Documenting Pharmacogenomic Test Results in Electronic Health Records: Practical Considerations for Primary Care Teams

With increasing patient interest in and access to pharmacogenomic testing, clinicians practicing in primary care are more likely than ever to encounter a patient seeking or presenting with pharmacogenomic test results. Gene-based prescribing recommendations are available to healthcare providers through Food and Drug Administration-approved drug labeling and Clinical Pharmacogenetics Implementation Consortium guidelines. Given the lifelong utility of pharmacogenomic test results to optimize pharmacotherapy for commonly prescribed medications, appropriate documentation of these results in a patient’s electronic health record (EHR) is essential. The current “gold standard” for pharmacogenomics implementation includes entering pharmacogenomic test results into EHRs as discrete results with associated clinical decision support (CDS) alerts that will fire at the point of prescribing, similar to drug allergy alerts. However, such infrastructure is limited to the few institutions that have invested in the resources and personnel to develop and maintain it. For the majority of clinicians who do not practice at an institution with a dedicated clinical pharmacogenomics team and integrated pharmacogenomics CDS in the EHR, this report provides practical tips for documenting pharmacogenomic test results in the problem list and allergy field to maximize the visibility and utility of results over time, especially when such results could prevent the occurrence of serious adverse drug reactions or predict therapeutic failure.

Ciprofloxacin and Metronidazole Allergy- A Case Report

Fluoroquinolones are well-tolerated antibiotics widely used for treating infections. According to the literature, ciprofloxacin is mostly involved in Drug-induced hypersensitivity reactions. The various reactions that are reported in various case reports due to ciprofloxacin include Steven Johnson syndrome, eczema, erythroderma, maculopapular rashes. Metronidazole is a 5-nitroimidazole compound introduced in 1959 to treat Trichomonas vaginalis infections. Ciprofloxacin and Metronidazole hypersensitivity is not very frequent it is usually well tolerated but allergic reactions to these drugs occur due to their increased use either alone or in combination. An 83-year-old female was admitted to the private ward of surgery at Shri Mahant Indiresh hospital with chief complaints of abdominal pain and chronic constipation as the patient was not passing stools for 10 days. The patient was diagnosed with Subacute intestinal obstruction (SAIO) based on various laboratory findings and the symptomatic treatment was given treatment. Hypersensitivity reactions can be of two types immediate that occurs within few hours of drug administration and delayed that occurs within 24-48 hours of drug administration. Here in this case the person developed vomiting immediately after few hours of Ciprofloxacin administration so it is an immediate IgE mediated anaphylactic reaction. Metronidazoleis causing Type 4 Delayed hypersensitivity reaction in this patient as rashes and itching developed the next day after administration of metronidazole drug. Healthcare professionals should maintain the record of a medication history of the patient to identify any drug allergy so that it can be avoided in the future and in case of any ADR it should be reported. The patient should be advised to go for a sensitivity test to check which drug he/ she is allergic to and should avoid taking that medication. The patient should tell his/ her history of drug allergy to the doctor so that doctor doesn’t prescribe that medication. Keywords: CBC-Complete Blood Count, RFT-Renal Function tests, LFT-Liver function tests, Hb-Hemoglobin, SGOT-Serum Glutamic oxaloacetic transaminases, ALP-Alkaline phosphatase, MCH-mean corpuscular Hemoglobin, MCHC-Mean corpuscular hemoglobin concentration, RBC-Red Blood Cells, SAIO-Subacute intestinal obstruction, USG- Ultrasound.