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Pharmacogenomics > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

Number 1 on website for Pharmacogenomics

A

CPIC

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2
Q

Pathogens can exist as

A

Bacteria
Viruses
Fungi
Parasites

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3
Q

When discussing the patient and antimicrobial agent, what else must be taken into consideration?

A

Pathogen

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4
Q

Goals of Pharmacogenomics in ID

A

Ensure optimal dosing to achieve desired drug concentrations at the site of infection

Avoid drug toxicity due to supratherapeutic dosing

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5
Q

HLA-B is responsible for

A

Presenting peptides to immune cells and plays a critical role in normal immune recognition of pathogens

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6
Q

A variant allele, HLA-B*57:01 is associated with

A

Increased risk of hypersensitivity reaction to the anti-HIV drug ABACAVIR

*Abacavir is NOT recommended

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7
Q

Guideline for Efavirenz is based on what P450 CYP?

A

CYP2B6

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8
Q

Efavirenz - 2B6 -> 8-hydroxyefavirenz (inactive) -2B6-> 8,14 dihydroxyefavirenz (inactive)

Efavirenz -2B6-> 7-hydroxyefavirenz (inactive)

A

WITHOUT CYP2B6 or with CYP2B6 variant allele, Efavirenz will stay active

  • With Variant CYP2B6 516 G>T
  • Leads to increased EFV concentrations and CNS toxicity
  • EFV dose reductions may benefit patients with 516 G>T
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9
Q

Normal Efavirenz symptoms

A

CNS Toxicity which leads to
Poor Quality of Life
Decreased Adherence
Treatment Discontinuation

Symptoms begins within 1 to 2 days after initiation and may resolve within 2 to 4 weeks of continued therapy.

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10
Q

Atazanavir INHIBITS

A

UGT1A1

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11
Q

UGT1A1 28/28 is a significant risk factor for

A

Severe Hyperbilirubinemia among patients taking atazanavir

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12
Q

Voriconazole is metabolized by

A

CYP2C19

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13
Q

*17 in CYP2C19 represents poor metabolizer or ultrarapid?

A

Ultrarapid

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14
Q

In Adults take Voriconazole and is a CYP2C19 ultrarapid, rapid, or poor metabolizer, should you consider an alternative agent?

A

Yes

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15
Q

In Pediatrics taking Voriconazole and is a CYP2C19 Ultrarapid or poor metabolizer, should an alternative agent be considered?

A

Yes

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16
Q

PPIs are METABOLIZED BY

A

CYP2C19

17
Q

Omeprazole/Esomeprazole is 90% CYP2C19 to

A

Inactive 5-hydroxy-omeprazole

18
Q

The mitochondrion contains its own circular dsDNA. mtDNA is solely present in ova, resulting in strict maternal inheritance. mtDNA contains 37 genes

  • 13 protein-encoding genes involved in oxidative phosphorylation
  • 24 genes involved in protein translation
    • 22 tRNA
    • 2 rRNA genes
  • MT-RNR for 12S rRNA*
A

MT-RNR1 1555A>G producees a mitochondrial 12s rRNA that is structurally similar to bacterial rRNA

19
Q

MT-RNR1 1555A>G variant + Aminoglycoside Exposure

A

Irreversible Ototoxicity

= Decrease mitochondrial protein synthesis, ATP production in the cochlea, and apoptosis

20
Q

With warfarin

A

Balance risk of thrombosis vs bleeding

21
Q

S-Warfarin inhibits

A

VKORC1 and uses CYP2C9 to inactivate metabolites

22
Q

CYP2C9 affects PK or PD

A

PK, metabolism of S-warfarin

23
Q

VKORC1 affects PK or PD

A

PD, warfarin target

24
Q

VKORC1 -1693G>A polymorphism

A

GA = reduced warfarin dose

AA greatly reduced warfarin dose (more sensitive)

25
Q

85-90% of Clopidogrel is converted to inactive acid metabolite. What P450 Cytochrome is used to convert clopidogrel to an active form?

A

CYP2C19

26
Q

If Clopidogrel Biotransformation and Platelet Inhibition Decreases and the patient has Loss of Function of Alleles

A

Risk of CV Events Increase

27
Q

Although a study proved that ticagrelor/prasugrel is noninferior to Clopidogrel in terms of thrombotic events, the two medication does

A

Lower bleeding risk

28
Q

If a patient is genotyped as an Intermediate Metabolizer or Poor Metabolizer (has any variant gene), they should be treated how?

A

Prasugrel 10 mg QD or Ticagrelor 90 mg BID

29
Q

Adverse of Effects of Statins

A

Myalgia
Myopathy
Rhabomyolysis

30
Q

Simvistatin relies on ________ for uptake of activated simvastatin

A

SLCO1B1

31
Q

If there is an variant on SLCO1B1

A

the adverse effects are at an increase

32
Q

For a poor metabolizerof SLCO1B1

A

Consider an alternative agent (pravastatin, rosuvastatin, fluvastatin)

33
Q

A 62 year old female has STEMI treated with PCI and DES. Her CYP2C19 genotype is ordered and returns as 1/2. Which therapy is best?

A. Prasugrel 5 mg daily
B. Clopidogrel 75 mg daily
C. Ticagrelor 90 mg BID
D. Clopidogrel 150 mg daily

A

C

34
Q

A 62 year old female has STEMI treated with PCI and DES. Her CYP2C19 genotype is ordered and returns as 1/1. Which therapy is best?

A. Clopidogrel 75 mg daily
B. Prasugrel 5 mg daily
C. Clopidogrel 150 mg daily
D. Ticagrelor 90 mg BID

A

A

Pharmacogenomics (1 decks)

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