Exploring Pharmacogenomic Testing (CNE)

Pharmacogenomic testing can provide clinical information about how specific variants may impact therapeutic efficacy and toxicity, as well as how to select the most appropriate drug, the optimal dose, and how to identify patients at risk for more frequent adverse drug reactions.

Precision Medicine for Your Practice is a series of short (30 min), online modules covering specific topics in genomics and precision medicine. In this module, Exploring Pharmacogenomic Testing, participants will learn about the benefits and limitations of pharmacogenomic testing, how to determine whether pharmacogenomic testing is appropriate for the patient and the application of test results to patient management. There are five parts of the module: overview via an animated video; practice cases to facilitate learning-by-doing; "dig deeper" for more in-depth topics; and logistics and additional resources for more detail.

To claim credit, follow the steps in the learning path.

CNE Disclosures

Activity Overview
Precision Medicine for Your Practice: Exploring Pharmacogenomic Testing (CNE)

Original Publication Date:  May 20, 2021
Renewal Date:  September 14, 2022
Expiration Date: September 14, 2024

Learning Outcome
Upon completion of this educational activity, the learner will be able to:

• Recognize the benefits and limitations of pharmacogenomic testing for the purpose of supporting shared decision-making

Target Audience
This activity is designed to meet the educational needs of clinicians who are using or interested in using pharmacogenomic information to help make decisions about drug selection and dosing.

CNE Approval Statement
The Jackson Laboratory is co-providing this continuing nursing education activity with the American Medical Association and Scripps Health. This nursing continuing professional development activity was approved by the Northeast Multistate Division Education Unit, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

In order to claim credit 1) answer the pre-assessment questions, 2) work through the module content in its entirety, 3) successfully complete the post-assessment answering 4 out of 5 questions correctly and 4) complete the evaluation.  

Nurses are eligible for a maximum of .50 contact hours upon the completion of this activity.

Planning Committee

• Emily Edelman, MS, CGC, Director, Clinical Education, The Jackson Laboratory
• Therese Ingram, MA, Associate Director and Senior Instructional Designer/Technologist, Clinical Education, The Jackson Laboratory
• Laura Nicholson, MD, PhD, Director of Research, Graduate Medical Education (GME), Scripps Health
• Kate Reed, MPH, ScM, CGC, Director, Precision Oncology Education, Clinical Education, The Jackson Laboratory
• Karen Reinbold, MBA, Health and Science Director, American Medical Association
• Linda Steinmark, MS, CGC, Project Manager, Clinical Education, The Jackson Laboratory
• Janet K. Williams, PhD, RN, FAAN, Professor of Nursing, Chair of Behavioral and Social Science Research, University of Iowa

Faculty and Authors

• Emily Edelman, MS, CGC, Director, Clinical Education, The Jackson Laboratory (Author)
• Therese Ingram, MA, Associate Director and Senior Instructional Designer/Technologist, Clinical Education, The Jackson Laboratory (Author)
• Sean C. McConnell, PhD, Senior Policy Analyst, Science, Medicine & Public Health, CME Program Committee, American Medical Association (Author)
• Kate Reed, MPH, ScM, CGC, Director, Precision Oncology Education, Clinical Education, The Jackson Laboratory (Author)

Subject Matter Experts

• Kristin Wiisanen, PharmD, FAPhA, FCCP, Clinical Professor, Associate Director Pharmacogenetics, University of Florida/UF Health (Content Reviewer)
• Jason Vassy, MD, MPH, Assistant Professor, Harvard Medical School (Content Reviewer)

Conflict of Interest Disclosure
Unless otherwise noted, the program planners and faculty do not have a financial interest/arrangement or affiliation with any organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this course. All educational material has been peer-reviewed by external reviewers to assess for bias.

The following disclosures are reported that could be perceived as a real or apparent conflict of interest in the education program:

Janet K. Williams, PhD, RN, FAAN, stockholder of Pfizer. In her role as a planner, Dr. Williams recused herself from all deliberations relating to content related to the commercial entities with which she has a financial interest and is not responsible for reviewing for bias any related content. 

In 2020 Ms. Edelman received salary support through a proposal selected by the American Community Cancer Centers and Pfizer for an education project. In her roles as a planner and author, Ms. Edelman recused herself from all deliberations relating to content related to the commercial entity with which she has financial interest and was not responsible for reviewing for bias any related content. 

References

Abbasi J. Getting Pharmacogenomics Into the Clinic. JAMA. 2016; 316(15):1533-1535.

Adams SM, Crisamore KR, Empey PE. Clinical Pharmacogenomics: Applications in Nephrology. Pharmacogenomics J. 2019; 13(10):1561-1571.

Association for Molecular Pathology Position Statement. Best Practices for Clinical Pharmacogenomic Testing. 2019 Sept 4.

Barbarino JM, Whirl-Carrillo M, Altman RB, Klein TE. PharmGKB: A worldwide resource for pharmacogenomic information. Wiley Interdiscip Rev Syst Biol Med. 2018; 10(4):e1417.

Borden BA, Lee SM, Danahey K, et al. Patient-provider communications about pharmacogenomic results increase patient recall of medication changes. Pharmacogenomics J. 2019; 19(6):528-537.

Caraballo PJ, Hodge LS, Bielinski SJ, et al. Multidisciplinary model to implement pharmacogenomics at the point of care. Genet Med. 2017; 19(4):421-429.

