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

Osteoarthritis: Natural Supplements for Joint Health

An estimated 46 million adults in the U.S. are affected by arthritis, with osteoarthritis (OA) being the most common. Due to the limited pharmacologic therapy available to treat this condition, many patients are turning to dietary supplements to relieve their symptoms. Some of the most popular supplements available for the treatment of OA are glucosamine, chrondroitin and methylsulfonylmethane (MSM), but many less studied products are also available. Due to limited evidence of efficacy, it is difficult to make a strong recommendation for any of these products; however, pharmacists must be able to educate the patients that choose to use these supplements in the treatment of their OA

The HIV VACCINE: Learning from Failure and Building on Success

An effective vaccine for acquired immune deficiency syndrome (AIDS) has eluded researchers since the identification of the HIV virus. There are many challenges in developing an effective HIV vaccine, including the lack of knowledge regarding the immune response to the virus and its diverse nature. Ethical concerns further complicate research. A recent phase III trial was performed in Thailand and showed that a significant reduction in HIV infection is possible. Pharmacists need to stay informed of these important breakthroughs in AIDS research in order to provide quality health information to patients in their community. This paper aims to evaluate the past failures and successes as well as explore the recent advancements towards finding a vaccine for HIV. An estimated 33.4 million individuals worldwide are currently living with acquired immune deficiency syndrome (AIDS).1 According to the Centers for Disease Control and Prevention, approximately 56,300 new cases of Human immunodeficiency Virus (HIV) developed during 2006 in the United States alone.2 A cure for this disease has puzzled and eluded researchers since the identification of the HIV virus in 1983. However, hope is on the horizon with the advances in research that could eventually lead to an effective HIV-1 vaccine. As one of the most accessible health care providers, pharmacists need to stay informed on these important breakthroughs in HIV/AIDS research in order to provide quality health information to patients in their community