NR-565 Week 1 Discussion: Pharmacogenomics (Original Post, Peer Response)
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NR 565
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Chamberlain College Of Nursing
NR-565 Week 1 Discussion: Pharmacogenomics (Original Post, Peer Response) NR565 week 1 discussion Professor and class, Before initiating abacavir, an anti-retroviral, for a newly diagnosed HIV p ositive patient the nurse practitioner orders HLA-B*5701 allele genetic testing. The test confirms that ...
nr 565 week 1 discussion pharmacogenomics original post
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NR 565
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NR-565 Week 1 Discussion: Pharmacogenomics
(Original Post, Peer Response)
NR565 week 1 discussion
Professor and class,
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 allele.
The HLA-B*5701 is genetic testing used to determine the potential risk for severe side effects
from the antiviral medication abacavir (De Spiegelaere et al., 2015). The HLA-B gene has an
impact on how the immune system responds and recognizes various pathogens while mediating
hypersensitivity reactions (De Spiegelaere et al., 2015). If a copy of the HLA-B*5701 is positive,
it determines there is at least one copy of the allele. This test is run by obtaining a sample of the
patient's saliva or blood. Abacavir is a nucleoside reverse transcriptase inhibitor used as an
antiretroviral therapy in HIV patients (De Spiegelaere et al., 2015). Due to this drug having a
hypersensitive reactionto patients that are HLA-B*5701 carriers, the FDA has recommended all
providers pre- screen their patients before prescribing this medication in the treatment of HIV
patients (De Spiegelaere et al., 2015).
In this scenario, the patient carries the HLA-B*5701 allele; therefore, they should not be
prescribed abacavir. The side effects of a patient receiving abacavir that test positive forthe HLA-
B*5701 allele can be fatal (De Spiegelaere et al., 2015). Additionally, they mayexhibit symptoms
that include a fever, rash, vomiting, and shortness of breath (De Spiegelaere et al., 2015).
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 clopidrogel may have been ineffective. How might genetic
testing have been beneficial in this case?
For the last ten years, I have been working in the cardiac Cath Lab. Antiplatelet therapyis a
crucial aspect of positive patient outcomes. Plavix (clopidogrel) is an antiplatelet drug that
inhibits the ability of platelets from sticking together, preventing clot formation.Plavix has been
a gold standard for patients that receive coronary interventions. If a patient has another cardiac
event, we use P2Y12 blood samples to determine if the patient is responsive to Plavix. When a
patient is resistant to Plavix, it generally meansthe CYP2C19 gene is nonfunctional (Moon
et.al., 2018). When the CYP2C19 gene is nonfunctional, it cannot convert Plavix to its active
form (Moon et.al., 2018).
In this scenario, pre-genetic testing could have determined if Plavix would have been aneffective
Antiplatelet therapy for this patient. Unfortunately, patients that have genetic variants of
CYP2C19 have an increased risk for developing a major cardiac event, stroke, and death (Moon
et.al., 2018).
Identify 2 limitations of pharmacogenomics testing. Explain.
Two limitations of pharmacogenetics testing are the lack of genetic knowledge and cost-
effectiveness evidence (Krebs, & Milani, 2019). Many providers do not order genetic
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