Picture this: you see someone. They’re sneezing. Their nose is runny. Their eyes seem to be watery, and they keep rubbing them like they’re itchy. If you thought to yourself, “That person could use a hanky”, well you’re probably not wrong. But if you also thought, “Looks like they have allergies”, then you nailed it. Some people have had allergies for as long as they can remember. Some may not have ever had allergies then they moved someplace else and suddenly developed them. Others might be lucky enough to never develop them in the first place. The truth is that pesky allergies exist in many forms and arise from multiple allergens. We’ll investigate the why, what, and how when it comes to allergies.

Allergies occur because of the body’s immune system and its overreaction to a certain substance that it deems as an ‘intruder’ or ‘harmful’. This results in an allergic reaction. Any substance that causes such a reaction is labeled an ‘allergen’. Usually these allergens are relatively harmless, and what may trigger a reaction in one person may not cause the same reaction in another.

There are different kinds of allergies triggered by various allergens: food, pet, latex, mold, and drug, to name a few. Allergic rhinitis or ‘hay fever’ is used to describe the condition causing the symptoms previously described such as sneezing, runny nose, and itchy, watery eyes. Allergies may be seasonal or perennial meaning that it doesn’t just occur depending on the season but rather year-round. It is usually triggered by pollen. While sneezing and itching are milder and more common symptoms of an allergic reaction, hives and anaphylaxis are more severe symptoms that require prompt medical care.

Allergy Testing

It is important to figure out what triggers an allergy as sometimes the triggers may not be obvious. If allergies are suspected, an allergist would be the best healthcare provider to go to. Their roles involve performing allergy testing, identifying the trigger, and accurately diagnosing the condition. After a complete medical history and physical exam is done, an allergy test may be performed. Common allergy tests include:

● Skin testing – a tiny drop of allergen is pricked onto the skin or injected underneath
● Blood testing – involves a single needle prick and a sample is sent to a lab
● Patch testing – the allergen is applied to a patch which is then applied to the skin

Management and Treatment

If triggers are obvious and able to be anticipated, most patients can be treated completely with over the counter (OTC) medications. Some may still need prescriptions to alleviate their allergies. Regardless, pharmacists are in an important position for helping patients select the appropriate OTC options to help manage their symptoms. Pharmacists can help patients acquire the right oral antihistamine, decongestant, intranasal steroid, or eye drop based on the symptoms present. Patients should always consult with a doctor or pharmacist before taking any OTC drug. Some common treatment options for allergies include the following:

Allergies can be a nuisance, but dealing with them shouldn’t have to be. By understanding why they occur and recognizing the common triggers, patients can make informed decisions on what action to take to treat their condition as quickly as possible. In addition, patients can also come to recognize who to seek out for help (such as pharmacists) in selecting the most effective treatment option that is available.

Midrara Kashmari

RxPharmacist Team

References:

1. Types of Allergies. Asthma & Allergy Foundation of America. https://aafa.org/allergies/types-of-allergies/.
2. Allergy Treatments | AAFA.org. Asthma & Allergy Foundation of America. https://aafa.org/allergies/allergy-treatments/.
3. Allergic Conditions. ACAAI Public Website. https://acaai.org/allergies/allergic-conditions/.
4. Types of Allergies | Mount Sinai – New York. Mount Sinai Health System. https://www.mountsinai.org/care/allergy-immunology/allergy-types.
5. Mayo Clinic Staff. Allergy medications: Know your options. Mayo Clinic. Published 2017. https://www.mayoclinic.org/diseases-conditions/allergies/in-depth/allergy-medications/art-20047403.

Are you taking medication? Are you pregnant? Are you pregnant AND taking medication? These are important questions to consider especially for women of childbearing age as medication use during pregnancy is quite common. Per the CDC, 9 out of 10 women take some type of medication with 7 out of 10 women taking at least one prescription medication.¹

Women who are pregnant and/or lactating experience major physiological and psychological changes that require special attention to medication and healthcare. Pharmacists are in a unique position to offer additional advice in terms of medication safety, nutritional support, and general well-being in managing acute pregnancy issues. Not only does this ensure that the mother is provided with the safest and utmost care possible, but that the health of the baby is considered in equal measure as well.

Medication Safety

For all children and adults, it is important to speak to a doctor prior to using any medication, whether it’s a prescription drug or an over the counter (OTC) drug. During pregnancy and lactation, this warning is ever more critical to remember.

Taking inappropriate medication without proper consultation with a doctor may cause some undesirable effects in certain adults who are yet otherwise healthy. Women who are pregnant and/or lactating however, are more vulnerable for experiencing harm from certain kinds of medications, as is the baby.

