Medication Selection by Genotype

Pharmacogenomics in the nursing literature: an integrative review

BACKGROUND

Pharmacogenomics is a rapidly growing component of personalized health care, and nurses must be competent to deliver genomic-focused nursing care.

METHODS

We conducted an integrative review of pharmacogenomics in the nursing literature. A comprehensive search of the nursing literature was conducted using the key words pharmacogenomics and pharmacogenetics. A total of 47 unique articles were included.

RESULTS

Articles represented mainly narrative reviews, with limited discussions of the implications for nursing practice, education, or research. As such, they provide limited direction for advancing either clinical practice or scientific inquiry.

CONCLUSIONS

This review serves as a call to action for more systematic and empirical publications addressing pharmacogenomics in nursing practice, education, and research. Nurses must be involved in and contribute to interdisciplinary conversations and burgeoning clinical practice initiatives related to pharmacogenomics.

From the lab to the prescription pad: genetics, CYP450 analysis, and medication response

TOPIC

Conventional child and adolescent psychopharmacology practices and its inherent risks are reviewed and the implications of pharmacogenomics and cytochrome P450 (CYP450) analysis are discussed. A case study is utilized to further depict the value of CYP450 analysis.

PURPOSE

An understanding of pharmacogenomics, specifically the CYP450 enzyme system and its involvement in the metabolism of psychotropic medications, can be utilized to improve child and adolescent psychopharmacology practices by prescribers.

SOURCES

An integrative literature review from nursing, psychiatry, medicine, and pharmacology.

CONCLUSIONS

The current trial and error process of choosing medications for child and adolescent psychiatric patients, and the growing trend of polypharmacy, results in poor outcomes and high risk of serious adverse drug reactions. The utilization of knowledge from the field of pharmacogenomics can improve prescribing practices in child and adolescent psychopharmacology management. Psychiatric nurse prescribers can improve treatment outcomes and reduce adverse drug reactions by incorporating information from the study of pharmacogenomics.

Nursing advocacy in a postgenomic age

The Human Genome Project will change how health is defined and how disease is prevented, diagnosed, and treated. As the largest group of health care providers in contact with patients, nurses need to be competent in the science of genetics. Beyond this, nurses need to understand the complexities that arise in genomic health care. Ethical, legal, and social issues are integral to the delivery of genomic health care, and nurses must have an astute understanding of such complexities. What it means to know, to reason, and to act in this postgenomic age is explored.

Cytochrome P450 testing for better psychiatric care

Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental health professionals prescribe psychiatric medications for their patients. Cytochrome P450 testing uses a blood sample to determine an individual's required dosage of identified drugs that are metabolized by the two enzymes. To provide care for patients and families, nurses should be able to demonstrate identified essential nursing competencies related to genetics and genomics, which include an understanding of cytochrome P450 testing. As patient advocates, nurses are expected to understand how to identify patients most likely to benefit from CYP2D6 and CYP2C19 testing, how to ensure informed consent for such testing, and how to educate patients about testing and test results.

Genetic competencies essential for health care professionals in primary care

The completion of the sequencing of the human genome in 2003 signaled the onset of the genomic era in health care. The knowledge gleaned from the Human Genome Project has led to the understanding that every health problem has a genetic component and that clinicians should include the application of genetic information in all aspects of health care. This article describes the genetic competencies essential for all health care professionals in primary care. Health care professionals should augment their current practice by obtaining a multigenerational genetic family history for each patient, assessing all patients for potentially heritable conditions, providing referrals to genetic health professionals as needed, offering genetic testing when indicated, and considering an individual's genetic makeup in the selection of medications and treatments for that person. Finally, all health care professionals ought to be prepared to address the complex personal, cultural, theological, ethical, legal, and social issues associated with genetic testing and other genetic issues commonly encountered in clinical practice.

Supporting parents who have a child referred for genetic investigation: the contribution of health visitors

AIM

This paper reports a study of the views of health visitors in relation to their role in supporting parents of children referred for genetic investigations.

BACKGROUND

An increasing number of children are likely to be referred for genetic investigations as our understanding of genetic inheritance develops and a wider range of tests becomes available. Internationally, there are growing expectations that nurses will be able to discuss the referral and testing processes with parents, as well as facilitate informed decision-making. However, previous studies have highlighted the limited support received from staff in primary care services by parents of children referred for genetic investigation.

METHODS

A questionnaire survey of 345 health visitors was undertaken in 11 community health and social services trusts in Northern Ireland. Questionnaires were distributed at health visitor team meetings and returned in prepaid envelopes. Data collection occurred in 2003.

FINDINGS

Completed questionnaires were returned by 194 health visitors (56.2% response rate). Many were unsure of the location of their Regional Clinical Genetics Service and reported limited contact with these services. The majority of health visitors were not informed that children on their caseload had a forthcoming appointment, or that they had attended an appointment with a geneticist. Health visitors did not routinely visit parents of children referred for genetic investigation to discuss the appointment, and they reported limited confidence in supporting parents in relation to genetic investigations.

CONCLUSION

Improved communication links are needed with Regional Clinical Genetics Services and to ensure that health visitors are informed when children on their caseload have been referred for genetic investigation. In addition, steps need to be taken to increase the coordination of support to parents provided by health visitors and staff within regional genetic services.

Genomic Influences on Schizophrenia-Related Neurotransmitter Systems

PURPOSE

(a) to summarize genomic influences in schizophrenia, (b) to review the molecular genetic profile associated with schizophrenia, (c) to summarize the genetic factors affecting dopamine and serotonin neurotransmitter systems, and (d) to list nursing implications for this knowledge.

ORGANIZING FRAMEWORK

Schizophrenia and schizophrenia-spectrum disorders, both clustered in families, arise from both genetic and environmental influences. Schizophrenia does not develop from a single genetic mutation but rather from many genetic alterations acting together.

CONCLUSIONS

Studies focused on genetic polymorphisms of neurotransmitter systems pique nurses' interest because pharmacological interventions affecting those systems remain the primary approach to treatment. Atypical antipsychotics have in common the ability to antagonize dopaminergic and serotonergic receptors. This review includes the recent discoveries regarding genetic modifications affecting dopamine and serotonin neurotransmitter systems and their potential as a basis for treatment.

Nursing Leadership in Genomics for Health and Society

PURPOSE

This article is part of the series regarding genomics and nursing practice, science, education, and policy. Issues in genetic testing, genetic information and the lessons learned through applications of genetic and genomic science are analyzed and discussed.

FRAMEWORK

Scientists, scholars, and members of the public have articulated a vision to guide genomics research and scholarship. The three overarching themes of this conceptual framework are genomes to biology, genomes to health, and genomes to society.

CONCLUSIONS

Nurses can promote the use of genomic research technologies and information in the context of health, biology, and society, as well as in nursing research, practice, education, and policy.