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Personalized Medicine Jan 2022Characterize current perceptions, practices, preferences and barriers to integrating pharmacogenomics into patient care at an institution with an established...
Characterize current perceptions, practices, preferences and barriers to integrating pharmacogenomics into patient care at an institution with an established pharmacogenomics clinic. A 16-item anonymous survey was sent to healthcare professionals practicing at Tampa General Hospital and the University of South Florida Health. Survey participants consisted of nine advanced practice providers, 41 pharmacists and 64 physicians. Majority of survey participants did not feel confident in their ability to interpret and apply pharmacogenomic results. In the past 12 months, 27% of physicians reported ordering a pharmacogenomic test. The greatest reported barrier to integrating pharmacogenomics was the absence of established guidelines or protocols. Most clinicians believed pharmacogenomics would be useful in their clinical practice but do not feel prepared to interpret pharmacogenomic results.
Topics: Delivery of Health Care; Health Personnel; Humans; Pharmacists; Pharmacogenetics; Pharmacogenomic Testing
PubMed: 34881640
DOI: 10.2217/pme-2021-0061 -
Human Molecular Genetics Oct 2008Pharmacogenetics is the study of the role of inheritance in variation in drug response phenotypes. Those phenotypes can range from life-threatening adverse drugs... (Review)
Review
Pharmacogenetics is the study of the role of inheritance in variation in drug response phenotypes. Those phenotypes can range from life-threatening adverse drugs reactions at one end of the spectrum to equally serious lack of therapeutic efficacy at the other. Over the past half century, pharmacogenetics has--like all of medical genetics--evolved from a discipline with a focus on monogenetic traits to become pharmacogenomics, with a genome-wide perspective. This article will briefly review recent examples of the application of genome-wide techniques to clinical pharmacogenomic studies and to pharmacogenomic model systems that vary from cell line-based model systems to yeast gene deletion libraries. Functional validation of candidate genes and the use of genome-wide techniques to gain mechanistic insights will be emphasized for the establishment of biological plausibility and as essential follow-up steps after the identification of candidate genes.
Topics: Gene Expression Profiling; Gene Targeting; Genetic Variation; Genome, Human; Humans; Pharmacogenetics
PubMed: 18852207
DOI: 10.1093/hmg/ddn270 -
American Journal of Health-system... Dec 2016The current state of pharmacogenomics education for pharmacy students and practitioners is discussed, and resources and strategies to address persistent challenges in... (Review)
Review
PURPOSE
The current state of pharmacogenomics education for pharmacy students and practitioners is discussed, and resources and strategies to address persistent challenges in this area are reviewed.
SUMMARY
Consensus-based pharmacist competencies and guidelines have been published to guide pharmacogenomics knowledge attainment and application in clinical practice. Pharmacogenomics education is integrated into various pharmacy school courses and, increasingly, into Pharm.D. curricula in the form of required standalone courses. Continuing-education programs and a limited number of postgraduate training opportunities are available to practicing pharmacists. For colleges and schools of pharmacy, identifying the optimal structure and content of pharmacogenomics education remains a challenge; insufficient numbers of faculty members with pharmacogenomics expertise and the inadequate availability of practice settings for experiential education are other limiting factors. Strategies for overcoming those challenges include providing early exposure to pharmacogenomics through foundational courses and incorporating pharmacogenomics into practice-based therapeutics courses and introductory and advanced pharmacy practice experiences. For practitioner education, online resources, clinical decision support-based tools, and certificate programs can be used to supplement structured postgraduate training in pharmacogenomics. Recently published data indicate successful use of "shared curricula" and participatory education models involving opportunities for learners to undergo personal genomic testing.
CONCLUSION
The pharmacy profession has taken a leadership role in expanding student and practitioner education to meet the demand for increased pharmacist involvement in precision medicine initiatives. Effective approaches to teaching pharmacogenomics knowledge and driving its appropriate application in clinical practice are increasingly available.