Drugs that are considered toxic to the developing fetus during pregnancy (i.e., result in birth defects) are known as teratogenic drugs, and pose the most risk during the first trimester. Some medications may also decrease milk production during lactation. These drugs should be discontinued before pregnancy or once a woman is determined to be pregnant and safer options should be utilized instead.

Nutritional Support- Vitamin and Mineral Supplementation

A developing baby needs an appropriate amount of nutrients. Two vital examples of important nutritional support are folic acid and calcium and vitamin D. Deficiencies in folic acid (i.e., folate) causes birth defects of the brain and spinal cord known as neural tube defects, whereas deficiencies in calcium and vitamin D can hinder the development of the skeletal system.

Folic acid: Foods rich in folic acid include green leafy vegetables, dried beans, cereals, and orange juice. The recommended dietary folate equivalent (DFE) per day is 600 mcg DFE per day during pregnancy.

Calcium and Vitamin D: During pregnancy, 1000 mg per day of calcium and 600 IU per day of vitamin D are recommended. This can either be achieved through supplements or natural sources. Some foods rich in calcium include milk, cheese, yogurt, and green leafy vegetables.6 Good natural sources for Vitamin D include sunlight, milk, and fish/salmon.⁶

Common Pregnancy Discomforts and How to Treat Them

While not an all-inclusive list of all issues experienced during pregnancy, below are some drug treatments for common discomforts. Lifestyle measures or behavioral interventions will always be first line before implementation of drug therapy. These include eating smaller, more frequent meals while avoiding spicy food for morning sickness and GERD/heartburn. Drinking more water and increasing physical activity helps with constipation. Using hot/cold packs and relaxation/stress management techniques are useful in managing pain and headaches.

Enrolling in a pregnancy registry is also encouraged to help gather information on the use of a drug during pregnancy. For each woman, the journey will be unique, therefore personalized guidance from healthcare professionals remains paramount. Through collaboration and consultation with healthcare providers, making informed choices about medications and supplements, and focusing on proper nutrition, women can embrace pregnancy with confidence and optimal health. Some helpful resources for additional information are:

● LactMed
● March of Dimes
● Mother to Baby
● InfantRisk Center
● Office on Women’s Health

Midrara Kashmari

RxPharmacist Team

References:

1. CDC. Pregnant or thinking of getting pregnant? Centers for Disease Control and Prevention. Published July 19, 2018. https://www.cdc.gov/pregnancy/meds/treatingfortwo/facts.html.
2. DiPiro JT, Yee GC, Haines ST, Nolin TD, Ellingrod V, L. Michael Posey. DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition. McGraw Hill Professional; 2023.
3. Maryland SHL PharmD Primary Care Clinical Pharmacy Specialist Kaiser Permanente Mid-Atlantic States Clinical Pharmacy Services Silver Spring. OTC Medication Use in Pregnancy and Breastfeeding. www.uspharmacist.com. https://www.uspharmacist.com/article/otc-medication-use-in-pregnancy-and-breastfeeding.
4. Jin J. Safety of Medications Used During Pregnancy. JAMA. 2022;328(5):486. doi:https://doi.org/10.1001/jama.2022.8974.
5. American College of Obstetricians and Gynecologists. Nutrition During Pregnancy. www.acog.org. Published March 2022. https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy.

Currently, in a rapidly evolving healthcare landscape, the world of medicine relies heavily upon facts and evidence. As a healthcare professional, making informed decisions about medications, treatments, and interventions is crucial. What role does evidence-based medicine (EBM) play into all of this? Let’s investigate.

As a pioneer in EBM, Dr. David Sackett’s most recent definition of it is: “The integration of best available evidence with clinical expertise and patient values into the decision-making process for patient care.”¹ EBM serves to provide a scientific framework for being able to ask and provide answers to clinical questions while keeping in mind the needs of the patient in different clinical settings. The components of EBM fall into three categories: best available evidence, clinical expertise, and the values and preferences of the patient.

1. (Best Available) Evidence: refers to the findings from clinical research, from the best available resource that is relevant to patient care.2 These findings can be from systematic reviews, and clinical research from experimental and observational studies. It is the gathering of research information to help inform decision-making.
2. Clinical Expertise: involves using clinical skills and experience to evaluate evidence related to the patient’s current health status.2 Pharmacists have the skills and experience related to pharmacotherapy and clinical service. They can be valuable resources in both the access and translational aspects of pharmacotherapy evidence as this is relevant to patient care.
3. Patient Values and Preferences: refer to the goals, expectations, and beliefs that patients have for decisions and their outcomes.2 The values and preferences of a patient regarding the healthcare choices they make or decide upon are based on their beliefs, attitudes, cultural, and spiritual factors. It is vital to ensure that delivery of healthcare is mindful of all these factors and that they are used as a guide when it comes to clinical decisions.