Carere DA, VanderWeele TJ, Vassy JL, et al. Prescription medication changes following direct-to-consumer personal genomic testing: findings from the Impact of Personal Genomics (PGen) Study. Genet Med. 2017; 19(5):537-545.

Cavallari LH, Van Driest SL, Prows CA, et al. Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribing. Genet Med. 2019; 21(10):2255-2263.

Chanfreau-Coffinier C, Hull LE, Lynch JA, et al. Projected Prevalence of Actionable Pharmacogenetic Variants and Level A Drugs Prescribed Among US Veterans Health Administration Pharmacy Users. JAMA Netw Open. 2019; 2(6):e195345.

Crews KR, Gaedigk A, Dunnenberger HM et al. Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450 2D6 Genotype and Codeine Therapy: 2014 Update. Clin Pharmacol Ther. 2014; 95(4):376-382.

Gaedigk A, Sangkuhl K, Whirl-Carrillo M, Klein T, Leeder JS. Prediction of CYP2D6 phenotype from genotype across world populations. Genet Med. 2017; 19: 69-76.

Haga SB. Pharmacogenomic Testing In Pediatrics: Navigating The Ethical, Social, And Legal Challenges. Pharmacogenomics Pers Med. 2019; 12:273–285.

Haga SB and Mills R. A review of consent practices and perspectives for pharmacogenomic testing. Pharmacogenomics. 2016; 17(14):1595-1605.

Hicks JK, Dunnenberger HM, Gumpper KF, Haidar CE, Hoffman JM. Integrating pharmacogenomics into electronic health records with clinical decision support. Am J Health Syst Pharm. 2016; 73:1967–76.

Hippman C, Nislow C. Translating pharmacogenomics into clinical decisions: do not let the perfect be the enemy of the good. J Pers Med. 2019; 9(3).

Jarvis JP, Peter AP, Shaman JA. Consequences of CYP2D6 Copy-Number Variation for Pharmacogenomics in Psychiatry. Front Psychiatry. 2019; 10:432.

Krebs K, Milani L. Pharmacogenomic Testing: Clinical Evidence and Implementation Challenges. Hum Genomics. 2019; 13(1):39.

Lemke AA, Hulick PJ, Wake DT, et al. Patient perspectives following pharmacogenomics results disclosure in an integrated health system. Pharmacogenomics. 2018; 19(4):321-331.

Malki MA, Pearson ER. Drug–drug–gene interactions and adverse drug reactions. Pharmacogenomics J. 2020; 20:355-366.

Mukerjee G, Huston A, Kabakchiev B, Piquette-Miller M, van Schaik R, Dorfman R. User considerations in assessing pharmacogenomic tests and their clinical support tools. NPJ Genom Med. 2018; 3:26.

Patel JN, Wiebe LA, Dunnenberger HM, McLeod HL. Value of Supportive Care Pharmacogenomics in Oncology Practice. Oncologist. 2018; 23(8):956-964.

Patient-Centered Primary Care Collaborative. The Patient-centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes Resource Guide, Second Edition. June 2012, accessed September 2020 from https://www.pcpcc.org/sites/default/files/media/medmanagement.pdf.

Pratt VM, Cavallari LH, Del Tredici AL, et al. Recommendations for Clinical CYP2C9 Genotyping Allele Selection: A Joint Recommendation of the Association for Molecular Pathology and College of American Pathologists. J Mol Diagn. 2019; 21(5):746-755.

Reisberg S, Krebs K, Lepamets M. Translating genotype data of 44,000 biobank participants into clinical pharmacogenetic recommendations: challenges and solutions. Genet Med. 2019; 21(6):1345-1354.

Relling MV, Evans WE. Pharmacogenomics in the clinic. Nature. 2015; 526(7573):343-50.

Roden DM, McLeod HL, Relling MV, Williams MS, Mensah GA, Peterson JF, et al. Pharmacogenomics. Lancet. 2019; 1394(10197):521-532.

van der Wouden CH, van Rhenen MH, Jama WOM, et al. Development of the PGx-Passport: A Panel of Actionable Germline Genetic Variants for Pre-Emptive Pharmacogenetic Testing. Clin Pharmacol Ther. 2019; 106(4):866-873.

Wang L, McLeod HL, Weinshilboum RM. Genomics and drug response. N Engl J Med. 2011; 364(12):1144-53.

Weitzel KW, Duong BQ, Arwood MJ, et al. A stepwise approach to implementing pharmacogenetic testing in the primary care setting. Pharmacogenomics. 2019; 20(15):1103-1112.

Hardware/Software Requirements
Audio speakers or headphones
Screen resolution of 800X600 or higher
Adobe Reader 5.0 or higher 

Check the supported browsers.

Should you have technical questions or questions regarding the content of the activity, please email Clinical and Continuing Education at the Jackson Laboratory.

Disclaimer 
All information in Precision Medicine for Your Practice is provided for educational purposes only. This information is not a substitute for clinical guidance or the consultation of a medical professional. Always seek the advice of a qualified health professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in Precision Medicine for Your Practice. Reliance on any information in Precision Medicine for Your Practice is solely at your own risk. The Jackson Laboratory does not endorse or recommend any specific procedures, tests, products, services, health professionals or other information that may be found in Precision Medicine for Your Practice.