NANOMEDICNE AND NANOPHARMACY

If a bresktrough to s universal assembler accours in the next 10 to 15 years, an entirely new field ao
nanomedicine and perhaps nanopharmacy will emerge by 2020. Nanomedicine has been difined as
“monitoring, repair, contruction, and control human biological system at the mocular level, using
engineered nanodevices and nanostructures. “nanopharmacy might be defined as “the preparation
and delivery of ultrasmall pharmaceuticals, therapeutic subtance and delivery system.”

Nanopharmacy may involve the use of “nanomotors.” Such motors, consisting of ATPase
molecules with a metalic substrate on one end and a chemical “propeller” on the other end. Have
already been created as ATP breaks down, biomotor moves. The motor may be able to compound
tiny quantities of drugs and pump them direcly to the target times under direction or programing of
pharmacist.

To help secure a distinct for pharmacy in the new world of nanotechnology pharmacist
should keep up with development in the field through reading and trough participation in national
organizations.

PHARMACOGENOMICS

Depinition

The terms pharmacogenetics and pharmacogenomics have often been used interchangeably but
each represent a different entity. Pharmacogenetics, a science for almost 50 years. “is defined as
“the study of the effect of a medication as it relates to single or defined sets of genes” it focus on
genetic polymorphisms that influene the structure or function of the protein for which the gene
codes”. Pharmacogenomics, on the other hand.”goes even further by identifying genes or whole
genomes responsible for modifying an organism’s response to drug” it aldo includes the use of
genomics in the search for new therapeutic targets “thus, pharmacogenomics is broader in scope
than pharmacogenetics it looks at “not only the molecular composition of genetics variants
associated with drugs response but also the behavior of those variants, includinghow those genes
affect drug receptor sites.

Pharmacogenomics will change clinical practice, individual patients’ therapy will be based an
their genetic makeup. Felix Frueh, an official in the area of genomic at the U.S food and Drug
Administration (FDA), has said that whereas medicine to date has taken a trial and error approach,
treating everyone with the same dose, a pharcogeonimic driven approach will mean individualizing
or personalizing the dose for effective treatmen.

Pharmacogeonomic offers the tools for prescribing personalized medicine that will improve
treatmen outcomes, decrease the occurrence of drag related adverse effect and ultimately reduce
the cost of medicale care. In essence, pharmacogeonomics provides “tha right dose of the right drug
for the right indication for the right patient at the right time” the goal of compounding pharmacists.

Benefits of personalized medicine

The reason each patient’s unique genetic makeup directs his or her response to drug therapy is the
genes encode enzymes , including drug – metabolizing enzymes (DMEs). Variation in gene
sequencing cause DMEs to be expressed in different forms in different people. This is why the same
drug is processed differently in different people, with different effects.

Pharmacogenomic – based medical care will be streamlined and simplified. In theory, a one – time
analysis of patient’s blood sample will yield a genetic blueprint that can be used to guide all
subsequent drug treatment for that individual. Trial - and error therapy will be avoided, and early
treatment with the appropriate drug in the right dose will enable cure or management. Becouse
overdosing and underdosing will be eliminated, the occurrence of adverse effect and the expenses
related to their treatment will be greatly reduced. Nonresponders and those intolerant of a specific
drug will never receive it.

With a physician’s prescription and the patient’s pharmacogenomic profile in mind, a compounding
pharmacist will be able to prepare a customized medication in the patient’s unique best dosage, free
of undesirable fillers and additives, and in the most effective and acceptable form. This targeted
treatment will be safer, less expensive overall, more effective, and less likely to cause adverse effect
than is today’s treatment with alimited number of commercially prepared doses and one - size –
fits-all prescribing.

Long championed by compounding pharmacists, the pharmacogenomic approach to care is now

receiving attention from leading U.S. government and private organization the FDA Center for Drug
Evaluation,13 ee “Center for Dscase Control and Prevention”, and American Medical Association. As
guardians of the public welfare, consumers’ best interest and economy of investment, these
organizations have identified the potential of personalized drug treatment to improve outcomes
while reducing the costs of therapy.

The chance of overreaction or underresponse to drug treatment is indeed high: Drug related adverse
events cause more than 2 million hospitalizations and 100,000 deaths annually in the United States.
These figures underscore the value of genetically guided therapy According to Bolonna and
colleagues, “The aim of pharmcogenomic research is to enable customized drug treatment by
identiyfing varitions within multiple candidate genes those encoding drug – targeted
neurotransmitter receptors, tranporters, and metabolic enzymes that are likely to confer the
interindividual differences in drug response and develpment of drug – induced side effects. “In their
recent study of pharmacogenomics and drug development, Guo and colleagures “ showed that
“efficacy is increased and toxicity is reduced when a genetically guided dose adjustment strategy is
utilized in a clinical trial. “Weber and colleagues estimated that only 50% to 75% of patients benefit
from drug therapy. They predicted that data from the Human Genome Project” will result in drugs
personalized to small genetically defined groups of patients or even to individuals”.

Applications

The potential applications of pharmacogenomics armany. Genotypically guided regimens are under
investigation for the treatment of human immunodeficiency virus (HIV) in fections non – small – cell
lung cancer, Alzheimer’s disease , childhood acute lympoblastic leukimia cardiovascular disease, and
colon cancer. Targeted drugs commercially available include trastuzumab (Herceptin) for the
treatment of breast cancer, cetuximab, cetuximab (Erbitux) for coloretal cancer, erlotinib (Tarceva)
for lung cancer, imatinib mesylate (Gleevec) for chronic myelogenous leukimia, atomoxetine HCl
(Strattera) for attention – deficit hyperactivity disorder, and mercaptopurine (6-MP, Purinethol) for
leukemia.

Genomics is changing modern medicine . Phisicians have long known that not all drugs are
appropriate for all patients. Some medications are effective only in specific subpopulations
(responders), and the early identification of responders dramatically improves the success of
treatment. Treating nonresponders puts those patients at unnecessary risk fod avers events,
provides no benefit, and may delay treatment with an effective agent. For example, identifying
women whose breast cancer nonresponsive to Herceptin prior to initiating Herceptin treatment
could direct the prescription of another drug that would be effective and could save thousands of
dollars that might have been spent in failed treatment.

Pharmacogenomically guided medicine is the future of drug therapy. Analytically and dincally
validated tests are now available for predicting an individual’s genetic response to a paricular drug
and potentially reducing treatment – related adverse effects . FDA is encouraging the use of
pharmacogenomics and is supporting its translation into personalized medicine. The one – size – fits
– all model of drug treatment is truly outdated.

It is in valuable to be able to predict – before treatment is intiated – which patients will not respond
to a particular drug or will suffer unacceptable adverse event, nd to identify the correct dosage in
those who will benefit from therapy . For example , there is now an approved daignostic test to
detect patients with variations in the gene for CYP 2C9, which is involved in warfarin metabolism .
Patients with variants in this gene metabolize warfarin more slowly than others and require lower
doses ; they can now begin warfarin therapy at lower dosages.