Another way to view EBM is to look at it as a course of action: you receive a question, you search for the data to help answer the question, and then you end your search by relaying the information found. This course of action, in fact, can also be outlined in the 4 steps below.²

Step 1: Ask an Appropriate and Answerable Clinical Question
○ Make sure it is properly structured and guides the evidence search
○ What is the focus of the question? What type of information are you looking for?
Step 2: Find the Evidence
○ Search published literature from relevant resources
○ PubMed or Cochrane Library
Step 3: Appraise the Evidence Found
○ Review relevant information (all evidence ≠ each other) along with internal validity
○ Per the “Hierarchy of Evidence”, systematic reviews/meta-analyses are ranked the highest, then randomized controlled trials, and then cohort studies
Step 4: Apply the Evidence to Practice
○ External validity – can the results be applied to other populations, or more specifically, the patient in question?
○ Determine if the evidence is clinically significant, statistically significant, neither, or both

Through these steps, EBM incorporates interventions that work based on the high quality of evidence found, helps encourage communication among healthcare professionals, and facilitates the skill of research and keeping up with new information. However, that is not to say it is without its challenges or limitations. Individual patient factors must always be considered which may not always be synonymous with the evidence found, nor does EBM focus on explaining how the interventions are likely to work.

Making informed decisions in improving pharmacotherapy care is most effective through the utilization of EBM. Appropriate knowledge and skill are necessary to get the most out of it. EBM’s role in healthcare is inarguable, and it will continue to make an impact for years to come.

Midrara Kashmari

RxPharmacist Team

References:

1. Chant C. Evidence-Based Pharmacy Practice? The Canadian Journal of Hospital Pharmacy. 2017;70(4). doi:https://doi.org/10.4212/cjhp.v70i4.1673.
2. Aparasu RR, Bentley JP. Principles of Research Design and Drug Literature Evaluation. Jones & Bartlett Learning; 2015.
3. The Pharmacist’s Guide to Evidence-Based Medicine for Clinical Decision Making. ASHP. https://www.ashp.org/-/media/store-files/p1770-sample-chapter-1.
4. Wagner K. Research Guides: Introduction to Evidence-Based Practice: Overview. guides.lndlibrary.org. https://guides.lndlibrary.org/c.php?g=705624&p=5011032
5. Straus SE, Glasziou P, Warren Scott Richardson, R. Brian Haynes. Evidence-Based Medicine.; 2019.

Diabetes as a health condition has become so prevalent that the number of cases are reported to be the highest that they have ever been. Per CDC, ~37 million people in the United States have diabetes and 1 in 5 people don’t even know that they have diabetes.¹ Moreover, prevalence, is projected to continue to rise in the coming years reaching almost 40 million by 2030.⁶

That doesn’t mean it’s all doom and gloom. Diabetes can be managed with medication treatment, and even better, prevented or delayed with achievable lifestyle changes. But there are different kinds of diabetes, and despite the name, they’re not all the same nor are they treated in the same manner. Here we’ll focus on type 1 and type 2 diabetes, what makes them different, their symptoms, and their management.

Overview of Diabetes

Diabetes mellitus (DM) is a chronic health condition where your blood glucose, or blood sugar, is too high. Insulin is a hormone produced by the pancreas that helps to control blood glucose by allowing glucose to enter cells and provide the body with energy. By affecting insulin, the blood glucose is also affected. The body is relying on its star player in this role to keep blood glucose in check. Without insulin, blood glucose will rise, leading to health problems over time with key organs such as the heart, kidneys, eyes, and nerves being damaged. There is no cure for diabetes.

Type 1 vs Type 2

Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have some sort of malfunction issue with insulin, causing it to become deficient.

In T1DM, the body cannot make insulin, stops making it, or it is not making enough of it because the cells in the pancreas that produce insulin are destroyed by the body’s own immune system. The primary cause is believed to be caused by genes and/or environmental causes. It can develop in early childhood/adolescence compared to later in adulthood in people with T2DM.

In T2DM, the body cannot use the insulin despite still making it. Insulin resistance is usually the primary cause of T2DM due to physical inactivity and obesity. Because of this resistance, the body is less able to absorb glucose over time which is why this condition is slow progressing. This contrasts with T1DM where the body is not able to absorb glucose at all and the condition can develop quite suddenly.

