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Week 1: Pharmacogenomics
In the provided scenario, it is pertinent for the nurse to understand outliers and reaction factors attributed to abacavir. Following the HLA-B*5701 allele gene testing, the test reveals that the patient carries the allele. This result implies that the caregiver should not administer abacavir owing to the fact that it will cause an adverse drug reaction. In recent studies, the allele is associated with an increased risk of hypersensitivity to abacavir. In fact, 100% of the tests resulted to the adverse reaction (Woo & Robinson, 2016). Therefore, the nurse must seek alternative intervention other than the abacavir.
In the second scenario, due to acute myocardial infraction (MI), the patient was prescribed antiplateletes in which the clopidogrel was administrated. However, this intervention led to an adverse outcome as six months later, the patient suffered from another MI. Considering that the patient was adherent to all the therapy and more so, the intervention administered was standard, the outcome was unforeseeable. Nonetheless, this outcome could have been avoided altogether if genetic testing were conducted prior to the intervention. As contended by Robert Shmerling, a Senior Faculty editor at Harvard Health Publishing, medication side effect is a significant problem that many in the healthcare field are looking to resolve (Shmerling, 2017). Genetic testing offers solutions in this regard as it could aid in predicting success of the medication, and more so, the side effects (Shmerling, 2017). Administering the correct dynamics of the medication could result into better outcomes for the patients. Consequently, the fine-tuned information could provide better evidence and aid in the avoidance of needless drug toxicity.
Despite the benefits that the pharmacogenomics presents, it is subject to some limitations. First, the process requires optimization based on the specific drug variants, which means that the novel genetic testing can be relatively long (Woo & Robinson, 2016). The second disadvantage is that at time, the outcomes of such testing results to ambiguous evidence that are non-corresponsive with existing clinical guidelines (Lapane & Weinstock, 2007). In fact, this technical hurdle is among the reasons why the genotyping practice is not widely practiced. Therefore, for the practice to be popularized these areas must be addressed.
Besides, the administration of pharmacogenomics is subject to some ethical concerns. First, the lack of clarity in the process might cause adversarial health outcomes than benefits. Second, there are no clear guideline regulating the process and therefore, there is a risk of non-standardized studies that pose long-term impacts to people. Due to the need to uphold ethical practice, the ethical aspects of pharmacogenomics must also be addressed first.
Lapane, K., & Weinstock, M. A. (2007). The power and limitations of pharmacogenetic epidemiology. Journal of Investigative Dermatology, 127(8), 1851-1852. https://doi.org/10.1038/sj.jid.5700854 (Links to an external site.)
Shmerling, H. R. (16 Oct. 2017). Genetic testing to predict medication side effects. Harvard Health Publishing. https://www.health.harvard.edu/blog/genetic-testing-to-predict-medication-side-effects-2017101612517 (Links to an external site.)
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers. FA Davis.
This is the professor reply and the writer needs to reply to to the professor comment .
Thank you for the information. While we are considering pharmacogenomics for medications there are multiple medications where liver and kidney function also needs checked prior to prescribing as well as ongoing monitoring while on the drug.
What are liver and kidney function labs we would monitor when those need monitored? What specific lab tests would we look at for liver and kidney?
Woo, T.M. & Robinson, M.V. (2016). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (4th ed.). F.A. Davis Company.
Chapter 2: Review of Basic Principles of Pharmacology (WO1.1)
Chapter 7: Cultural and Ethnic Influences in Pharmacotherapeutics (WO1.2)
Chapter 8: An Introduction to Pharmacogenomics (WO1.3)
Textbooks and Resources
The following books are required for this course:
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advance Practice Nurse prescribers (4th ed.). F. A. Davis Company.
This textbook is available as an e-book and can be accessed from the module view.
American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). American Psychological Association. https://doi.org/10.1037/0000165-000