HCI 3 - M6: PGx

What is an example of pharmacokinetics?

Metabolizing enzymes

Transporters

What is an example of pharmacodynamics?

Off-target

Drug targets

What is fixed dosing?

Same standard dosing and dosing interval for most patients

What are the different types of individualized dosing?

Priori adjustment

Posteriori adjustment

What is priori adjustment?

uses information already known before the patient

What is posteriori adjustment?

using info that is obtained during treatment

What is precision medicine?

Using genetic, clinical, environmental, lifestyle, and other patient-specific information to target drugs

What is personalized medicine?

A complete unique treatment that is made per each individual

What is key distinction?

Identifying groups of patients with shared characteristics who are more likely to benefit from a specific strategy

T or F:

PGx is a tool that is used to support precision medication decisions

True

T or F:

Clinical utility associated PGx clinical application will vary

T

What are examples of how clinical utility will be varied?

Psychiatry; anti-depressants

CVD; DAPT

What are the 4 factors that influence PGx clinical utility?

What: drug-gene pairs & therapeutic relevance

When: Timing of PGx timing

Who: population characteristics

Where: practice setting

T or F:

Lower prevalence of actional variants in a population enhances the impact and cost-effectiveness of pharmacogenomic testing

False; Higher prevalence

what is pre-emptive testing of PGx

Testing performed BEFORE a medication is prescribed

what is the goal and benefit of pre-emptive testing?

Goal: have genetic info readily available before a med is given

Benefit: gives real-time clinical decision support

what is reactive PGx testing?

testing that is ordered in response to or after a specific clinical event

what is the goal and benefits to reactive PGx testing?

Goal: to guide therapy after a problem or decision point has emerged

Benefit: more targeted

What is anticipatory/near-treatment testing?

Testing that is given because a treatment decision is expected soon

Reactive testing is done in response to what 3 events?

new prescriptions

adverse reactions

treatment failure

when using PGx to help with the quality of care for a patient, what should you must always do to make sure that the medication is working to reach clinical outcome goals in an AmCare pharmacy setting?

Longitudinal follow-up and medication management

What 4 steps should be done to implement PGx in a hospital based setting?

1. Needs & Readiness assessment

2. Stakeholder & implementation team engagement

3. Workflow & infrastructure design

4. Metrics, evaluation & continuous improvement

What are the 3 categories in needs and infrastructure assessment?

Infrastructure

Clinical opportunity

Personnel

What genes does Clopidogrel inhibit?

CYP2C19

what genes does Voriconazole inhibit?

CYP2C19

what genes does PPIs inhibit?

CYP2C19

what genes does SSRIs inhibit?

CYP2C19

T or F:

The role of pharmacists will depend on the implementation plan and resources available

True

What are the 5 ways pharmacists roles can be included in the clinical team regarding PGx?

Apply PGx results in daily practice

Collaborate with PGx team

Support workflow adoption

Identify eligible patients

Promote culture of precision medicine

T or F:

Engaging clinicians early helps with ensuring better alignment with clinical workflows and goals

True

What are the 4 roles in which a physician or a prescribing champions includes?

Advocating for appropriate gene-drug testing

Collaborating on the design and integration of clinical decision support tools

Serving as a peer influencer to promote PGx adoption and address skepticism

Supporting training and education within their clinical team

What are the 3 ways of integrating PGx into existing clinical workflows?

Minimize disruption

Engage clinicians early

Embed into routine care

What are the 3 steps of workflow and implementation plan?

1. Map the current workflow

2. Align PGx with value-based care goals

3. Design a PGx workflow that fits

How can we measure the implementation of PGx with service-process KPIs?

Turnaround time

Time from genotype result ---> recommendation

# of inappropriate genotyping orders

# of delayed genotype results

How can we measure PGx implementation using Service-Utilization KPIs?

PGx consult volume

Utilization by clinical service

Testing uptake

How can we measure PGx implementation using Patient/Provider satisfaction KPIs?

Provide satisfaction surveys

What is a big barrier of PGx implementation across different healthcare settings?

Health IT integration

- Limited decision support tools

- Difficulty integrating genetic results into EHRs

When implementing PGx services, which stakeholders are critical to engage with:

IT

Laboratory

Pharmacy team

Clinical teams (prescibers)

Which of the following factors influence the clinical utility of a PGx test?

The therapeutic relevance of the drug-gene pair

The timing of when the test is performed

The practice setting (eg., inpatient vs outpatient)

What is a key role of physician champions in PGx implementation?

Promote PGx adoption among peers and help design clinical decision support tools

Which scenario best represents preemptive PGx testing?

Testing ordered routinely before a specific drug is needed

In which of the following ways can population genetics most directly influence the value of PGx testing?

High prevalence of actionable alleles increases utility and cost-effectiveness

What statement best describes personalized medicine?

Personalized medicine uses a patient's clinical characteristics, preferences, lifestyle, and other individual factors guide healthcare decisions

Which statement best defines precision medicine?

Precision medicine uses genetic, biomarker, and other biologic information to help identify treatments that are most likely to benefit specific patients or patient subgroups

A pharmacist is discussing two approaches to optimizing drug therapy. She explains that personalized medicine considers a patient's overall clinical characteristics, preferences, and environment when selecting therapy, whereas precision medicine uses specific biologic data, such as genetic or molecular markers, to identify the most appropriate treatment for a subgroup of patients.

Precision medicine and personalized medicine are synonymous terms and can be used interchangeably in all healthcare settings

What kind of testing helps with enabling real-time clinical decision support?

Pre-emptive testing