Management of Diabetes

There is a difference between how either condition is managed. Diet, exercise, drug therapy, and weight management (weight loss is more associated with T1DM whereas weight gain is more associated with T2DM) play critical roles in controlling blood sugar.

Understanding the difference between Type 1 and Type 2 diabetes is essential for effective management and improved health outcomes. Pharmacists as healthcare professionals can provide education, guidance, and support through helping individuals navigate the challenges of these conditions and work towards better health through a combination of lifestyle changes, medication management, and blood glucose monitoring.

Midrara Kashmari

RxPharmacist Team

References:

1. Centers for Disease Control and Prevention. What Is Diabetes? Centers for Disease Control and Prevention. Published April 24, 2023. https://www.cdc.gov/diabetes/basics/diabetes.html.
2. CDC. The Facts, Stats, and Impacts of Diabetes. Centers for Disease Control and Prevention. Published 2022. https://www.cdc.gov/diabetes/library/spotlights/diabetes-facts-stats.html.
3. Differences Between Type 1 and Type 2 Diabetes – DRC. Diabetes Research Connection. Published July 11, 2016. https://diabetesresearchconnection.org/differences-type-1-type-2-diabetes/?gclid=CjwKCAjwivemBhBhEiwAJxNWN4Hy-wLZ7LNw0yqLEzbHiQ21nhpBRs_0yeq16PHSc69ZPXkZkXhoAhoC5cMQAvD_BwE.
4. Type 1 Vs Type 2 Diabetes. DRIF. https://diabetesresearch.org/type-1-vs-type-2-diabetes/.
5. NIDDK. Symptoms & Causes of Diabetes | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published March 2019. https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes
6. Lin J, Thompson TJ, Cheng YJ, et al. Projection of the future diabetes burden in the United States through 2060. Population Health Metrics. 2018;16(1). doi:https://doi.org/10.1186/s12963-018-0166-4.

“Now remember to complete the entire course of your antibiotic until it’s finished, even if you feel better.”

How often has a patient heard this from either their doctor or pharmacist? Hopefully every time. As vital drugs, antibiotics have saved countless lives. Akin to other drugs, they can also be misused or overused. However, what sets them apart as a class of drugs is the unique threat that comes with their use: antibiotic resistance. Why is that a threat?

Understanding Antibiotic Resistance

Antibiotic resistance refers to the ability of microorganisms such as bacteria to continue to grow and ultimately defeat the very drug (antibiotic) intended to limit their growth or kill them altogether.¹ In other words, the microorganism becomes resistant to the antibiotic treatment. Eventually, resistance of the microorganism to even one drug poses a risk to other drugs in the same class. When this occurs, infections become harder and harder to treat.

Now why this occurs is because bacteria can adapt and develop resistance through natural selection by the mere presence of antibiotics. The purpose of antibiotics is to kill bacteria, regardless of if they’re the bad bacteria that cause infection or the good bacteria that protect us from infection. Killing the good bacteria would cause loss of the protection that they normally provide allowing the bad bacteria to grow. What could make this worse?

Factors Contributing to Antibiotic Resistance

1. Incomplete courses of antibiotic treatment → by not finishing the entire course, bacteria that survived become resistant and multiply or pass on their resistant genes to other surviving bacteria
2. Inappropriate prescribing of an antibiotic → using an inappropriate antibiotic drug that wouldn’t effectively treat the infection or using antibiotics when not needed allows bacteria to spread and either worsen or cause an infection
3. Overprescribing of antibiotics → increased use of antibiotics gives bacteria more chances to grow, survive, and become resistant through multiple mechanisms of current and future antibiotics

The Consequences

If antibiotic resistance develops to the point of utilizing first-line treatment options, then use of second or third-line options may become necessary. However, they are not always ideal or as effective, and prolonged drug treatment use may cause serious side effects and may lead to a delay in recovery. In addition, some patients with chronic conditions may not have a strong immune system to fight off simple infections, much less infections from resistant bacteria. In addition, it is possible that in some cases there are not any more treatment options to continue. All these aspects contribute to increased healthcare costs, decreased effectiveness of interventions, and poor health outcomes for patients.

Pharmacists and Antibiotic Stewardship

Pharmacists play a vital role in promoting responsible, appropriate, and effective antibiotic use. Some interventions performed by pharmacists involve dose adjustments, dose optimization (increasing or decreasing the dose depending on patient’s health status), drug-interactions, stop orders that are time sensitive, changing IV antibiotics to oral formulation, and removing or discontinuing duplicate antibiotic therapy.³

Antibiotic resistance is a multifaceted challenge. Pharmacists have a vital role in educating patients, promoting responsible antibiotic use, and advocating for evidence-based prescribing practices. Their knowledge and skills allow them to provide education to both patients and other healthcare providers regarding adherence, drug dosing, and proper antibiotic use. Through collaboration with providers, proper and effective antibiotic use can improve and continue for all current and future generations.

