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

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22 Applying Pharmacogenomics in Therapeuticsand nurses/nurse practitioners who provide anticoagulation services. 163 The surveyresponse rate was low (22%), which included five knowledge-based questions.Approximately one-third of respondents correctly answered the knowledge-basedquestions. Knowledge was poor in areas of the length of time required to perform atest, interpreting test results, and CYP2C9 and VKORC1 allele frequencies. 163 In anInternet-based survey of genetics education in psychiatry residency programs, morethan 50% of physicians felt that pharmacogenomic training was minimal. 169The NCHPEG is a working group of specialists with experience in genetics andhealth professions, with the intent of developing genomic/pharmacogenomic educationalcontent for healthcare professionals. 149 In 2007, NCHPEG developed 18 corecompetencies, which include, but are not limited to, understanding basic genetic terminology;identifying genetic variations that facilitate prevention, diagnosis, and treatmentoptions; and identifying available resources to assist those seeking genetic informationor services. 149 Such competencies have been adapted in part by professional organizations.For pharmacists, the AACP Academic Affairs Committee reported specific competenciesin pharmacogenetics and pharmacogenomics, which were derived from 2001NCHPEG competencies. Examples include a pharmacist being able to identify patientsfor whom pharmacogenetic testing is indicated, identify an appropriate pharmacogenomictest for a patient, and be able to provide recommendations based on pharmacogenomictesting results. 150 For physicians, the AAFP Core Educational Guideline andthe AAMC Contemporary Issues in Medicine: Genetics Education Report have alsoprovided some considerations in pharmacogenomics/genomics. 170,171SUMMARYThe future applicability of pharmacogenomic tests in clinical practice is unknown,and there is both excitement and trepidation by the potential possibilities of thesetests among patients and healthcare professionals. With the rapid discoveries of newgenes and polymorphisms that affect drug efficacy, toxicity, and dosing, personalizedmedicine is quickly becoming a reality. There is increasing hope for not onlybeing able to individualize drug treatment but also to treat diseases that were previouslyconsidered incurable. As we venture into the next decade of personalizedmedicine, healthcare professionals in all disciplines need to be knowledgeable ininterpreting scientific evidence and appropriately educating patients so that they canmake informed decisions about their healthcare.STUDY QUESTIONSCase 1AS 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 significantfor occasional headaches and seasonal allergies. She currently takes acetaminophen325 mg every 6 hours as needed. She has no known drug allergies. Her physicianorders a urea breath test, which reveals H. pylori peptic ulcer disease. She is prescribeda triple therapy consisting of omeprazole, amoxicillin, and clarithromycin.
Concepts in Pharmacogenomics and Personalized Medicine231. The patient obtains information about a commercially available CYP2C19pharmacogenomic test and decides to complete the test. The test revealsthat she has a CYP2C19*3/*3 genotype. Based on the patient’s genotype,what is her anticipated CYP2C19 enzyme activity?a. Normal CYP2C19 enzyme activityb. Increased CYP2C19 enzyme activityc. Decreased CYP2C19 enzyme activityd. No CYP2C19 enzyme activity2. Based on the patient’s CYP2C19*3/*3 genotype, what is the anticipatedeffect on omeprazole pharmacokinetics?a. Decreased omeprazole area under the concentration–time curveb. Increased omeprazole plasma concentrationsc. Decreased omeprazole volume of distributiond. Increased omeprazole clearanceCase 2KK is a 29-year-old breastfeeding woman who is receiving codeine after giving birthto a healthy baby boy. After three days, she started to experience symptoms of sleepinessand dizziness. Now, after five days, she noticed that her infant seems sleepy allday, does not want to breastfeed, and may be losing body tone.3. Codeine is metabolized to morphine by which CYP enzyme?a. CYP2D6b. CYP2C9c. CYP2C19d. CYP3A44. Which metabolizer phenotype most accurately describes a person who doesnot respond to codeine?a. Extensive metabolizerb. Intermediate metabolizerc. Poor metabolizerd. Ultrarapid metabolizer5. Which ethnic population has the highest incidence of carbamazepineinducedSJS/TEN?a. African Americansb. Caucasiansc. Han Chinesed. HispanicsAnswer Key1. d2. b3. a4. c5. c
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BIOMEDICAL SCIENCEApplying Pharmaco
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Feng, Xiaodong_ Xie, Hong-Guang - Applying pharmacogenomics in therapeutics-CRC Press (2016)

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