Pharmacogenomics: Foundations, Competencies, and the Pharmacists’ Patient Care Process, Second Edition provides a basic and clinical foundation for the application of drug-gene interactions in clinical therapeutics. As the field of PGx advances and changes rapidly, there is a need for a regularly updated, pharmacy-focused resource that can be a reference for practicing pharmacists and student pharmacists in the context of the Pharmacists’ Patient Care Process (PPCP). Specific information is presented through “PGx Pearls.” Each of the 20 cases are presented in the context of the PPCP, with “Competency Connections” related to updated pharmacists’ competencies in genetics and genomics. Each chapter provides content and objective-related questions with the answers provided.

Abstract Background Pharmacodynamics and pharmacogenetics are being explored in pharmacological treatment response for major depressive disorder (MDD). Interactions between genotype and treatment response may be dose dependent. In this study, we examined whether MDD patients with Met/Met, Met/Val, and Val/Val COMT genotypes differed in their response to bupropion in terms of depression scores. Methods This study utilized a convenience sample of 241 adult outpatients (≥18 years) who met DSM‐5 criteria for MDD and had visits at a Midwest psychopharmacology clinic between February 2016 and January 2017. Exclusion criteria included various comorbid medical, neurological, and psychiatric conditions and current use of benzodiazepines or narcotics. Participants completed genetic testing and the 9 question patient‐rated Patient Health Questionnaire (PHQ‐9) at each clinic visit (M = 3.8 visits, SD = 1.5) and were prescribed bupropion or another antidepressant drug. All participants were adherent to pharmacotherapy treatment recommendations for >2 months following genetic testing. Results Participants were mostly Caucasian (85.9%) outpatients (154 female and 87 male) who were 44.5 years old, on average (SD = 17.9). For Val carriers, high bupropion doses resulted in significantly lower PHQ‐9 scores than no bupropion (t(868) = 5.04, p < .001) or low dose bupropion (t(868) = 3.29, p = .001). Val carriers differed significantly from Met/Met patients in response to high dose bupropion (t(868) = −2.03, p = .04), but not to low dose bupropion. Conclusion High‐dose bupropion is beneficial for MDD patients with Met/Val or Val/Val COMT genotypes, but not for patients with Met/Met genotype. Prospective studies are necessary to replicate this pharmacodynamic relationship between bupropion and COMT genotypes and explore economic and clinical outcomes.

Akathisia is a relatively common adverse effect that may emerge during treatment with antipsychotics and other medication classes. We present a case of akathisia that may have been induced by the abrupt discontinuation of varenicline and review existing literature related to this phenomenon. A 46-year-old female with a past psychiatric history of bipolar disorder and borderline personality disorder was admitted to the acute psychiatric services department for suicidal ideation after 3 weeks of a new course of varenicline. This was prescribed for smoking cessation and titrated to 1 mg twice daily. Upon admission, the varenicline was discontinued. Roughly 3 days later, the patient began to complain of akathisia. The patient had experienced akathisia previously while taking antipsychotics for her bipolar disorder and was able to recognize its emergence. As the akathisia worsened, propranolol 10 mg 3 times daily was ordered and was effective in relieving her symptoms. A PubMed search using the terms varenicline, akathisia, withdrawal, and discontinuation was conducted. No literature of this phenomenon was found; however, reports of other extrapyramidal symptoms were noted. Considering the timing of varenicline's discontinuation and its mechanism, a pharmacological link between its use and akathisia is possible. Akathisia is a severely uncomfortable sequela of medications that may produce severe outcomes, such as suicidal ideation. In this case, it is possible that the discontinuation of varenicline after 3 weeks of therapy led to akathisia, which was successfully treated with propranolol.

Aim: To systematically assess methodological quality of pharmacogenomics clinical practice guidelines. Methods: Guidelines published through 2017 were reviewed by at least three independent reviewers using the AGREE II instrument, which consists of 23 items grouped into 6 domains and 2 items representing an overall assessment. Items were assessed on a seven-point rating scale, and aggregate quality scores were calculated. Results: 31 articles were included. All guidelines were published as peer-reviewed articles and 90% (n = 28) were endorsed by professional organizations. Mean AGREE II domain scores (maximum score 100%) ranged from 46.6 +/- 11.5% ('applicability') to 78.9 +/- 11.4% ('clarity of presentation'). Median overall quality score was 72.2% (IQR: 61.1-77.8%). Conclusion: Quality of pharmacogenomics guidelines was generally high, but variable, for most AGREE II domains.

