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Pgx > NeuroPsychiatirc Disorders > Flashcards

NeuroPsychiatirc Disorders Flashcards

1
Q

What percentage of pt see remission for antidepressants?

A

30%

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2
Q

What is SLC6A4?

A

It is the serotonin transporter gene

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3
Q

What are the SLC6A4 type of allele?

A

Short doenst have 44bp insertion (more depression)
Long does have the 44 bp insertion
more common in whites the long allele
Asian more common to have the SS allele

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4
Q

Does gender play a role in SLC6A4 gene?

A

Yes females have a better response to Antidepressant if they have one L allele

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5
Q

Jama study

A

Pt with PGx information got drugs within 30 days
Approx 1000 each side
50% of population stop antidepressant
This helps remission faster

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6
Q

2D6 relation with Amitriptyline and Nortriptyline?

A

Hydroxylation to drug and they are directly correlated

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7
Q

CPIC for TCA PM?

A

Do not start TCA
If need to 50% dose reduction

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8
Q

CPIC for TCA IM?

A

25% reduction of dose

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9
Q

CPIC for TCA NM?

A

Regular dose

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10
Q

CPIC for TCA UM?

A

Avoid bc lack of efficacy of treatment
If needed consider increase dose

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11
Q

Amitriptyline and Nortriptyline how do they work?

A

They are the parent drug and the high the levels the better the efficacy

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12
Q

CPIC for 2C19 Tertiary Amines PM

A

Avoid - moderate
If need to use 50% reduction

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13
Q

CPIC for 2C19 Tertiary IM

A

Regular starting dose

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14
Q

CPIC for 2C19 Tertiary amines NM

A

Starting dose

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15
Q

CPIC for 2C19 tertiary UM

A

Avoid bc no effect and use a secondary amine

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16
Q

CPIC 2C19 for Citalopram and Escitalopram PM

A

Select alternative
Or lower dose by 50%

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17
Q

CPIC 2C19 for Citalopram and Escitalopram IM

A

Staring dose

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18
Q

CPIC 2C19 for Citalopram and Escitalopram NM

A

Starting dose

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19
Q

CPIC 2C19 for Citalopram and Escitalopram UM

A

Select alternative
If need to use high dose required

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20
Q

Study with Citalopram and QTc?

A

Found that more prevalent QTc in PM and pt on 2C19 inhibitors (cimetidine)
Max 20mg dose

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21
Q

CPIC for 2C19 for Sertraline PM

A

Alternative or 50% reduce

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22
Q

CPIC for 2C19 for Sertraline IM

A

Starting dose

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23
Q

CPIC for 2C19 for Sertraline NM

A

Standard dose

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24
Q

CPIC for 2C19 for Sertraline UM

A

Starting dose

25
Q

CPIC for 2B6 for Sertraline PM

A

Alternative drug if use 25%
Optional

26
Q

CPIC for 2B6 for Sertraline IM

A

Standard dose

27
Q

CPIC for 2B6 for Sertraline NM

A

Standard dose

28
Q

CPIC for 2B6 for Sertraline UM

A

Standard dose

29
Q

CPIC for 2D6 Paroxetine PM

A

50% reduce in dose
Titration 50% slower
Maintenance 50% less

30
Q

CPIC for 2D6 Paroxetine IM

A

Lower starting dose
Optional

31
Q

CPIC for 2D6 Paroxetine NM

A

Standard therapy

32
Q

CPIC for 2D6 Paroxetine UM

A

Select drug alternative

33
Q

CPIC for 2D6 Venlafaxine PM

A

Consider alternative
Optional

34
Q

CPIC for 2D6 Venlafaxine IM

A

No recommendations

35
Q

CPIC for 2D6 Venlafaxine NM

A

Starting dose

36
Q

CPIC for 2D6 Venlafaxine UM

37
Q

CPIC for 2D6 Vortioxetine PM

A

50% reduction of dose w/ a max of 10mg
Optional

38
Q

CPIC for 2D6 Vortioxetine IM

39
Q

CPIC for 2D6 Vortioxetine NM

40
Q

CPIC for 2D6 Vortioxetine UM

A

Select alternative
If must use 50% increase in dose
Optional

41
Q

Is genotype for antidepressant required?

42
Q

Which polymorphism is most abundant in antidepressant?

43
Q

Which allele cause an increase in Steven Johnson for Carbamazepine?

A

HLA - A31:01
HLA - B15:08, 11, 21

44
Q

Population of HLA - A and B mutations

A

Hans Chinese, Singapore, Malaysian
Low in Japanese Koreans

45
Q

What pt are 100% risk for SJ syndrome

A

1 or 2 alleles fo HLA-B*1502
And of Han-Chinese

46
Q

Why is HLA-B*1502 so important

A

Affects all the anti seizure meds Lam, Oxcarb, phen, carbamazepine
Must be han-Chinese too

47
Q

HLA-B*3101 predicted effect?

A

Also Carbamazepine in Euro and Korean, Japanese

48
Q

What race do we test for with Anti-seizure meds?

A

all Asians

49
Q

CPIC Carbamazepine non carrier of HLA - B1502 and carrier HLA-A3101

A

CBZ naive with alternatives - use alternative
CBZ naive w/o alternative - use CBZ with close monitoring
CBZ > 3 months use with caution

50
Q

CPIC Carbamazepine non carrier HLA - B1502 and non carrier HLA-A3101

A

Standard dosing

51
Q

CPIC Oxcarbazepine carrier of HLA - B*1502

A

Increase risk
CBZ naive - do not use
If on CBZ > 3 months use with caution

52
Q

CPIC Oxcarbazepine NON carrier of HLA - B*1502

A

Standard dosing

53
Q

What is the relation with 2C19*3 allele and Phenytoin

A

Can clear the drug and have increase in cutaneous reactions

54
Q

Clinical algorithm for Phenytoin HLA-B*15:02 positive

A

Do not use

55
Q

Clinical algorithm for Phenytoin HLA-B*15:02 negative and 2C19 NM and UM

A

No adjustments

56
Q

Clinical algorithm for Phenytoin HLA-B*15:02 negative and 2C19 IM

A

First dose normal
Only for 1 score IM Following doses 25% less

57
Q

Clinical algorithm for Phenytoin HLA-B*15:02 negative and 2C19 PM

A

First dose normal
Following doses 50% less

58
Q

What is a 1 score for phenytoin and 2C19

Pgx (5 decks)

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