What you need to know about your genes and prescription medicine | Tuesdy Horner | TEDxABQ

today I’m going to talk to you about one

today I’m going to talk to you about one more thing that you can blame on your

more thing that you can blame on your

more thing that you can blame on your parents you’re welcome

parents you’re welcome

parents you’re welcome can you blame your parents for your

can you blame your parents for your

can you blame your parents for your genetics our differences are due to

genetics our differences are due to

genetics our differences are due to genetic mutations but that doesn’t mean

genetic mutations but that doesn’t mean

genetic mutations but that doesn’t mean that we’re mutants pharmacogenomics is

that we’re mutants pharmacogenomics is

that we’re mutants pharmacogenomics is just a fancy word that combines pharmacy

just a fancy word that combines pharmacy

just a fancy word that combines pharmacy and genomics the pharmacy part focuses

and genomics the pharmacy part focuses

and genomics the pharmacy part focuses on what the drug does to the body and

on what the drug does to the body and

on what the drug does to the body and what the body does to the drug the

what the body does to the drug the

what the body does to the drug the genomics focuses on your unique genetic

genomics focuses on your unique genetic

genomics focuses on your unique genetic makeup and how you individually respond

makeup and how you individually respond

makeup and how you individually respond to drugs back to parents my parent was a

to drugs back to parents my parent was a

to drugs back to parents my parent was a single mom and I don’t know if you know

single mom and I don’t know if you know

single mom and I don’t know if you know much about single moms but they mean

much about single moms but they mean

much about single moms but they mean business and especially in this case

business and especially in this case

business and especially in this case because it was just her and I we had to

because it was just her and I we had to

because it was just her and I we had to count on each other we were there for

count on each other we were there for

count on each other we were there for each other and that’s why I remember so

each other and that’s why I remember so

each other and that’s why I remember so clearly the day that shook my foundation

clearly the day that shook my foundation

clearly the day that shook my foundation I was about nine years old and school

I was about nine years old and school

I was about nine years old and school was out and I went outside with all the

was out and I went outside with all the

was out and I went outside with all the kids waiting a parent pickup and I saw

kids waiting a parent pickup and I saw

kids waiting a parent pickup and I saw the cars coming around the corner kid we

the cars coming around the corner kid we

the cars coming around the corner kid we get in the car and off they go the next

get in the car and off they go the next

get in the car and off they go the next car come around the corner kids get in

car come around the corner kids get in

car come around the corner kids get in the car off they go and I kept looking

the car off they go and I kept looking

the car off they go and I kept looking at the corner waiting for my mom to come

at the corner waiting for my mom to come

at the corner waiting for my mom to come and I waited and I waited and pretty

and I waited and I waited and pretty

and I waited and I waited and pretty soon I was the only one left and the

soon I was the only one left and the

soon I was the only one left and the parking lot was mostly empty and I was

parking lot was mostly empty and I was

parking lot was mostly empty and I was terrified and so scared and wondering

terrified and so scared and wondering

terrified and so scared and wondering where was she was she okay why isn’t she

where was she was she okay why isn’t she

where was she was she okay why isn’t she here to pick me up what am I going to do

here to pick me up what am I going to do

here to pick me up what am I going to do I ended up finding out later that my mom

