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Race, genetics, and drug therapy: Personalized pharmacy treatment

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By Bhawani Jain

We all have different genetics and backgrounds, so why should we all receive identical medical treatment for a diagnosis or condition? Today, personalized medicine is on the rise, with treatments tailored to a patient’s unique characteristics, genetic differences, and environmental conditions. Hospital pharmacists selecting safe and effective medication for their patients need to be conscious that certain drug treatments do not work universally in the same ways for all patients. Quality patient care can require hospital pharmacists to consider genetic and racial variations that impact medication therapy.

For instance, an estimated 45 per cent of individuals of East Asian descent carry the Aldehyde Dehydrogenase 2 mutation (ALDH2*2). This could impact the efficacy of certain medications. Patients with this mutation have a lowered ability to metabolize nitroglycerin to nitric oxide. Because nitroglycerin is a vasodilator used to prevent and treat angina and heart attacks (among other uses), patients with the ALDH2*2 mutation may need significantly more nitroglycerin to achieve therapeutic results. Hospital pharmacists should be conscious of this genetic mutation and the populations it commonly impacts, speaking with patients about their backgrounds and screening for ALDH2*2 as appropriate to determine the ideal drug therapy for each person.

Similarly, hospital pharmacists may take into account research showing that Black individuals with hypertension tend not to respond to treatment with angiotension-converting enzyme (ACE) inhibitors, although ACE inhibitors are common first-line treatments for hypertension in other patient populations. Although research has not determined precisely why, other types of medications have been shown to achieve greater therapeutic results in Black individuals. The American College of Cardiology and the American Heart Association therefore recommend medications such as diltiazem or chlorthalidone to most effectively treat hypertension in Black patients. As members of the interprofessional care team, hospital pharmacists can highlight the differences in response to ACE inhibitors to improve health outcomes.

As a final example, hospital pharmacists may note that an estimated 70% of Kurdish Jewish individuals are genetically predisposed to hemolysis, the destruction of red blood cells, due to a glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Studies show that episodes of acute hemolysis are often triggered by medication, so hospital pharmacists need to be alert to drugs that could put patients with G6PD deficiency at risk. If clinically appropriate, patients should be asked whether they identify as Kurdish Jewish and screened for G6PD deficiency using laboratory testing.

High quality patient care can require the interprofessional care team to respectfully discuss race with patients when clinically relevant. As trusted medication experts, hospital pharmacists tailor drug therapies to suit each patient’s individual needs, and often, that involves open and evidence-based discussions of genetic variations to optimize patient care.

Bhawani is a second-year pharmacy student at the University of Waterloo and worked as a Professional Practice Intern at CSHP earlier this year.

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