Midrara Kashmari

RxPharmacist Team

References:

1. Centers for Disease Control and Prevention. About Antimicrobial Resistance. CDC. Published March 13, 2020. https://www.cdc.gov/drugresistance/about.html.
2. Centers for Disease Control and Prevention. How Antibiotic Resistance Happens. CDC. Published October 5, 2022. https://www.cdc.gov/drugresistance/about/how-resistance-happens.html.
3. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. CDC. Published 2019. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.
4. Chan AHY, Beyene K, Tuck C, Rutter V, Ashiru-Oredope D. Pharmacist beliefs about antimicrobial resistance and impacts on antibiotic supply: a multinational survey. JAC-Antimicrobial Resistance. 2022;4(4). doi:https://doi.org/10.1093/jacamr/dlac062.

In today’s world, pharmacists are no longer limited to the traditional role of dispensing prescriptions and have decided to make use of the ever-expanding potential of information technology. Pharmacy informatics continues to be a dynamic field, combining the impact of pharmacy with the force of technology to transform the way that pharmacists manage patient care, streamline operations, and improve health outcomes. Let’s delve a little bit more into this topic.

What is Pharmacy Informatics?

Pharmacy informatics is defined as the application of clinical knowledge and expertise in combination with the use of health information technology (HIT) to improve the processes of medication management and drug delivery.¹ Pharmacists who work in this field, along with their knowledge and background in pharmacotherapy and pharmacy practice, have sufficient understanding of the discipline of informatics and health information technology.²

The Pharmacist’s Role

There are 5 basic responsibilities of pharmacists who work in pharmacy informatics.³ These have been defined by the American Society of Health-System Pharmacists (ASHP) as:

1. Information Management: overseeing medication management and sharing patient information to ensure patient safety
   • Bar code medication administration
   • Computerized provider order entry (CPOE)
   • Ease of information exchange among systems
2. Knowledge delivery: provision of knowledge and patient-specific information as clinical decision support
   • Clinical guidelines
   • Patient reports and summaries
   • Alerts and reminders
   • Optimizing electronic health records (EHR) to include mandatory indications and medication adjustments where appropriate
3. Data analytics: reviewing the data and analyzing it
   • Healthcare analytics- improving quality and efficiency of healthcare operations and processes by reviewing past performances
4. Clinical informatics: promoting the integration and application of information technology in healthcare settings for easier handoff and transition of care
   • Computerized medication reconciliation
   • Smart infusion pumps
5. Change management: the development, management, and continuous improvement of clinical information systems
   • Actively managing clinical decision support interventions to keep up with current and developing treatments

The Benefits and Challenges

Multiple advantages for adopting informatics exist in the form of reduced medication errors, improved medication adherence, and increased patient involvement. It is also important to highlight that decision making is being supported with data and facts to improve health outcomes for patients and contributes to evidence-based medicine (EBM) practices. As a result of using these systems and processes, pharmacists are able to identify potential drug-drug interactions, contraindications, and allergies with greater ease, safety, and efficiency.

That’s not to say that implementing pharmacy informatics systems comes without its challenges. One challenge lies in support training for all pharmacists so that there’s consistent quality of work and knowledge of using these systems across multiple settings. Another challenge includes maintaining proper safeguard measures and data security as more data is utilized in the healthcare setting. Some of these challenges can be overcome through continued education sessions, training and workshops, collaboration with IT for technology related developments, and staying open-minded to new technological innovations.

Closing Thoughts

Pharmacy informatics will continue to mold and reshape how pharmacy is being practiced. It has the ability to empower pharmacists in providing patient care that is safer and more efficient. Being more open-minded about the use of technology can open doors to embracing the optimization of medication management delivery so that the end result is improved patient health outcomes. Pharmacy informatics has the potential to change the future of healthcare and the future of pharmacy- let’s see where it will take us.

