Pharmacogenomics in the Clinic - Essay Example

"Pharmacogenomics in the Clinic" is a decent example of a paper on drug therapy.
Before initiating abacavir, an anti-retroviral, for a newly diagnosed HIV-positive patient, the nurse practitioner orders HLA-B*5701 allele genetic testing. The test confirms that the patient carries the HLA-B*5701 alleles.

a) Describe what these results mean.

The results mean that the patient has an HLAB85701 allele, thus they have a hypersensitivity reaction towards abacavir. 

b) Should the nurse practitioner prescribe abacavir in this case? If not, state why. 

No, the nurse practitioner cannot administer abacavir in this situation. The HLA-B*5701 allele genetic testing is supposed to determine potential risks or serious side effects before applying a drug called abacavir (Puangpetch et al., 2015). Since the test confirms that the patient carries the HLA- B*5701 allele, abacavir cannot be administered since they are at risk of developing life-threatening hypersensitivity reactions. Testing for this allele is always performed before prescribing abacavir to patients. Despite the drug being tolerated before, the test is still done before prescribing abacavir again.

A patient is prescribed antiplatelet therapy (clopidogrel) following an acute myocardial infarction (MI). Six months later, the patient suffers another acute MI. The patient has been adherent to therapy, and the nurse practitioner suspects that clopidogrel may have been ineffective. How might genetic testing have been beneficial in this case? 

The patient was supposed to undergo genetic testing before clopidogrel administration to determine the likely responses to clopidogrel, an antiplatelet drug by detecting changes in the gene CYP2C19  in coding for one of the enzymes which break down the drug (Fielder et al., 2015). Similar to this case, clopidogrel is administered to people who risk getting a heart attack and stroke to prevent blood clots. Genetic testing is done by obtaining a blood sample from the arm of the patient. A physician orders for this test before prescribing clopidogrel to a patient or just at the initial stage of treatment. Other times the genetic tests may be carried out when one is taking clopidogrel, but their responses are not as expected. This genetic test, therefore, determines whether the reason for unresponsiveness to clopidogrel is due to their genetic makeup by determining the genetic changes of the gene CYP2C19. A doctor is, therefore, able to decide whether to administer clopidogrel after one determines how effective it will be or make a choice to use another drug.

Identify 2 limitations of pharmacogenomics testing. Explain. 

-Determining the gene variations that cause particular drug responses is extremely complex. This is due to the fact that the human genome is very big and is made up of three billion bases with each nucleotide polymorphs occurring in every hundred to three hundred bases (Relling, & Evans, 2015). Considering how complex it is, therefore, it implies that limited information of all genes because each drug response is available which serves to prevent them from putting up with either one or two approved medications.

-Use of pharmacogenomics testing is limited because there lacks scientific evidence that shows better and improved patient care. Despite it being utilized to treat diseases like cancer \, HIV, or cardiovascular diseases, it happens to a limited scope.

Identify 2 ethical concerns of using pharmacogenomics testing. Explain. 

Nevertheless, there exist ethical concerns of pharmacogenomics testing that trigger a discussion. First, there is genetic discrimination. It is especially essential due to legislation that has been put in place to prevent its phenomenon. Secondly, the utilization of pharmacogenomics information is considered unethical ( Relling  & Evans, 2015). Additionally, it is not clear how one is supposed to get informed consent from individuals carrying out pharmacogenomics tests.it is thus significant that health care personnel comprehend the principles of pharmacogenomics while considering the ethical implications that might arise due to its use.