Cytochrome p450 Part 2

Integrating pharmacogenetic testing into primary care

Introduction

Pharmacogenetic (PGx) testing has greatly expanded due to enhanced understanding of the role of genes in drug response and advances in DNA-based testing technology development. As many primary care visits result in a prescription, the use of PGx testing may be particularly beneficial in this setting. However, integration of PGx testing may be limited as no uniform approach to delivery of tests has been established and providers are ill-prepared to integrate PGx testing into routine care.

Areas covered

In this paper, the readiness of primary care practitioners are reviewed as well as strategies to address these barriers based on published research and ongoing activities on education and implementation of PGx testing.

Expert Commentary

Widespread integration of PGx testing will warrant continued education and point-of-care decisional support. Primary care providers may also benefit from consultation services or team-based care with laboratory medicine specialists, pharmacists, and genetic counselors.

Technological Advances in Psychiatric Nursing: An update

Understanding and treating mental illness has improved in many ways as a result of the fast pace of technological advances. The technologies that have the greatest potential impact are those that (1) increase the knowledge of how the brain functions and changes based on interventions, (2) have the potential to personalize interventions based on understanding genetic factors of drug metabolism and pharmacodynamics, and (3) use information technology to provide treatment in the absence of an adequate mental health workforce. Technologies are explored for psychiatric nurses to consider. Psychiatric nurses are encouraged to consider the experiences of psychiatric patients, including poor health, stigmatization, and suffering.

Clinical implications of pharmacogenetic and microarray testing for advanced practice nurses

PURPOSE

The rapidly changing field of pharmacogenetics requires that advanced practice providers have a fundamental foundation in genetics and genetic testing on which new knowledge can be built. Testing for allelic variation in the well-researched Cytochrome P450 pathways and other pathways of drug metabolism is done through microarray testing. Understanding the process microarray testing provides a framework for understanding pharmacogenetic testing.

DATA SOURCES

Genetic, pharmacogenetic, and biotechnical literature is reviewed to explain the genetics and biotechnology behind testing for allelic variation. Clinical examples of applied pharmacogenetic testing in cardiology and psychiatry are provided from the nursing literature.

CONCLUSION

The advent and practical application of inexpensive and available testing aimed to identify genetic variations in individual patient metabolism of common and critical medications, necessitates that advanced practice registered nurses (APRNs) have a deeper understanding of the biotechnology involved in pharmacogenetic and pharmacogenomics testing.

IMPLICATIONS FOR PRACTICE

Providers with a working knowledge of the microarray testing method will have a framework for understanding which patients to test, what tests to order, and how to interpret the results of these genetic tests. APRNs need to increase their reliance on the interdisciplinary databases that maintain the most current and relevant knowledge of pharmacogenetics.