Midrara Kashmari

RxPharmacist Team

References:

1. Cortes D, Leung J, Ryl A, Lieu J. Pharmacy Informatics: Where Medication Use and Technology Meet. The Canadian journal of hospital pharmacy. 2019;72(4):320-326. Accessed January 25, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699873/#:~:text=Pharmacy%20informaticists%20are%20pharmacists%20with.
2. ASHP Statement on the Pharmacist’s Role in Clinical Informatics. ASHP. https://www.ashp.org/-/media/assets/policy-guidelines/docs/statements/pharmacists-role-clinical-informatics.ashx.
3. Pharmacy Informatics and Its Cross-Functional Role in Healthcare. www.himss.org. Published October 29, 2019. https://www.himss.org/resources/pharmacy-informatics-and-its-cross-functional-role-healthcare.

Pharmacogenomics is a hot topic that more and more people are talking about. Judging from the name alone, it can be deduced that it has something to do with both pharmacy and genetics. What exactly is the impact it could make towards personalization and precision medicine, and what is so special about it? Let’s delve into this topic and find out.

What is Pharmacogenomics?

Pharmacogenomics is essentially the study of how a person’s genetic makeup determines how they will respond to medications.¹ It’s linked to the field of precision medicine that focuses on each patient individually.

Its potential lies in the ability to use a person’s genetic information that is uniquely theirs to predict the response they will have to any drug while continuing to further optimize even dose selections once the drugs have been carefully selected.³ The end goal is fully personalized treatment that is cost-effective, safe, and improves health outcomes for the individual and to know whether or not the medication will work ahead of time.

Genes and Medication

Our genes affect the way our body responds to a drug. Drugs interact with our body in multiple ways, and certain proteins or enzymes present in our body affect how these drugs will work. Pharmacogenomics analyzes the variations among our genes to find these proteins and what effect they will have on the drug’s safety and effectiveness in the body.¹

Examples of how our genes can affect how we respond to a drug:²
1) Drug Receptors on Cell Surfaces
○ What type and how many receptors we have
○ Affects the intensity of response or no response to a drug
2) Drug Uptake into Tissues and Cells
○ How well the drug is taken up into tissues and cells (normal=drug works as expected and/or should)
○ Less uptake means the drug isn’t working as well as it should and may accumulate and cause problems
○ Increased uptake could cause adverse effects
3) Drug Breakdown by Enzymes
○ How quickly the body breaks down and gets rid of a drug
○ Might need less of a drug if the body breaks it down slowly
○ Might need more of a drug if the body breaks it down quickly

The Benefits and Drawbacks

The Food and Drug Administration (FDA) has pharmacogenomic information on the labels of more than 100 medications. This to assist doctors and other healthcare professionals when prescribing drugs pertaining to the dose, side effects, and potential effectiveness for those with certain gene variants.1 Medications with pharmacogenomic considerations include warfarin, clopidogrel, escitalopram, and codeine, to name a few. More examples can be found here.

Drug companies are using pharmacogenomics for developing and marketing drugs in use for patients with certain genetic variants for maximum therapeutic benefit. In addition, once gene variants are identified in patients, doctors are then able to select the appropriate and optimal medication along with the dose for that specific patient. Moreover, if these genes were to cause side effects from a certain drug, that drug can be avoided and prescribed only to those who don’t have those genes.

There are potential advantages to using pharmacogenomics such as optimized drug selection, improved treatment outcomes, enhanced safety, avoidance of trial and error approach when it comes to selecting a medication, and improved cost effectiveness due to not having to try multiple medications and/or treatments.

However, that’s not to say it’s all a flawless process. There are certain ethical and legal factors to be considered when it comes to pharmacogenomics. A patient’s autonomy along with their right to privacy are serious matters of consideration. Potential bias and discrimination could also occur through underrepresentation of certain groups in the data, or by making clinical decisions based on the data but failing to consider individual patient factors. Taking the proper steps to obtain informed consent and maintain patient confidentiality are key.

The Takeaway

Understanding pharmacogenomics can improve treatment methods and selection down the line, especially when they’re tailored to a patient’s own unique genetic profile. The field is still growing, but it’s growing quickly and there is still much to embrace in terms of knowledge, evidence, and implementation. Yet, with this personalized approach, healthcare providers such as pharmacists are at the forefront of being involved in delivering treatment that may be safer, more effective, and individualized for each patient.

Midrara Kashmari

RxPharmacist Team

References:

1. National Institute of General Medical Sciences (NIGMS). National Institute of General Medical Sciences (NIGMS). Published 2022. https://nigms.nih.gov/education/fact-sheets/Pages/pharmacogenomics.aspx#:~:text=Pharmacogenomics%20(sometimes%20called%20pharmacogenetics)%20is.
2. Centers for Disease Control and Prevention. Pharmacogenomics: What does it mean for your health? CDC. Published 2019. https://www.cdc.gov/genomics/disease/pharma.htm.
3. Krebs K, Milani L. Translating pharmacogenomics into clinical decisions: do not let the perfect be the enemy of the good. Human Genomics. 2019;13(1). doi:https://doi.org/10.1186/s40246-019-0229-z.

