NeuroPsychiatirc Disorders

Question 1

What percentage of pt see remission for antidepressants?

Answer 1

30%

Question 2

What is SLC6A4?

Answer 2

It is the serotonin transporter gene

Question 3

What are the SLC6A4 type of allele?

Answer 3

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

Question 4

Does gender play a role in SLC6A4 gene?

Answer 4

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

Question 5

Jama study

Answer 5

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

Question 6

2D6 relation with Amitriptyline and Nortriptyline?

Answer 6

Hydroxylation to drug and they are directly correlated

Question 7

CPIC for TCA PM?

Answer 7

Do not start TCA
If need to 50% dose reduction

Question 8

CPIC for TCA IM?

Answer 8

25% reduction of dose

Question 9

CPIC for TCA NM?

Answer 9

Regular dose

Question 10

CPIC for TCA UM?

Answer 10

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

Question 11

Amitriptyline and Nortriptyline how do they work?

Answer 11

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

Question 12

CPIC for 2C19 Tertiary Amines PM

Answer 12

Avoid - moderate
If need to use 50% reduction

Question 13

CPIC for 2C19 Tertiary IM

Answer 13

Regular starting dose

Question 14

CPIC for 2C19 Tertiary amines NM

Answer 14

Starting dose

Question 15

CPIC for 2C19 tertiary UM

Answer 15

Avoid bc no effect and use a secondary amine

Question 16

CPIC 2C19 for Citalopram and Escitalopram PM

Answer 16

Select alternative
Or lower dose by 50%

Question 17

CPIC 2C19 for Citalopram and Escitalopram IM

Answer 17

Staring dose

Question 18

CPIC 2C19 for Citalopram and Escitalopram NM

Answer 18

Starting dose

Question 19

CPIC 2C19 for Citalopram and Escitalopram UM

Answer 19

Select alternative
If need to use high dose required

Question 20

Study with Citalopram and QTc?

Answer 20

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

Question 21

CPIC for 2C19 for Sertraline PM

Answer 21

Alternative or 50% reduce

Question 22

CPIC for 2C19 for Sertraline IM

Answer 22

Starting dose

Question 23

CPIC for 2C19 for Sertraline NM

Answer 23

Standard dose

Question 24

CPIC for 2C19 for Sertraline UM

Answer 24

Starting dose

Question 25

CPIC for 2B6 for Sertraline PM

Answer 25

Alternative drug if use 25% Optional

Question 26

CPIC for 2B6 for Sertraline IM

Answer 26

Standard dose

Question 27

CPIC for 2B6 for Sertraline NM

Answer 27

Standard dose

Question 28

CPIC for 2B6 for Sertraline UM

Answer 28

Standard dose

Question 29

CPIC for 2D6 Paroxetine PM

Answer 29

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

Question 30

CPIC for 2D6 Paroxetine IM

Answer 30

Lower starting dose Optional

Question 31

CPIC for 2D6 Paroxetine NM

Answer 31

Standard therapy

Question 32

CPIC for 2D6 Paroxetine UM

Answer 32

Select drug alternative

Question 33

CPIC for 2D6 Venlafaxine PM

Answer 33

Consider alternative Optional

Question 34

CPIC for 2D6 Venlafaxine IM

Answer 34

No recommendations

Question 35

CPIC for 2D6 Venlafaxine NM

Answer 35

Starting dose

Question 36

CPIC for 2D6 Venlafaxine UM

Answer 36

No action

Question 37

CPIC for 2D6 Vortioxetine PM

Answer 37

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

Question 38

CPIC for 2D6 Vortioxetine IM

Answer 38

Standard

Question 39

CPIC for 2D6 Vortioxetine NM

Answer 39

Standard

Question 40

CPIC for 2D6 Vortioxetine UM

Answer 40

Select alternative If must use 50% increase in dose Optional

Question 41

Is genotype for antidepressant required?

Answer 41

NO

Question 42

Which polymorphism is most abundant in antidepressant?

Answer 42

2D6

Question 43

Which allele cause an increase in Steven Johnson for Carbamazepine?

Answer 43

HLA - A*31:01 HLA - B*15:08, 11, 21

Question 44

Population of HLA - A and B mutations

Answer 44

Hans Chinese, Singapore, Malaysian Low in Japanese Koreans

Question 45

What pt are 100% risk for SJ syndrome

Answer 45

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

Question 46

Why is HLA-B*1502 so important

Answer 46

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

Question 47

HLA-B*3101 predicted effect?

Answer 47

Also Carbamazepine in Euro and Korean, Japanese

Question 48

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

Answer 48

all Asians

Question 49

CPIC Carbamazepine non carrier of HLA - B*1502 and carrier HLA-A*3101

Answer 49

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

Question 50

CPIC Carbamazepine non carrier HLA - B*1502 and non carrier HLA-A*3101

Answer 50

Standard dosing

Question 51

CPIC Oxcarbazepine carrier of HLA - B*1502

Answer 51

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

Question 52

CPIC Oxcarbazepine NON carrier of HLA - B*1502

Answer 52

Standard dosing

Question 53

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

Answer 53

Can clear the drug and have increase in cutaneous reactions

Question 54

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

Answer 54

Do not use

Question 55

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

Answer 55

No adjustments

Question 56

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

Answer 56

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

Question 57

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

Answer 57

First dose normal Following doses 50% less

Question 58

What is a 1 score for phenytoin and 2C19

Answer 58

1/3, 2/2