I ended up finding out later that my mom

I ended up finding out later that my mom had had an adverse drug reaction see

had had an adverse drug reaction see

had had an adverse drug reaction see average drug reactions don’t just affect

average drug reactions don’t just affect

average drug reactions don’t just affect the patient it affects their family it

the patient it affects their family it

the patient it affects their family it affects their loved ones and that day it

affects their loved ones and that day it

affects their loved ones and that day it affected me the projected cost of

affected me the projected cost of

affected me the projected cost of adverse drug reactions is an astounding

adverse drug reactions is an astounding

adverse drug reactions is an astounding 177 billion dollars that’s a lot of

177 billion dollars that’s a lot of

177 billion dollars that’s a lot of money let’s break that down quick math

money let’s break that down quick math

money let’s break that down quick math 337 thousand dollars a minute is spent

337 thousand dollars a minute is spent

337 thousand dollars a minute is spent on adverse drug reactions adverse drug

on adverse drug reactions adverse drug

on adverse drug reactions adverse drug reactions are something that we really

reactions are something that we really

reactions are something that we really need to look at and our government wants

need to look at and our government wants

need to look at and our government wants to find some ways to save on costs and

to find some ways to save on costs and

to find some ways to save on costs and health care this would be a good place

health care this would be a good place

health care this would be a good place to look

to look

to look 80% of the prescription drugs are

80% of the prescription drugs are

80% of the prescription drugs are metabolized by liver enzymes and there’s

metabolized by liver enzymes and there’s

metabolized by liver enzymes and there’s a lot of genetic variation to those

a lot of genetic variation to those

a lot of genetic variation to those liver enzymes sometimes they can cause

liver enzymes sometimes they can cause

liver enzymes sometimes they can cause drugs to be metabolized too slowly or

drugs to be metabolized too slowly or

drugs to be metabolized too slowly or too quickly so if they’re metabolized

too quickly so if they’re metabolized

too quickly so if they’re metabolized too slowly what happens is the drug

too slowly what happens is the drug

too slowly what happens is the drug hangs around in the body for too long

hangs around in the body for too long

hangs around in the body for too long interacting with each other causing side

interacting with each other causing side

interacting with each other causing side effects if it’s metabolized too quickly

effects if it’s metabolized too quickly

effects if it’s metabolized too quickly the drug doesn’t really work as well in

the drug doesn’t really work as well in

the drug doesn’t really work as well in the body as a pharmacist clinician I

the body as a pharmacist clinician I

the body as a pharmacist clinician I work with a healthcare team like this

work with a healthcare team like this

work with a healthcare team like this and I want to talk about a hypothetical

and I want to talk about a hypothetical

and I want to talk about a hypothetical patient so Mary is a healthy active

patient so Mary is a healthy active

patient so Mary is a healthy active elderly woman and Mary over time has

elderly woman and Mary over time has

elderly woman and Mary over time has started to take more and more

started to take more and more

started to take more and more prescription drugs but Mary’s also

prescription drugs but Mary’s also

prescription drugs but Mary’s also started to feel worse and worse more

started to feel worse and worse more

started to feel worse and worse more tired more fatigued and less energy and

tired more fatigued and less energy and

tired more fatigued and less energy and so one day Mary’s daughter calls her to

so one day Mary’s daughter calls her to

so one day Mary’s daughter calls her to check on her and she doesn’t answer the

check on her and she doesn’t answer the

check on her and she doesn’t answer the phone so her daughter goes over to her

phone so her daughter goes over to her

phone so her daughter goes over to her house and finds married down on the

house and finds married down on the

house and finds married down on the ground weak and in pain wearing the same

ground weak and in pain wearing the same

ground weak and in pain wearing the same clothes she had worn the previous day

clothes she had worn the previous day

clothes she had worn the previous day mary had fallen and had a hip fracture

mary had fallen and had a hip fracture

mary had fallen and had a hip fracture and was unable to get up and get any

and was unable to get up and get any

and was unable to get up and get any help so Mary came to the hospital by

help so Mary came to the hospital by

help so Mary came to the hospital by ambulance

ambulance

ambulance here’s a list of the medications that

here’s a list of the medications that

here’s a list of the medications that Mary was on this is called Polly

Mary was on this is called Polly

Mary was on this is called Polly pharmacy and you’ll notice that there

pharmacy and you’ll notice that there

pharmacy and you’ll notice that there are lots of medications there and this

are lots of medications there and this

are lots of medications there and this is not unusual for elderly individuals

is not unusual for elderly individuals

is not unusual for elderly individuals unfortunately but this is also very high

unfortunately but this is also very high

unfortunately but this is also very high risk for adverse drug reactions so what

risk for adverse drug reactions so what

risk for adverse drug reactions so what I do is I look at this list and try to

I do is I look at this list and try to

I do is I look at this list and try to figure out is anything here gonna clue

figure out is anything here gonna clue

figure out is anything here gonna clue me in as to why Mary came into the

me in as to why Mary came into the

me in as to why Mary came into the hospital were there any drug drug

hospital were there any drug drug

hospital were there any drug drug interactions really any side effects

interactions really any side effects

interactions really any side effects anything like that one of the first

anything like that one of the first

anything like that one of the first things I notice is how the drugs are

things I notice is how the drugs are

things I notice is how the drugs are metabolized so on that far right side

metabolized so on that far right side

metabolized so on that far right side one of those liver enzymes is SIPTU t6

one of those liver enzymes is SIPTU t6

one of those liver enzymes is SIPTU t6 responsible for the metabolism of

responsible for the metabolism of

responsible for the metabolism of several drugs there but I still don’t

several drugs there but I still don’t

several drugs there but I still don’t know what that means for Mary how does

know what that means for Mary how does

know what that means for Mary how does that enzyme work in Mary does it break

that enzyme work in Mary does it break

that enzyme work in Mary does it break down drugs the way that it’s supposed to

down drugs the way that it’s supposed to

down drugs the way that it’s supposed to or is it too fast or is it too slow I

or is it too fast or is it too slow I

or is it too fast or is it too slow I need a pharmacogenomic test here is her

need a pharmacogenomic test here is her

need a pharmacogenomic test here is her drug list with the pharmacogenomic

drug list with the pharmacogenomic

drug list with the pharmacogenomic testing included what you get is drugs

testing included what you get is drugs

testing included what you get is drugs that are color-coded much like a