There’s a certain Latin saying that goes, “It is better and more useful to meet a problem in time than to seek a remedy after the damage is done.” If you’re not familiar with it, don’t fret. You’re probably more familiar with the short and sweet version of it: “Prevention is better than cure”, said by a certain Dutch philosopher. Well, however old the saying may be, it’s certainly timeless.

Prevention is the cornerstone of good health, and health screenings play a big part in that by identifying potential health concerns early on. Pharmacists play a vital role in health screenings that may commonly be observed in communities. We’ll dive into the importance of health screenings, the different types of screenings, and the role that pharmacists play in these scenarios.

Why Health Screenings Matter

As commonly said in healthcare, “the earlier the detection, the better the health outcome.”1 Partaking in health screenings is a proactive step towards taking care of oneself. The primary advantage lies in the ability to catch potential health concerns before they become problematic. By identifying risk factors and early signs of conditions, individuals take matters into their own hands by making such decisions and taking action to improve their health.

Types of Health Screenings

There are various health screenings available to patients that are offered by pharmacies. The most common screenings include blood glucose testing, blood pressure monitoring, and total cholesterol checks. Other health screenings that are not usually offered at pharmacies but still utilize involvement from pharmacists are for mental health conditions, osteoporosis, opioid use disorders, and sexually transmitted disease (STDs).^2,3

Ask The Pharmacist for Help

Pharmacists are well equipped to guide patients through the entire health screening process. They are allies when it comes to disease prevention, especially for the most common health conditions of diabetes and blood pressure. Not only are pharmacists able to help patients understand what their results mean, but they are able to recommend certain lifestyle changes and even provide counsel on necessary follow-up steps for further care. Pharmacists are trusted healthcare professionals and easily accessible to patients when it comes to who to ask regarding their medications AND when it comes to their health as a result of health screenings.³

The Bottom Line

Through early detection, education, and collaboration with patients and healthcare professionals, pharmacists can help manage and prevent health issues for all patients. Patients themselves can take matters into their own hands and improve their own health by taking the necessary steps for management such as partaking in health screenings. Moreover, pharmacies can continue to be known not only as the place to get medications from, but also the place to seek out for taking steps toward disease prevention. Being proactive will pay off in the long run, so don’t hesitate to get that screening and talk to the pharmacist. Your future self may thank you one day.

Midrara Kashmari

RxPharmacist Team

References:

1. Givler DN, Givler A. Health Screening. Nih.gov. Published 2019. https://www.ncbi.nlm.nih.gov/books/NBK436014/.
2. Get Screened – MyHealthfinder | health.gov. health.gov. https://health.gov/myhealthfinder/doctor-visits/screening-tests/get-screened.
3. Jennifer Gershman P. Pharmacists Play Vital Role in Health Screenings. wwwpharmacytimescom. 2022;88. https://www.pharmacytimes.com/view/pharmacists-play-vital-role-in-health-screenings.

We all know the general idea about how medications work, right? Drugs that save lives, control diseases, and even prevent or delay certain ones from developing in the first place. In addition, not only do they come in various forms, but they’re also taken into the body in ways other than the mouth. It’s fascinating to see the evolution of drugs over the years and the invention of new ones. What’s even more fascinating is the way that these magic bullets work in the body. Thanks to the brilliant teamwork of pharmacokinetics and pharmacodynamics, drugs are able to do what they do. Let’s navigate these concepts together.

Pharmacokinetics: The Body’s Effect on the Drug

Pharmacokinetics has to do with what the body does to a drug and involves 4 processes: absorption, metabolism, distribution, and excretion.¹

Step 1: Absorption

• Once a drug is administered, (via the oral, intravenous, intramuscular, subcutaneous etc. routes) it enters systemic circulation. The method of administration has its own characteristics of absorption which affect the speed and amount of drug that reaches the desired location of effect.

Step 2: Distribution

• The drug travels through the blood to be dispersed throughout the tissues. How well it gets distributed depends on the biochemical properties of the drug and the physiology of the person. The end goal is to achieve effective drug concentration at the desired destination.

Step 3: Metabolism

• Most drugs pass through to the liver which is the main site of drug metabolism. Active drugs are either converted to inactive forms that are more hydrophilic to move on to renal clearance, or in the case of a prodrug, it is subsequently converted into active metabolites.

