Nurse empowerment through Pharmacogenetics

this is a quantitative, cross-sectional, observational, descriptive study, whose final sample was 67 individuals. The participants were healthy at the time of the study and reported a history of previous use and the occurrence of adverse effects by drugs commonly used and metabolized by CYP2C9. We collected 4 mL of venous blood for subsequent DNA extraction by salting out method and genotyping of the CYP2C9*2 and CYP2C9*3 polymorphisms, using Polymerase Chain Reaction in real time using Taqman assays.

Results:

the use of drugs metabolized by CYP2C9 was frequent (more than 75% of the individuals have already used between 2 or 4 of these drugs). Regarding adverse events, there were 19 perceived symptomatic occurrences associated with drugs metabolized by CYP2C9. The allele frequency of the polymorphism * 2 and * 3 in the population studied was 11.1% and 7.5%, respectively, and there was a coincidence between the presence of alleles of low enzyme activity and the occurrence of adverse effects.

Conclusion:

there are elements that justify the adoption of pharmacogenetics in the nursing care to reduce the occurrence of adverse reactions to drugs metabolized by CYP2C9.

Descriptors:
Cytochrome P-450 CYP2C9; Pharmacogenetics; Drug-Related Side Effects; Adverse Reactions; Nursing; Nursing Process

Variables	n^* * n = Values in number of observations;	%^† † % = Percentage frequency;
Gender
Female	42	62,7
Male	25	37,3
Age
Average ± SD^‡ ‡ SD = Standard deviation	52 ± 9
Skin color
White	51	76,1
Non-white	16	23,9
Nationality
Brazilian	67	100

Parameter	N (%)^* * n (%) = Values in number of observations or percentage frequency
Previously used drugs metabolized by CYP2C9	66 (98.5%)
Ibuprofen	32 (17.2%)
Acetylsalicylic Acid	54 (29%)
Diclofenac	55 (29.6%)
Celecoxib	12 (6.5%)
Rosuvastatin	12 (6.5%)
Prasugrel	1 (0.5%)
Phenytoin	1 (0.5%)
Irbesartan	0 (0%)
Losartan	17 (9.1%)
Warfarin	2 (1.1%)
Number of medications already used
= 1	10 (15.2%)
2 - 4	50 (75.8%)
>4	6 (9%)
Occurrence of adverse events	19 (27.5%)
Nausea	1 (5.3%)
Headache	1 (5.3%)
Vertigo	1 (5.3%)
Decreased urinary output	1 (5.3%)
Pain in the legs	1 (5.3%)
Paresthesia	2 (10.4%)
Stomach pain	8 (42.1%)
Allergic reactions	4 (21%)
Medications related to the occurrence of adverse events
Aspirin	9 (42.8%)
Diclofenac	8 (38.1%)
Losartan	2 (9.5%)
Rosuvastatin	1 (4.8%)
Celecoxib	1 (4.8%)

Polymorphism	Genotype	Phenotype	n^* * n = Values in number of observations;	%^† † % = Percentage frequency;
CYP2C9 ^* * n = Values in number of observations; 2 (rs1799853)	C/C (^* * n = Values in number of observations; 1/^* * n = Values in number of observations; 1)	EM^‡ ‡ EM = Extensive metabolizer;	52	77.6
	C/T (^* * n = Values in number of observations; 1/^* * n = Values in number of observations; 2)	IM^§ § IM = Intermediate metabolizer (slower)	15	22.4
CYP2C9 ^* * n = Values in number of observations; 3 (rs1057910)	A/A (^* * n = Values in number of observations; 1/^* * n = Values in number of observations; 1)	EM^‡ ‡ EM = Extensive metabolizer;	57	85.1
	C/A (^* * n = Values in number of observations; 1/^* * n = Values in number of observations; 3)	IM^§ § IM = Intermediate metabolizer (slower)	10	14.9

Polymorphism	Alele	n^* * n = Values in number of observations;	RP(%)^† † RP = Population of Ribeirão Preto, São Paulo;	CEU(%)^‡ ‡ CEU = caucasian europeans - population of Caucasian origin composed of descendants of Europeans who inhabit the Utah region in the United States (USA);	YRU(%)^§ § YRU = Yorubans - population of African origin from the Yoruba ethnic group, inhabitants of Ibadan, Nigeria;	Pa^‖ ‖ Pa = p-value of the comparison between populations RP vs. CEU;	Pb^¶ ¶ Pb = p-value of the comparison between populations RP vs. YRU;
CYP2C9 ^* * n = Values in number of observations; 2 (rs1799853)	^* * n = Values in number of observations; 1	119	88.8	89.6	100	-	-
	^* * n = Values in number of observations; 2	15	11.1	10.4	0	0.818	<0.001^* * n = Values in number of observations; ^* * n = Values in number of observations;
CYP2C9 ^* * n = Values in number of observations; 3 (rs1057910)	^* * n = Values in number of observations; 1	124	92.5	94.2	100	-	-
	^* * n = Values in number of observations; 3	10	7.5	5.8	0	0.774	0.007^* * n = Values in number of observations; ^* * n = Values in number of observations;

Item	Catalog number	Value paid^* * Values obtained from www.thermofisher.com in 10/04/2019;	Price per exam^† † The following items were included for this cost analysis: Taqman probes and respective Master Mix for genotyping; Latex gloves and vacutainer tubes; phenol and Eppendorf-type plastic tubes;
Taqman Probes	4362691	3,600.00	R$ 9.57
Master Mix	4371357	4,000.00	R$ 2.00
Collection Material	-	-	R$ 1.50
Value of DNA extraction^‡ ‡ DNA = Deoxyribonucleic acid; ^§ § Approximate values - have been rounded up since there are other low-cost items that are also used, in addition, personnel and equipment costs, not necessary in a context of service provided by the university, have been excluded from this calculation	-	-	R$ 8.00
Total			R$ 21.07

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Riccardo Lacchini E-mail: rlacchini@eerp.usp.br

Brasil

Brasil

Nurse empowerment through Pharmacogenetics* * Supported by Pró-Reitoria de Cultura e Extensão of Universidade de São Paulo, Brazil, grants #1385/2015 and #1769/2016.

Objective:

Method:

Results:

Conclusion:

Nurse empowerment through Pharmacogenetics^* * Supported by Pró-Reitoria de Cultura e Extensão of Universidade de São Paulo, Brazil, grants #1385/2015 and #1769/2016.