Medication Optimization Using Pharmacogenomic Testing in a Complex Mental Health Population Prescribed Psychiatric Polypharmacy.

The use of polypharmacy has become significantly more common over the past two decades, increasing the risk of drug-drug interactions and adverse drug reactions. Pharmacogenomic (PGx) assays have the purported benefit of being able to predict an individual's response to a specific medication based on genetic markers, which may facilitate the development of optimized medication regimens for patients prescribed polypharmacy. This 12-week pilot study examined the impact of the PGx results on the clinical management of Veterans who were prescribed psychiatric polypharmacy. Psychiatric medication providers were given access to the PGx assay results, including notification of drug-drug-gene interactions computed from an algorithm decision tool, to assist with medication management decisions. Veteran outpatients (N = 53) prescribed polypharmacy (mean = 13.15 medications) were enrolled into the study. In 92.4% of cases, providers changed medications at baseline, with 83% of providers indicating that they changed their original medication plan based on the PGx results. Clinical improvement over the 12-week treatment phase was seen in depression (F(1.63, 45) = 5.45, P = .01, η2  = .11) and mental health quality of life (F(2.00, 45) = 4.16, P < .05, η2  = .16). Adverse drug effects were unchanged or improved over time. Rates of polypharmacy remained unchanged. The results suggest that medication changes based on the PGx assay may be beneficial in a complex patient population prescribed polypharmacy.

Evaluating the efficacy of EMLA topical anesthetic in sealant placement with rubber dam.

PURPOSE: The purpose of this study was to investigate the efficacy of EMLA (eutectic mixture of local anesthetics, 2.5% lidocaine and 2.5% prilocaine) cream in reducing discomfort from pressure applied by rubber dam clamp. METHODS: A consecutive sample of 31 patients, ages 6 to 12 years who presented for sealants from September 2002 through March 2003, participated in this within-subjects controlled clinical study. The facial pain scale (FPS) measured discomfort of dental dam placement on first permanent molars on opposite sides of the mouth after EMLA and placebo application for 5 minutes on the gingiva surrounding each tooth. RESULTS: 18 subjects (58%) were female, and 13 (42%) were male. Twenty (65%) of the teeth studied were permanent maxillary first molars, and 11 (35%) were permanent mandibular first molars. Fourteen (44%) patients were 9 years old or younger, and 17 (56%) patients were over 9 years old. The mean FPS score for EMLA teeth of 0.47+/-0.27 was significantly lower than that for non-EMLA teeth of 0.64+/-0.24 (P<.001). EMLA vs non-EMLA FPS scores by age, gender, and arch were not significantly different. CONCLUSIONS: The EMLA cream was effective in reducing discomfort caused by the dental dam clamp.