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Geriatrics > PGx > Flashcards

PGx Flashcards

1
Q

What does SLCO1B1 polymorphism affect?

A

Codes for OATP protein which facilitates hepatic uptake of all statins for metabolism

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2
Q

What are the actionable phenotypes possible for SLCO1B1?

A

Decreased/possibly decreased function
Poor function

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3
Q

Which statins require alternatives if the patient is tested decreased SLCO1B1 function?

A

Lovastatin
Simvastatin
or limit dose for both

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4
Q

What is the dose-related risk for rosuvastatin?

A

Myopathy risk if doses >20 mg

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5
Q

What does ABCG2 polymorphism affect?

A

Encodes BCRP that exports statin into the ECF

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6
Q

Which statin is affected by two genetic polymorphisms?

A

Rosuvatstain (SLCO1B1 & ABCG2)
Fluvastatin (SLCO1B1 & 2C9)

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7
Q

In general, what should we limit rosuvastatin dose to?

A

≤20 mg as starting dose

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8
Q

When do we limit rosuvastatin dose to ≤10 mg/day?

A

SLCO1B1 DF + ABCG2 PF
SLCO1B1 PF + ABCG2 PF

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9
Q

What are the two HLAs genotypes that affect carbamazepine?

A

HLA-B15:02
HLA-A31:01

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10
Q

If a person is tested HLA-B*15:02, what anti-epileptics should be avoided?

A

Carbamazepine
Oxcarbazepine
Phenytoin
Lamotrigine
Phenobarbital

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11
Q

What is the difference between the skin reactions detected by the two genotypes for carbamazepine?

A

HLA-B15:02 - SJS/TEN
HLA-A31:01 - mainly MPE, some SJS/TEN & DRESS

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12
Q

What is the genotype that predicts abacavir-related hypersensitivity?

A

HLA-B*57:01

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13
Q

What predicts allopurinol-induced hypersensitivity?

A

Renal impairment
Concomitant diuretics
High starting dose (>100 mg/day)
HLA-B*58:01
Rapid dose escalation
Elderly

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14
Q

What are the antidepressants affected by 2D6 polymorphism?

A

Amitriptyline & nortriptyline
Paroxetine
Fluvoxamine
Venlafaxine
Vortioxetine

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15
Q

What are the actionable phenotypes for 2D6?

A

URM
NM
IM
PM

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16
Q

Which antidepressant is affected by both 2D6 and 2C19 polymorphism?

A

Amitriptyline

17
Q

Why is nortriptyline not affected by 2C19 polymorphism?

A

2C19 metabolises amitriptyline to nortriptyline

18
Q

What is the general recommendation for 2D6 URMs on antidepressants?

A

Ami: switch or increase dose
Paroxetine: switch
Fluvoxamine: no data
Venla: increase dose
Vortioxetine: switch or increase dose

19
Q

Which antidepressants require dose reduction in 2D6 IMs?

A

Amitriptyline (25%)
Paroxetine

20
Q

Which antidepressants are recommended to be switched to an alternative drug for 2D6 PMs?

A

Amitriptyline (or reduce dose)
Venlafaxine
Fluvoxamine (or reduce dose)
Vortioxetine (or reduce dose)

21
Q

What are the actionable phenotypes for 2C19?

A

URM
RM
NM
IM
PM

22
Q

Which antidepressant may be kept at the same dose for 2C19 URM & RM?

A

Sertraline

23
Q

What are the general recommendations for 2C19 PMs on antidepressants?

A

Switch to alternative drug or use 50% lower starting dose

24
Q

What is the general starting dose of antidepressants for 2C19 IMs?

A

Standard dose

25
Q

Which SSRIs are not primarily cleared via 2C19?

A

Fluoxetine
Fluvoxamine
Paroxetine

26
Q

What are the recommendations for individuals with 2D6 IM & 2C19 IM?

A

25% lower starting dose for Amitriptyline

27
Q

What ie the difference between recommendations for clopidogrel between different indications?

A

ACS/PCI: IM or PM to use prasugrel/ticagrelor
Stroke/TIA: IM or PM to use ticagrelor/ticlopidine

28
Q

What are the recommendations for 2C19 URM & RM using clopidogrel for ACS/PCI indications?

A

Use standard dose

29
Q

When do we consider higher doses for PPIs in 2C19 polymorphisms

A

URM: 100% higher doses for all
RM/NM: consider higher doses if H pylori or esophagitis

30
Q

What is the metabolite for tramadol?

A

O-desmethyltramadol via 2D6

31
Q

What is the metabolite for codeine?

A

Morphine via 2D6

32
Q

When do we need to avoid tramadol or codeine?

A

2D6 URM or PM

33
Q

What are the recommendations for SLCO1B1 & ABCG2 polymorphisms for rosuvastatin?

A

DF: Standard dose
PF: Limit to 20 mg starting dose. Consider combining or alternative if higher doses needed

Geriatrics (3 decks)

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