that are color-coded much like a

that are color-coded much like a stoplight Green is okay to take yellow

stoplight Green is okay to take yellow

stoplight Green is okay to take yellow use with caution and red don’t take

use with caution and red don’t take

use with caution and red don’t take these if you notice mary has four drugs

these if you notice mary has four drugs

these if you notice mary has four drugs that are red these are for drugs that

that are red these are for drugs that

that are red these are for drugs that Mary should have never been on and had

Mary should have never been on and had

Mary should have never been on and had we had the right test we would have

we had the right test we would have

we had the right test we would have known that prevented her a lot of pain

known that prevented her a lot of pain

known that prevented her a lot of pain and suffering potentially one of the

and suffering potentially one of the

and suffering potentially one of the blood pressure lowering meds there is

blood pressure lowering meds there is

blood pressure lowering meds there is lopressor you can see that one in red

lopressor you can see that one in red

lopressor you can see that one in red that in these types of patients that do

that in these types of patients that do

that in these types of patients that do not metabolize well that drug can be up

not metabolize well that drug can be up

not metabolize well that drug can be up to five times higher in her blood

to five times higher in her blood

to five times higher in her blood imagine having a blood pressure med five

imagine having a blood pressure med five

imagine having a blood pressure med five times what it should be that could

times what it should be that could

times what it should be that could absolutely explain her fall

absolutely explain her fall

absolutely explain her fall another interesting notice her pain med

another interesting notice her pain med

another interesting notice her pain med there tramadol also in red that means

there tramadol also in red that means

there tramadol also in red that means that that pain drug is not providing the

that that pain drug is not providing the

that that pain drug is not providing the relief that it should for her that she’s

relief that it should for her that she’s

relief that it should for her that she’s still in pain and

still in pain and

still in pain and when she goes to her doctor and she’s

when she goes to her doctor and she’s

when she goes to her doctor and she’s still complaining of pain it could be

still complaining of pain it could be

still complaining of pain it could be perceived as drug seeking so in addition

perceived as drug seeking so in addition

perceived as drug seeking so in addition to the drug drug interactions from the

to the drug drug interactions from the

to the drug drug interactions from the previous slide of her home meds and this

previous slide of her home meds and this

previous slide of her home meds and this drug gene interaction that we see here

drug gene interaction that we see here

drug gene interaction that we see here with the different colors we need to

with the different colors we need to

with the different colors we need to consider drug drug gene interactions and

consider drug drug gene interactions and

consider drug drug gene interactions and that is also represented here where the

that is also represented here where the

that is also represented here where the antidepressant prozac actually inhibits

antidepressant prozac actually inhibits

antidepressant prozac actually inhibits the metabolism of that sip 2d6

the metabolism of that sip 2d6

the metabolism of that sip 2d6 enzyme you can see that hydrocodone is

enzyme you can see that hydrocodone is

enzyme you can see that hydrocodone is metabolized by that drug that means the

metabolized by that drug that means the

metabolized by that drug that means the prozac is stopping the metabolism of

prozac is stopping the metabolism of

prozac is stopping the metabolism of that drug and so Mary isn’t receiving

that drug and so Mary isn’t receiving

that drug and so Mary isn’t receiving any pain relief at all so this type of

any pain relief at all so this type of

any pain relief at all so this type of information is super important hopefully

information is super important hopefully

information is super important hopefully down the road we’re going to see this

down the road we’re going to see this

down the road we’re going to see this pharmacogenomic testing included in this

pharmacogenomic testing included in this

pharmacogenomic testing included in this patient care why is this test not done

patient care why is this test not done

patient care why is this test not done right now one of them could it be cost

right now one of them could it be cost

right now one of them could it be cost no this test is included and insurance

no this test is included and insurance

no this test is included and insurance coverage the out-of-pocket cost for this

coverage the out-of-pocket cost for this

coverage the out-of-pocket cost for this test for Mary this one in particular

test for Mary this one in particular

test for Mary this one in particular would have been about two hundred and

would have been about two hundred and

would have been about two hundred and fifty dollars is it a painful test no

fifty dollars is it a painful test no

fifty dollars is it a painful test no it’s a cheek swab and you get the test

it’s a cheek swab and you get the test

it’s a cheek swab and you get the test back in a couple of days

back in a couple of days

back in a couple of days there is the misperception that this

there is the misperception that this

there is the misperception that this test might tell you if you have

test might tell you if you have

test might tell you if you have predisposition to disease like cancer or

predisposition to disease like cancer or

predisposition to disease like cancer or something it does not it’s strictly

something it does not it’s strictly

something it does not it’s strictly about pharmacogenomics strictly about

about pharmacogenomics strictly about

about pharmacogenomics strictly about the way that people process their

the way that people process their

the way that people process their medications and is it time the

medications and is it time the

medications and is it time the pharmacists have the expertise to be

pharmacists have the expertise to be

pharmacists have the expertise to be able to evaluate these reports and they

able to evaluate these reports and they

able to evaluate these reports and they also see patients and clinics such as

also see patients and clinics such as

also see patients and clinics such as these these are pharmacists that are

these these are pharmacists that are

these these are pharmacists that are learning about the physical exam so that

learning about the physical exam so that

learning about the physical exam so that they can go back home and run their

they can go back home and run their

they can go back home and run their clinics where they see patients and do

clinics where they see patients and do

clinics where they see patients and do complete medication reviews so including

complete medication reviews so including

complete medication reviews so including this test with that medication review

this test with that medication review

this test with that medication review will decrease the

will decrease the

will decrease the of adverse drug events because again

of adverse drug events because again

of adverse drug events because again like I said it does not just affect the

like I said it does not just affect the

like I said it does not just affect the patient it affects everybody thank you

patient it affects everybody thank you

patient it affects everybody thank you [Applause]

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