Answer 2 for DNP 810 How does the variability of responses result in tailoring pharmacologic agents to the care of these patients? 

About three in five Americans aged 20 years and above take prescription drugs on a monthly basis and many either encounter adverse drug reactions or reduced treatment efficacy. The strong genetic component of altered drug response in patients is well known and attributed to variants affecting drug pharmacokinetics and pharmacodynamics (Schärfe, Tremmel, Schwab, et al., 2017). Everyone’s body is different and each patient act differently to drugs, and failure to understand the variations will lead to drug toxicity and adverse drug reactions. Some of the genetic factors that could influence drug response includes, absorption, distribution, metabolism and excretion, due to body weight, genetic conditions, genetic polymorphism of drug metabolizing enzymes, height, race, receptor sensitivity, and sex.

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Despite the availability of several pharmacologic treatment options for hypertension, only fewer patient of North Americans achieves target blood pressure goals.  Extrinsic and intrinsic factors play a potentially different pathophysiology of hypertension in African American population and others. Polymorphism in these genes may be responsible for the high prevalence and increased severity of hypertension. Typically, African American patients require a high dosage of angiotensin-converting enzyme (ACE) inhibitors or combined therapy with low-dose diuretics to reduce blood pressure effectively.

As a DNP prepared nurse, it is important to remember that a person should be treated holistically to ensure the right drug at the right dose and the right time is prescribed to maximize the effect and minimize harm to the patient.

Schärfe, C.P.I., Tremmel, R., Schwab, M. et al. Genetic variation in human drug-related genes. Genome Med 9, 117 (2017). https://doi.org/10.1186/s13073-017-0502-5