Michael J. Schuh, PharmD, MBA, FAPhA, Assistant Professor of Pharmacy, Family Medicine, and Palliative Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA; Heather Randles, PharmD, Ambulatory Pharmacist, Mayo Clinic Florida, Jacksonville, Florida, USA; Sheena Crosby, PharmD, BCGP, Ambulatory Pharmacist, Mayo Clinic Florida, Jacksonville, Florida, USA.
J Pain Palliat Care Pharmacother. 2020 Sep;34(3):114-119. doi: 10.1080/15360288.2020.1734140. Epub 2020 Mar 18.
Tailoring an individual patient's pain treatment is paramount to decreasing patient suffering and diminishing morbidity. Performing pharmacogenomic (PGx) testing can help guide prescribing decisions for current and future medication therapy by assisting dosage adjustments to increase therapeutic efficacy, decrease adverse drug reactions and avoid potentially ineffective medications. Pharmacogenomics is the study of inherited genetic information that influences drug response. Therapeutic response to pain medications is influenced by several factors including age, sex, body weight, concomitant diseases, compliance, lifestyle, drug interactions and genes. Genes of interest associated with pain medications include cytochrome P450 (CYP) enzymes, OPRM1, COMT, ABCB1, UGT, COX, OPRK1, OPRD1. To properly use PGx results in clinical application requires the healthcare provider to distinguish the difference between types of PGx tests, interpret test results, be familiar with PGx databases to use for prescribing guidance, and evaluate the level of evidence for specific gene-drug associations. This article introduces these concepts to assist the healthcare provider with incorporating PGx into practice to improve pain management.
为减轻患者痛苦和降低发病率，为每位患者量身定制疼痛治疗方案至关重要。进行药物基因组学 (PGx) 检测可通过帮助调整剂量以提高治疗效果、减少药物不良反应和避免潜在无效药物，从而有助于指导当前和未来的药物治疗决策。药物基因组学是研究影响药物反应的遗传基因信息。疼痛药物的治疗反应受到多种因素的影响，包括年龄、性别、体重、合并症、依从性、生活方式、药物相互作用和基因。与疼痛药物相关的感兴趣基因包括细胞色素 P450 (CYP) 酶、OPRM1、COMT、ABCB1、UGT、COX、OPRK1 和 OPRD1。为了在临床应用中正确使用 PGx 结果，医疗保健提供者需要区分 PGx 测试的类型，解释测试结果，熟悉用于处方指导的 PGx 数据库，并评估特定基因-药物关联的证据水平。本文介绍了这些概念，以帮助医疗保健提供者将 PGx 纳入实践，从而改善疼痛管理。
