How pharmacogenomics can affect community practice

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How pharmacogenomics can affect community practice

Pharmacogenomics is coming to a pharmacy near you. Pharmacogenomics is the individual genetic testing of how we metabolize medications. Pharmaco-genomics combines pharmacology with genomics, the science of mapping genomes. All that is needed is a cheek swab sent to a lab to obtain results. Results are sent back to a physician’s office or patient in the form of a report, sometimes with a medication list of how that patient metabolizes medications on the list. The testing is becoming very popular.

Foundation of Knowledge
What relevancy does this have on community pharmacy? A lot. Pharmacists already have the best foundation knowledge in pharmacology, pharmacokinetics and pharmacodynamics, so they are the natural “go to” as the most accessible healthcare professional to help interpret the testing and clinically use it.

We have been telling patients for years not to drink grapefruit juice with statins. Now we know specifically why. Furanocoumarins in grapefruit juice inhibit the enzyme CYP3A4 so blood levels of certain statins may be increased, resulting in the adverse drug reactions of muscle soreness and elevated liver enzymes if grapefruit juice is taken with certain statins. Other CYP3A4-metabolized medications could be affected as well.

Getting Smarter
As software is being developed, soon pharmacogenomics information will be deployed into dispensing software to identify gene-drug interactions just as one would identify and record allergies into a patient’s pharmacy health record. Our genetic makeup to metabolize medications generally does not change over our lifetime. Like allergies or other drug intolerances, pharmacogenomics testing can help determine which medications may be more effective or more likely to cause an adverse drug reaction.

Educating Patients
So what can we do until this software is available to flag certain medications for ineffectiveness or adverse drug reactions? We can educate ourselves about this new science to acquire at least a working knowledge. With this knowledge, we can help patients when they come into the pharmacy with their reports. We can explain the basics and possibly manually add any actionable, important gene-drug interactions to their pharmacy record. This can help us to make recommendations to patients or their physicians on the best medication therapy to use before the prescription gets filled.

Added Clinical Value
Pharmacogenomics can be a market differentiator. It can set one apart from the competition as a more clinically oriented dispensing pharmacy, or it may add another service revenue stream to a pharmacy that already emphasizes services. Patients will pay out of pocket for the testing and related interpretive or clinical services. Local providers will know your store as one with better prescription screening, and use yours as the preferred for interprofessional collaboration. Patients will identify and trust your pharmacy as one with more comprehensive service, resulting in increased foot traffic and increased sales.

Michael Schuh is an ambulatory pharmacist, assistant professor of family and palliative medicine, and assistant professor of pharmacy at the School of Health Sciences College of Medicine.