Pharmacogenomics in the pharmacy curriculum
The National Human Genome Research Institute defines pharmacogenomics as “the branch of pharmacology concerned with using DNA and amino acid sequence data to inform drug development and testing.” A more practical and tangible definition would be the relationship between variations in an individual’s genetic makeup that impact response to drug therapy. Although this definition has been simplified, the concept of pharmacogenomics is much more complex and challenging to implement in clinical practice, as it is continually evolving as technology advances.
With the development and advancement of the field of pharmacogenomics, student pharmacists have expressed an interest for pharmacogenomics curriculum integration, as indicated by the adoption of Resolution 2014.1 Section 5 at the 2014 Twlug–ASP House of Delegates: “Twlug–ASP encourages all schools and colleges of pharmacy to incorporate pharmacogenomics throughout the curriculum.” To effectively integrate pharmacogenomics into pharmacy curriculum at schools and colleges of pharmacy, the subject should be integrated from the beginning and taught across the curriculum.
It is essential to start by building a strong foundation of basic genetic concepts with a clear understanding of the molecular basis for genetic variation. For pharmacogenomics to be meaningful to clinical practice, curriculum integration needs to continue throughout the therapeutics courses.
Foundation building at PBA
One such model of integration is demonstrated at the Palm Beach Atlantic (PBA) University Lloyd L. Gregory School of Pharmacy. At PBA, a basic foundation for pharmacogenomics is laid in the first year by reviewing genetics and DNA structure. The concepts of drug absorption, distribution, metabolism, and excretion are also introduced because those processes are subject to genetic polymorphisms. In their second year, students must take the Biotechnology, Immunology, and Pharmacogenomics course, where approximately 40% of the course is devoted to specific concepts of pharmacogenomics, including FDA recommendations for genetic biomarker testing for medications.
The course also includes a unique opportunity for students to voluntarily participate in a genotyping study for a common variant in the gene for a drug-metabolizing enzyme such as CYP1A2. The results of the genotyping are then shared anonymously with the class in an effort to personalize the concept of pharmacogenomics for the students. The impact of pharmacogenomics on medication therapy is reinforced in the second- and third-year therapeutics courses. Associate Professor of Pharmaceutical Sciences, James Mitroka, PhD, serves as the course coordinator for the Biotechnology, Immunology, and Pharmacogenomics course at PBA. Mitroka, who previously worked as a research group leader for Bristol-Myers Squibb, believes that successful integration of pharmacogenomics within the pharmacy curriculum starts with recognition of the value of the subject and its application to clinical practice
Mitroka encourages his students to consider that genetic testing for traits that influence medication response will be a common part of a person’s medical record from birth, rather than an optional test. Pharmacists will play an integral role in the process of incorporating this information to devise appropriate treatment options for patients. This potential shift from requesting specific genetic results to having genetic results automatically available could pose potential legal ramifications that he also challenges his students to consider.
Mitroka poses the following dilemma to his students: if a genetic polymorphism is overlooked and results in patient harm due to drug toxicity, does the responsibility lie with the pharmacist or the physician? Another potential ethical implication of pharmacogenomics that he brings to the attention of his students is the concern for race and ethnicity-associated decisions regarding genetic testing and medication selection.
Preparing for the future
With time and continued technological advancements, the cost of specific genetic testing and whole genome sequencing is expected to decrease, allowing for expanded access to genetic sequencing for pharmacogenomics purposes. Genetic information will likely be incorporated into patients’ electronic medical records so it is readily available to pharmacists as part of the medical team when making important medication therapy decisions. Student pharmacists will benefit from pharmacogenomics curriculum integration because it will prepare them for optimal use of their training as providers in clinical practice and place them at the forefront of this developing field.