This is a joint episode recorded with Dr. Chloe Gomez of the My Favorite Learner podcast. This episode explores the foundational concepts of pharmacogenetics and its impact on drug responses during anesthesia, highlighting how genetic, genomic, and epigenetic variations shape individual reactions to commonly used medications in perioperative care. Designed for nurse anesthesia residents, the show walks through the scenarios of variable drug response, the roles of metabolizing enzymes, transport molecules, and molecular targets, as well as the influence of environmental factors and polymorphisms such as single-nucleotide variants and ethnic differences in metabolism. Key topics include disease-specific considerations like G6PD deficiency, acute intermittent porphyria, long QT syndrome, Brugada syndrome, atypical pseudocholinesterase, and malignant hyperthermia, with a focus on clinical implications for personalized medicine, precision dosing, and ethical issues surrounding genetic testing, privacy, and patient equity. Practical advice covers vigilant monitoring, individualized dosing, preoperative assessment for genetic risk, and strategies for documenting and communicating findings for safer anesthesia practice.

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