Finally, implications of this framework and suggestions for future research will be discussed

Sipuleucel-T (Provenge®): Therapeutic Use and Financial Implications

Although mortality rates have been declining, prostate cancer accounts for a large percentage of cancer diagnoses around the world. Sipuleucel-T (Provenge®), an autologous cellular immunotherapy targeted against the antigen expressed in most prostate cancers, has been shown to increase the median survival rate of castration-resistant prostate cancer. Even so, the therapeutic risks and benefits, as well as financial implications, all currently play a role in the governmental decision to reimburse for this new therapy

Polycystic Ovarian Syndrome and Hyperinsulinemia: Overview and Treatment

Polycystic ovary syndrome is a prevalent issue in women\u27s health that is associated with hyperinsulinemia and insulin resistance and can lead to long-term health problems. The most highly recommended treatments are diet and lifestyle changes. If these changes alone are not enough, pharmacologic treatments may be employed which include metformin, spironolactone or thiazolidinediones, although more research is needed to fully realize their role. The role of the pharmacist in this disease state includes counseling patients on healthy lifestyle changes, consulting with the physician about prescribing the best medication for each patient, and monitoring therapy adherence in the patient

The challenge of the spaceship: Arthur C. Clarke and the history of the future, 1945-75

Arthur C. Clarke’s 1946 essay on ‘The Challenge of the Spaceship’ was one of the founding manifestoes of the Space Age, and helped to establish him as the West’s leading techno-prophet. Restating his ideas in subsequent factual and fictional works, Clarke successfully propagated the belief that man’s destiny lay in space and that the process was already underway. On the surface Clarke’s oeuvre offers a classic astrofuturist model of progress as technology-driven, but on closer examination it also incorporates a more pessimistic, historically based strand of philosophy, British rather than American. This essay traces the genesis of Clarke’s early work and the influence upon him of the historian Arnold J. Toynbee and the moral philosophers Olaf Stapledon and C.S. Lewis. Toynbee was essentially a Christian pessimist who believed that western civilization was on the way out; his long historical perspectives were an important source of inspiration for Clarke, leading him to a cyclical rather than a simply progressive model of history which contemplated both the beginning and the end of civilizations. The concerns of Stapledon and Lewis with grand narratives of decline and redemption were also influences on Clarke. All this needs to be understood in relation to both the European experience of World War I and to the coming of the atomic bomb, the latter a profound influence on Clarke’s generation. Such perspectives gave European astroculture a more modulated vision of the human future in space than the technologically based astrofuturism which dominated in the USA