Pharmacogenomics (PGx) Patient with Mixed Levels of Actionable Variant Evidence

  • Michael J. Schuh Mayo School of Health Related Sciences
  • Sheena Crosby, PharmD, BCGP Mayo Clinic Florida
Keywords: CPIC, CYP2C19, CYP2D6, CYP3A4, Medication therapy management, MTM, PGx, Pharmacogenomics, PharmGKB


Objective: To demonstrate the types of clinical recommendations a pharmacogenomics pharmacist may make to medical clinicians with regard to medication management to improve therapeutic outcomes based on varied levels of medical literature evidence.

Summary: This case demonstrates how a common type of patient seen in a pharmacist practice may present with a varied pharmacogenomic (PGx) profile, how they may benefit from PGx analysis, and how varying levels of medical literature evidence can be used with clinical decision making.

Conclusion: PGx testing can help avoid adverse drug reactions (ADRs) or medication inefficacy by assisting in the adjustment of current or future medication doses. It can also help predict the best medications to use or those to avoid in advance by eliminating much of the existing dosing or medication selection method of trial and error.


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Author Biography

Michael J. Schuh, Mayo School of Health Related Sciences

Michael J. Schuh, BS, PharmD, MBA, FAPhA

Dr. Schuh received a Bachelor of Science in pharmacy from the University of Florida, an MBA from the University of Phoenix and a PharmD from Nova Southeastern University. He is the former Outpatient Pharmacy Operations Manager of Mayo Clinic Florida, a clinical pharmacist and an Assistant Professor of Pharmacy, Family and Palliative Medicine at Mayo Clinic Florida. He is also a member of the Florida Society of Health-System Pharmacists Board of Directors. On a national level he is an APhA Fellow, past Chair of APhA’s Academy of Pharmacy Practice and Management Administrative Section, Executive Committee where he served as Communications Committee Chair, and an APhA Congressional Key Contact. He was an active member of APhA’s MTM Task Force and is co-founder and past coordinator of the APhA Medication Management Special Interest Group where he served as Chair of both the Education and Business/Practice Model Committees. Dr. Schuh is also a past Clinical Assistant Professor at the University of Florida, Coordinator of the UF MTM Master of Science program and holds clinical appointments at other leading universities. Outside of pharmacy, he served as a National Quality Forum Advisory Panel Member, Chamberlain College of Nursing Advisory Committee member, and as a Visiting Professor of Nutrition Health and Wellness, Integrated Science, Business Management and Nursing Pharmacology at DeVry University.

Received 2020-04-16
Accepted 2020-04-23
Published 2020-05-05
Pharmacy Practice & Practice-Based Research