Step 4: Excretion

• The drug reaches the final step in its journey through the body where it can now be removed. The kidneys usually perform this major function with the drug excreted via urine. Other forms of excretion are bile, sweat, or stool.

Pharmacodynamics: The Drug’s Effect on the Body

Pharmacodynamics has to do with what the drug does to the body and involves the drug’s characteristics and physiological effects. Drugs produce effects by interacting with the body either through direct or indirect means. Direct effects result from the direct interaction of the drug with a receptor or enzyme that produces the effect. Indirect effects result from an interaction of the drug with a receptor or protein somewhere else that produces the desired effect. The interaction with specific receptors, enzymes, or molecules is what leads to desired therapeutic effects or undesired side effects.

The Balancing Act

It’s not enough to select the right drug. Finding the right dose is also key. It is essentially a balancing act. Too much of a drug can be toxic while too little may not produce the intended effect. Considering factors such as the drug’s physical and chemical properties, the characteristics of the patient it’s being given to (because no two individuals are the same), and the correct dose and dosage form of the drug are all paramount to achieving balance and the desired result. The teamwork between pharmacokinetics and pharmacodynamics is a captivating spectacle that simply could not work without each working alongside the other.

Midrara Kashmari

RxPharmacist Team

References:

1. Grogan S. Pharmacokinetics. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK557744/.
2. Marino M, Zito PM. Pharmacodynamics. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK507791/.

The small, butterfly-shaped thyroid gland is in the neck and packs a punch when it comes to regulating the body’s metabolism. But what happens when it’s no longer balanced? What happens when it is working too hard or not hard enough? Let’s explore the difference between two common thyroid disorders- hypothyroidism and hyperthyroidism.

Hypothyroidism: An Underactive Thyroid

Hypothyroidism has to do with the thyroid’s inability to produce enough thyroid hormone.¹ The most common cause of hypothyroidism is Hashimoto’s disease, an autoimmune disorder where antibodies attack the thyroid gland.² There is a deficiency in the T4 hormone (thyroxine) that causes an elevation in thyroid-stimulating hormone (TSH). TSH regulates thyroid hormone production. Because of the deficiency, the body compensates by trying to produce more thyroid hormone, hence the elevated TSH. When T4 is low, the body slows down. This results in fatigue, weakness, weight gain, cold intolerance, dry skin, constipation, and so on.² Hypothyroidism is more common than hyperthyroidism and occurs more often in females.

Hyperthyroidism: An Overactive Thyroid

On the other hand, hyperthyroidism is the complete opposite. The most common cause of hyperthyroidism is Graves’ disease which is also an autoimmune disorder where antibodies stimulate increased thyroid production of the T4 hormone.² There is an increase in T4 hormone that causes TSH to be low. When T4 is high, the body speeds up. This results in anxiety, tremor, fatigue, weakness, weight loss, heat intolerance, frequent bowel movements, and so on.² Hyperthyroidism is more common among females of older age.

Diagnosis and Treatment

Making an accurate diagnosis is crucial as both conditions involve the thyroid, and some symptoms may appear similar even though there is still a difference. Measuring thyroid hormone levels via laboratory blood tests will confirm diagnosis.

Treatment for hypothyroidism involves thyroid hormone replacement such as levothyroxine (Synthroid) or liothyronine (Cytomel), while treatment for hyperthyroidism involves antithyroid medication such as Propylthiouracil (PTU) or methimazole, surgery, or using radioactive iodine to destroy part of the gland.²

Pharmacists play a role in managing these disorders through collaboration with other healthcare providers. Such actions involve providing dosing guidance, counseling patients on medication usage and side effects, offering recommendations for symptom management, and addressing potential complications of not treating the disorder that could result in cardiovascular and fertility issues alike. They can also monitor drug interactions and educate patients on the importance of medication adherence.

In Summary

Hypothyroidism and hyperthyroidism- two sides of an imbalanced thyroid gland have a profound effect on the body. To understand and manage each condition, appropriate understanding is required as to what makes them different, what symptoms to watch out for, and how to treat each condition accordingly to achieve thyroid balance once more.

Midrara Kashmari

RxPharmacist Team

References:

1. Hypothyroidism vs. hyperthyroidism: What’s the difference? NIH MedlinePlus Magazine. https://magazine.medlineplus.gov/article/hypothyroidism-vs-hyperthyroidism-whats-the-difference.
2. Hyperthyroidism vs. Hypothyroidism: Here’s How to Tell The Difference | Hartford HealthCare | CT. hartfordhealthcare.org. https://hartfordhealthcare.org/about-us/news-press/news-detail?articleid=32994&publicId=395.