Topics: Education, Pharmacy; Humans; Patient Care; Pharmaceutical Services; Pharmacogenetics; Students, Pharmacy
PubMed: 27864206
DOI: 10.2146/ajhp160104 -
The Pharmacogenomics Journal Feb 2021The implementation of pharmacogenomics (PGx) has come a long way since the dawn of utilizing pharmacogenomic data in clinical patient care. However, the potential... (Review)
Review
The implementation of pharmacogenomics (PGx) has come a long way since the dawn of utilizing pharmacogenomic data in clinical patient care. However, the potential benefits of sharing PGx results have yet to be explored. In this paper, we explore the willingness of patients to share PGx results, as well as the inclusion of family medication history in identifying potential family members for pharmacogenomics cascade testing (PhaCT). The genetic similarities in families allow for identifying potential gene variants prior to official preemptive testing. Once a candidate patient is determined, PhaCT can be initiated. PhaCT recognizes that further cascade testing throughout a family can serve to improve precision medicine. In order to make PhaCT feasible, we propose a novel shareable HIPAA-compliant informatics platform that will enable patients to manage not only their own test results and medications but also those of their family members. The informatics platform will be an external genomics system with capabilities to integrate with patients' electronic health records. Patients will be given the tools to provide information to and work with clinicians in identifying family members for PhaCT through this platform. Offering patients the tools to share PGx results with their family members for preemptive testing could be the key to empowering patients. Clinicians can utilize PhaCT to potentially improve medication adherence, which may consequently help to distribute the burden of health management between patients, family members, providers, and payers.
Topics: Electronic Health Records; Genomics; Humans; Pharmacogenetics; Pharmacogenomic Testing; Precision Medicine
PubMed: 32843688
DOI: 10.1038/s41397-020-00182-9 -
Current Medical Research and Opinion Jul 2005The progressively aging population in the western world, rising socioeconomic expenditure and increasing costs for the treatment of adverse drug reactions, lead to... (Review)
Review
The progressively aging population in the western world, rising socioeconomic expenditure and increasing costs for the treatment of adverse drug reactions, lead to increasing pressure on public spending. The public acceptance of pharmacogenomics is high, therefore, because it promises individualized safe and effective treatment at lower cost. Pharmacogenomics studies the genetic polymorphisms that underlie the variability in drug response between individuals. Despite the great benefits being awaited from this new field, a number of ethical, social and legal concerns arise, which demand rapid strict international regulations in order to prevent discrimination or harm of any kind from society, industry, groups or individuals.
Topics: Delivery of Health Care; Drug Industry; Drug Therapy; Genetic Testing; Genetic Variation; Genetics, Population; Humans; Pharmacogenetics
PubMed: 16004671
DOI: 10.1185/030079905X50633 -
American Journal of Pharmacogenomics :... 2003Pharmacogenomic research promises to permit the development and delivery of safer and more effective drugs. If children are to receive these benefits, as justice would... (Review)
Review
Pharmacogenomic research promises to permit the development and delivery of safer and more effective drugs. If children are to receive these benefits, as justice would demand that they should, children must be included in trials that assess the impact of genetic variation, changing patterns of gene expression over time, and the effects of administering drugs. The ethical and legal challenges to conducting the necessary research include concerns about vulnerability and issues of consent, the scientific validity of the studies and the larger policy question of priority setting. Proposed strategies for ensuring the appropriate conduct of this research include analysis of the ethics based on risks and harms rather than presence or absence of a disorder, the development of model substrates to conduct physiological testing more safely, and the consideration of the disposition and impact of individual study results. With appropriate study, ultimately the use of pharmacogenomic testing can become available for children in the clinical setting.
