Feng, Xiaodong_ Xie, Hong-Guang - Applying pharmacogenomics in therapeutics-CRC Press (2016)

22 Applying Pharmacogenomics in Therapeutics
and nurses/nurse practitioners who provide anticoagulation services. 163 The survey
response rate was low (22%), which included five knowledge-based questions.
Approximately one-third of respondents correctly answered the knowledge-based
questions. Knowledge was poor in areas of the length of time required to perform a
test, interpreting test results, and CYP2C9 and VKORC1 allele frequencies. 163 In an
Internet-based survey of genetics education in psychiatry residency programs, more
than 50% of physicians felt that pharmacogenomic training was minimal. 169
The NCHPEG is a working group of specialists with experience in genetics and
health professions, with the intent of developing genomic/pharmacogenomic educational
content for healthcare professionals. 149 In 2007, NCHPEG developed 18 core
competencies, which include, but are not limited to, understanding basic genetic terminology;
identifying genetic variations that facilitate prevention, diagnosis, and treatment
options; and identifying available resources to assist those seeking genetic information
or services. 149 Such competencies have been adapted in part by professional organizations.
For pharmacists, the AACP Academic Affairs Committee reported specific competencies
in pharmacogenetics and pharmacogenomics, which were derived from 2001
NCHPEG competencies. Examples include a pharmacist being able to identify patients
for whom pharmacogenetic testing is indicated, identify an appropriate pharmacogenomic
test for a patient, and be able to provide recommendations based on pharmacogenomic
testing results. 150 For physicians, the AAFP Core Educational Guideline and
the AAMC Contemporary Issues in Medicine: Genetics Education Report have also
provided some considerations in pharmacogenomics/genomics. 170,171
SUMMARY
The future applicability of pharmacogenomic tests in clinical practice is unknown,
and there is both excitement and trepidation by the potential possibilities of these
tests among patients and healthcare professionals. With the rapid discoveries of new
genes and polymorphisms that affect drug efficacy, toxicity, and dosing, personalized
medicine is quickly becoming a reality. There is increasing hope for not only
being able to individualize drug treatment but also to treat diseases that were previously
considered incurable. As we venture into the next decade of personalized
medicine, healthcare professionals in all disciplines need to be knowledgeable in
interpreting scientific evidence and appropriately educating patients so that they can
make informed decisions about their healthcare.
STUDY QUESTIONS
Case 1
AS is a 40-year-old Korean woman with a chief complaint of epigastric pain after eating.
She denies any blood in her stools and fever. Her past medical history is significant
for occasional headaches and seasonal allergies. She currently takes acetaminophen
325 mg every 6 hours as needed. She has no known drug allergies. Her physician
orders a urea breath test, which reveals H. pylori peptic ulcer disease. She is prescribed
a triple therapy consisting of omeprazole, amoxicillin, and clarithromycin.