Pharmacogenomics (PGx) describes the relationship between an individual's genes and his or her response to drug therapy. Data are accumulating that indicate that PGx has application in the clinical setting for drugs across therapeutic categories, including drugs that are administered intravenously and are of greater familiarity to infusion nurses. This article provides an overview of the science and presents common examples of PGx as it relates to drug and/or drug dose selection. Additionally, there are brief summaries of the role infusion nurses can play relative to toxicity monitoring, patient education, and other aspects of PGx.

Related to many drug gene-product interactions, application of pharmacogenomics can lead to improved medication efficacy while decreasing or avoiding adverse drug reactions. However, utilizing pharmacogenomics without other information does not allow for optimal medication therapy. Currently, there is a lack of documentation of family medication history, in other words, inefficacy and adverse reactions across family members throughout generations. The family medication history can serve as an impetus for pharmacogenomic testing to explain lack of medication efficacy or an adverse drug reaction and pre-emptive testing can drive recognition and documentation of medication response in family members. We propose combining the family medication history via pedigree construction with pharmacogenomics to further optimize medication therapy. We encourage clinicians to combine family medication history with pharmacogenomics.

Aim: The aim of this study was to evaluate a pharmacogenomics certificate training program relative to pharmacist competencies in basic genetic concepts, genetics and disease, pharmacogenetics/pharmacogenomics and ethical, legal and social implication. Methods: Participants, including pharmacists, pharmacy students and pharmacy educators completed a survey related to to the competency statements. Following the pre-program survey, participants completed a 6-week home self-study with subject matter including basic science (three chapters) and clinical application of pharmacogenomics (eight chapters). The participants completed a quiz for each of the self-study chapters. Following the self-study, participants completed a day-long, 7-h live program which included a review of the competency statements and counseling sessions with seven different simulated patients (primarily pharmacy students). Participants then completed a post-program survey which included the same items as the pre-program survey. Results: Specifically, for the pharmacist participants, the average score of the self-study quizzes was 91%. For the pharmacists specifically, there was a statistically significant increase in self-assessed perception of competence related to pharmacogenomics. Additionally, it was observed that recommendations related to specific drug-gene interactions for the simulated patients were addressed correctly 95% of the time across all participant-patient encounters. Conclusion: Self-study and a live, interactive component in the certificate training program led to increased self-understanding of defined pharmacogenomics competencies. Additionally, pharmacy students, in the role of simulated patients gained knowledge during the live component of the program. This type of program, especially if made available through electronic-based platforms can serve to educate pharmacists and increase the uptake of pharmacogenomics in various healthcare settings.

It has been estimated by the Audit Commission that a quarter of hospital staff time is spent collecting data and using information. Information is a critical daily activity, and is a foundation of efforts to secure improvements in the quality of patient care and safety. But, despite its importance, information is not as well used as it could be in healthcare settings. The papers included in this review suggest we should be concerned at our current capacity to use information to underpin meaningful review and adaptation of practice. In 2001 the US Institute of Medicine stated that IT “has barely touched patient care”. It must “if a substantial improvement in quality is to be achieved”. In the UK, Derek Wanless’s review of future trends in health care called for an immediate doubling of expenditure on computing. These heavyweight views add force to existing strategies to promote better use of IT in health care, including a target that all clinicians should have access to electronic patient records by 2008. Tim Benson’s two-part discussion of “why general practitioners use computers and hospital doctors do not” is an informative history of the bumpy road to computerisation in the NHS. There are two main reasons for the difference, in Benson’s view: “incentives” and “scalability”. During the 1970s there was a lot of experimentation with computing, but by the end of the decade the trend had passed: “Progress ground to a halt”. We may even have gone backwards in some regards. “Today, few English hospitals have integrated patient administration and cumulative clinical laboratory reporting systems accessible from terminals on the wards and in outpatient clinics”. Yet, as long ago as 1975, such facilities were operational in several English hospitals including Charing Cross, the Royal London, and the Queen Elizabeth Medical Centre, Birmingham. One of the …