Clinical implications of pharmacogenetic and microarray testing for advanced practice nurses

Abstract

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.

The implementation of pharmacogenomics into UK general practice: a qualitative study exploring barriers, challenges and opportunities

“…With the lack of a body of support, professional GPs may feel that the implementation of pharmacogenomics may not be optimal. Barriers to implementation identified under the main themes are not unique to General Practice (Saul et al 2017;McGrath and Ghersi 2016), and are also barriers to mainstreaming genomic practice among staff affiliated with primary care such as practice nurses (Brennan 2015) and pharmacists (Clemerson et al 2006;Haga et al 2016). However, the opportunities in implementation includes personalising medicine, to reduce toxicity, to enhance the efficacy of drugs and to use genome guided therapy in the setting of polypharmacy (Swinglehurst and Fudge 2017).…”

Integrating pharmacogenetic testing into primary care

“…[55] Nurses are also an important part of the delivery of PGx testing and thus, need to be familiar with PGx to educate patients, assist with test orders, and communicate results. [56,57]…”

Nurse empowerment through Pharmacogenetics

“…The nursing professional is responsible for performing many competencies, among which we highlight three central care activities: 1) medication administration, 2) the nurse’s management skills, important, among other things, to identify the cost-benefit of a health action, and 3) the education of the patient about the illness he/she has. These skills can be improved by incorporating pharmacogenetics in the nursing process ( 12 ) .…”

“…Pharmacogenetics can be incorporated in almost all stages of the nursing process. In the data collection stage, it allows the health team to detect the individual’s genetic data, outlining a diagnosis that will guide care planning ( 12 ) . Thus, in the same way that it is necessary to obtain local information to adapt concepts of pharmacogenetics to our population that has a mixed ethnic origin ( 8 , 11 ) , it is necessary to understand whether and how this knowledge can be applied to the nurse’s daily life.…”