Explain how the role of epigenetics may contribute to pharmacologic action
Epigenetics is the study of how an individual’s behaviors and environment can result in changes that affect the functioning of genes (Centers for Disease Control and Prevention, 2020). Epigenetic changes can be reversed., they do not change the DNA sequence, but rather can change the way the body reads a DNA sequence. Epigenetic regulation of gene activity is shown to be involved in the evolution of diseases such as cancer and neurodegenerative disorders like Alzheimer’s. Recent classification of drugs regulates epigenetic mechanisms to counteract disease found in human beings (Stefanska & MacEwan, 2015). Personalized medicines are given to patients after collecting genomic information such as the levels of RNA, proteins and metabolites that could aid medical decision making.
Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.
The impact this information will have on my ability to prescribe medications is raising my concern for patient’s safety and need for critical thinking. This will create the awareness that each prescription should be individualized based on each patient’s presenting symptoms, overall goal of treatment and long-term effect of the medication. Knowing the pharmacokinetics, pharmacodynamics is essential in determining which drug should be prescribed for each patient. Pharmacogenomics provides understanding of the actual drug for each patient at the exact concentration and time. With the concern of multiple drug responses, factors including nutrition, age, body weight, sex, genetic behavior, infections, co-medications, and organ function are relevant to be considered with treatment of a disease and the ideal medication that should be prescribed.
For example, in the management of Alzheimer’s disease, using donepezil (Acetylcholinesterase inhibitors), it is important to educate the patient and family that gastrointestinal problems could be side effects from the medication. This could aid adherence to the medication with reduced abrupt discontinuation. Also, donepezil can lead to side effects such as seizures, bradycardia, and heart block, therefore reviewing each patient’s medical history and determining the best medication that is patient centered is essential to promote health and achieve positive outcomes from medications. Donepezil and other cholinomimetic agents can cause seizures; therefore healthcare professionals should be cautious in prescribing this medication in individuals with a history of seizure disorder ( Kumar & Sharma, 2020).
References
Centers for Disease Control and Prevention. (2020). Genomics & Precision Health. https://www.cdc.gov/genomics/disease/epigenetics.htm
Kumar, A., Sharma, S. (2020). Donepezil. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513257/
Li, S., Wong, A., Liu, F. (2014). Ligand-gated ion channel interacting proteins and their role in neuroprotection. Frontiers in Cellular Neuroscience, 8 (125). doi: 10.3389/fncel.2014.00125. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023026/
Stefanska, B., MacEwan, D. (2015). Epigenetics and pharmacology. British Journal of Pharmacology, 172(11), 2701-2704. doi: 10.1111/bph.13136. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439868/
US Department of health and Human services. (n.d). Pharmacological treatment. Indian Health Service. https://www.ihs.gov/opioids/recovery/pharmatreatment/
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