Topics: Child; Genetic Testing; Humans; Patient Selection; Pharmacogenetics
PubMed: 14672521
DOI: 10.2165/00129785-200303060-00007 -
Pharmacological Research Aug 2022
Topics: Africa; Genomics; Pharmacogenetics
PubMed: 35750300
DOI: 10.1016/j.phrs.2022.106317 -
Clinical Chemistry and Laboratory... 2007Pharmacogenetics and pharmacogenomics deal with genetically determined variations in how individuals respond to drugs. They hold the potential to revolutionize drug... (Review)
Review
Pharmacogenetics and pharmacogenomics deal with genetically determined variations in how individuals respond to drugs. They hold the potential to revolutionize drug therapy. The clinical need for novel approaches to improve pharmacotherapy stems from the high rate of adverse reactions to drugs and their lack of effectiveness in many individuals. Despite the accumulation of research findings showing the potential for clinical benefit for several drug-metabolizing enzymes and some receptors that constitute drug targets, the translation of these findings into tangible clinical applications occurs very slowly. The main steps for clinical implementation of pharmacogenomics include: a) education of clinicians and all other parties involved in the use and benefits of pharmacogenomics; b) execution of large prospective clinical and pharmacoeconomic studies showing the benefit of pharmacogenomic genotyping; c) provision of incentives to develop tests; d) development of specific clinical guidelines; and e) creation of a solid regulatory and ethical framework. Furthermore, the potential should be explored to use existing therapeutic drug monitoring laboratories to introduce pharmacogenomic testing into hospitals. Overall, our thesis is that pharmacogenomics is already a reality in clinical practice and is bound to continue gaining acceptance by clinicians in the coming years.
Topics: Clinical Trials as Topic; Cytochrome P-450 Enzyme System; Drug Monitoring; Drug-Related Side Effects and Adverse Reactions; Genetics, Population; Genotype; Humans; Pharmacogenetics; Polymorphism, Genetic; Technology, Pharmaceutical
PubMed: 17617019
DOI: 10.1515/CCLM.2007.184 -
Pharmacogenomics May 2003Children, as well as adults, should benefit from the discoveries of the genomic era. Many diseases with complex etiologies originate during childhood (e.g., asthma,... (Review)
Review
Children, as well as adults, should benefit from the discoveries of the genomic era. Many diseases with complex etiologies originate during childhood (e.g., asthma, autism, attention deficit/hyperactivity disorder, epilepsy and juvenile rheumatoid arthritis) and persist into adulthood. Attempts to better understand the genetic basis of age-specific disease processes requires an appreciation that the period of human development encompasses the prenatal period through adolescence, and is a rapidly changing, dynamic process. As a result, pharmacologic modulation of developing gene networks may have unintended and unanticipated consequences that do not become apparent or relevant until later in life. Thus, there is considerable potential for large-scale pharmacogenomic technologies to impact the development and utilization of new therapeutic strategies in children.
Topics: Child; Drug Delivery Systems; Drug Design; Female; Humans; Maternal-Fetal Exchange; Pediatrics; Pharmaceutical Preparations; Pharmacogenetics; Pregnancy; Technology, Pharmaceutical
PubMed: 12718723
DOI: 10.1517/phgs.4.3.331.22693 -
The Oncologist Aug 2018Genomic medicine provides opportunities to personalize cancer therapy for an individual patient. Although novel targeted therapies prolong survival, most patients with... (Review)
Review
UNLABELLED
Genomic medicine provides opportunities to personalize cancer therapy for an individual patient. Although novel targeted therapies prolong survival, most patients with cancer continue to suffer from burdensome symptoms including pain, depression, neuropathy, nausea and vomiting, and infections, which significantly impair quality of life. Suboptimal management of these symptoms can negatively affect response to cancer treatment and overall prognosis. The effect of genetic variation on drug response-otherwise known as pharmacogenomics-is well documented and directly influences an individual patient's response to antiemetics, opioids, neuromodulators, antidepressants, antifungals, and more. The growing body of pharmacogenomic data can now guide clinicians to select the safest and most effective supportive medications for an individual patient with cancer from the very first prescription. This review outlines a theoretical patient case and the implications of using pharmacogenetic test results to personalize supportive care throughout the cancer care continuum.
IMPLICATIONS FOR PRACTICE
Integration of palliative medicine into the cancer care continuum has resulted in increased quality of life and survival for patients with many cancer types. However, suboptimal management of symptoms such as pain, neuropathy, depression, and nausea and vomiting continues to place a heavy burden on patients with cancer. As demonstrated in this theoretical case, pharmacogenomics can have a major effect on clinical response to medications used to treat these conditions. Recognizing the value of supportive care pharmacogenomics in oncology and application into routine practice offers an objective choice for the safest and most effective treatment compared with the traditional trial and error method.
Topics: Female; Genomics; Humans; Medical Oncology; Middle Aged; Neoplasms; Palliative Care; Pharmacogenetics
PubMed: 29622698
DOI: 10.1634/theoncologist.2017-0599