Personalized Medicine

Question 1

What are some general medication side effects?

Answer 1

• Drug-metabolizing enzymes (influence pharmacokinetics)
• Poor clearance of drugs may increase to toxic levels
• HLAs (human leukocyte antigen) drug sensitivities may look like an allergy

Question 2

Goals/Benefits of Personalized Medicine?

Answer 2

Safer drugs, increased drug effectiveness, alt drugs for standard treatments, dosages based on genetics.

Question 3

What are some things that interfere with warfarin?

Answer 3

Vitamin K (RDA males 120 mcg (micrograms); RDA females 90 mcg
Avoid large amounts of kale, spinach, brussels sprouts, parsley, collard greens, chard, green tea
Avoid beverages: 
Cranberry juice, alcohol

Question 4

What genetic variants effect warfarin response?

Answer 4

Variants in both vitamin K epoxide reductase (VKORC1) and cytochrome p450 2C9 (CYP2C9) have a significant impact on warfarin sensitivity.

Question 5

SNPs aren’t always mutations (T/F)

Answer 5

T

Question 6

Polymorphism means:

Answer 6

Naturally occurring variants in base pair DNA sequence.

Question 7

What are three tests to find SNPs?

Answer 7

• Deep Sequencing (Rapidly increasing)
• Exon trapping
• Direct sequencing (This is by far the most common)

Question 8

Definition of “Pharmacogenetics”

Answer 8

The study of how an individual’s genetic inheritance affects the body’s response to drugs.
… decoding drug responsiveness
… the development of genetic tests that will tell doctors which people should get which drugs, to maximize drug effectiveness and minimize side effects

Question 9

With personalized medicine, mislabeling of patients as addicts would likely be less common. (T/F)

Answer 9

T

Question 10

Cytochrome P450 contribute to metabolism of about 10 percent of all medications.

Answer 10

F, about 50%

Question 11

2D6 is one enzyme that is required for..

Answer 11

codeine –> morphine

Question 12

If the balance of 3A4 is too high compared to 2D6, then the bioavailability of codeine is reduced (T/F)

Answer 12

T, Codeine is converted to norcodeine, which cannot be used by body.

Question 13

What are some different types of metabolizers for codeine?

Answer 13

A “poor metabolizer” (PM) cannot metabolize codeine (may OD on less)
“Extensive Metabolizers” (EM) metabolize codeine
“Ultrarapid Metabolizer” metabolizes too quickly to be able to effectively benefit from the codeine

Question 14

Grapefruit juice before you take some drugs can [ ] your 3A4 and taking Quinidine can [ ] codeine metabolism and [ ] 2D6.

Answer 14

reduce; inhibit; reduces

Question 15

Why must the clinical oncologist use a genetic test to determine if a patient may be prescribed Cetuximab?

Answer 15

Because it’s an expensive treatment and if you have a mutant Ras, the medication won’t work.