1
|
Aroke EN, Hicks TL. Pharmacogenetics of Postoperative Nausea and Vomiting. J Perianesth Nurs 2019; 34:1088-1105. [PMID: 31227296 DOI: 10.1016/j.jopan.2019.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 12/17/2022]
Abstract
Postoperative nausea and vomiting (PONV) remains one of the most common adverse effects of anesthesia, affecting up to 80% of high-risk patients within 24 hours after surgery. Patient-related factors, surgical procedure, and perioperative medications such as opioids determine a patient's risk for PONV. To prevent and manage PONV, ondansetron, a 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, is frequently administered. Ondansetron is metabolized predominantly by hepatic cytochrome P450 (CYP2D6) enzymes, encoded by the CYP2D6 gene, whereas most of the effects of opioids are exerted at the opioid mu-1 receptor, encoded by the OPRM1 gene. Genetic polymorphisms of the CYP2D6 and OPRM1 genes may have a role in interindividual variation in the occurrence of PONV. Specifically, the occurrence of the G-allele produced by the OPRM1 A118G appears to be protective against PONV, whereas CYP2D6 ultrarapid metabolism increases the risk for PONV. The Clinical Pharmacogenetics Implementation Consortium guidelines provide CYP2D6-guided therapeutic recommendations for ondansetron. However, further studies are needed to investigate the role of genetic polymorphism in the occurrence of PONV and response to antiemetics.
Collapse
|
2
|
Saiz-Rodríguez M, Ochoa D, Herrador C, Belmonte C, Román M, Alday E, Koller D, Zubiaur P, Mejía G, Hernández-Martínez M, Abad-Santos F. Polymorphisms associated with fentanyl pharmacokinetics, pharmacodynamics and adverse effects. Basic Clin Pharmacol Toxicol 2018; 124:321-329. [PMID: 30281924 DOI: 10.1111/bcpt.13141] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/20/2018] [Indexed: 12/28/2022]
Abstract
Fentanyl is an agonist of the μ-opioid receptor commonly used in the treatment of moderate-severe pain. In order to study whether pharmacogenetics explains some of the variability in the response to fentanyl, several genes related to fentanyl receptors, transporters and metabolic enzymes have been analysed. Thirty-five healthy volunteers (19 men and 16 women) receiving a single 300 μg oral dose of fentanyl were genotyped for 9 polymorphisms in cytochrome P450 (CYP) enzymes (CYP3A4 and CYP3A5), ATP-binding cassette subfamily B member 1 (ABCB1), opioid receptor mu 1 (OPRM1), catechol-O-methyltransferase (COMT) and adrenoceptor beta 2 (ADRB2) by real-time PCR. Fentanyl concentrations were measured by ultra-performance liquid chromatography combined with tandem mass spectrometry (UPLC-MS/MS). Fentanyl pharmacokinetics is affected by sex. Carriers of the CYP3A4*22 allele, which is known to reduce the mRNA expression, showed higher area under the concentration-time curve (AUC) and lower clearance (Cl) values. Although this finding might be of importance, its validity needs to be confirmed in other similar settings. Furthermore, carriers of the ABCB1 C1236T T/T genotype presented a lower AUC and higher Cl, as well as lower half-life (T1/2 ). As volunteers were blocked with naltrexone, the effect of fentanyl on pharmacodynamics might be biased; however, we could observe that fentanyl had a hypotensive effect. Moreover, ADRB2 C523A A allele carriers showed a tendency towards reducing systolic blood pressure. Likewise, OPRM1 and COMT minor allele variants were risk factors for the development of somnolence. CYP3A5*3, ABCB1 C3435T and ABCB1 G2677T/A were not associated with fentanyl's pharmacokinetics, pharmacodynamics and safety profile.
Collapse
Affiliation(s)
- Miriam Saiz-Rodríguez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Dolores Ochoa
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa (IP), Plataforma SCReN (Spanish Clinical Research Network), UICEC Hospital Universitario de La Princesa, Madrid, Spain
| | - Coral Herrador
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Carmen Belmonte
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa (IP), Plataforma SCReN (Spanish Clinical Research Network), UICEC Hospital Universitario de La Princesa, Madrid, Spain
| | - Manuel Román
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa (IP), Plataforma SCReN (Spanish Clinical Research Network), UICEC Hospital Universitario de La Princesa, Madrid, Spain
| | - Enrique Alday
- Anesthesiology Department, Instituto de Investigación Sanitaria la Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Dora Koller
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Gina Mejía
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa (IP), Plataforma SCReN (Spanish Clinical Research Network), UICEC Hospital Universitario de La Princesa, Madrid, Spain
| | - María Hernández-Martínez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa (IP), Plataforma SCReN (Spanish Clinical Research Network), UICEC Hospital Universitario de La Princesa, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Zhong W, Darmani NA. Intracellular vomit signals and cascades downstream of emetic receptors: Evidence from the least shrew ( Cryptotis parva) model of vomiting. REMEDY OPEN ACCESS 2017; 2:1083. [PMID: 30854512 PMCID: PMC6405232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nausea and vomiting are often considered as stressful symptoms of many diseases and drugs. In fact they are the most feared and debilitating side-effects of many cancer chemotherapeutics and the main cause of patient noncompliance. Despite years of substantial research, the intracellular emetic signals are at best poorly understood or remain unknown. Among different receptor-mediated emetic signaling cascades, one potential converging signal appears to be changes in the cytosolic concentration of Ca2+. In this editorial, we focus on Ca2+-related intracellular signals underlying emesis mediated by various emetogens. This strategy will help us understand common signaling mechanisms downstream of diverse emetogens and should therefore promote development of new antiemetics for the treatment nausea and vomiting caused by diverse diseases, drugs, as well as viruses and bacterial infections.
Collapse
Affiliation(s)
| | - Nissar A. Darmani
- Corresponding author: Nissar A. Darmani, PhD, Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences. 309 E. Second Street, Pomona, California, CA 91766,
| |
Collapse
|