Pharm: HLD, Coagulation, Anemia

Question 1

Patients with a butyrlcholinesterase polymorphism will have a poor response to which drug. How do you treat the life threatening complication?

Answer 1

Succinylcholine; treat with continuous mechanical ventilation

Question 2

Patients with an N-acetyltransferase polymorphism will either be slow or fast acetylators. What are 4 examples of drugs and their AE’s?

Answer 2

1. Isoniazide: neuropathy, hepatotoxicity
   2/3. Hydralazine + Procainamide: SLE
2. Sulfonamides: Hypersensitivity & Hemolytic Anemia, SLE

Question 3

Patients with a CYP2D6 polymorphism can be ultra-rapid or slow metabolizers of certain drugs due to increased copies of the gene. What are 4 examples of drugs?

Answer 3

1. Metoprolol
2. Haloperidol
3. Codeine/Dextromethophan (slow: ineffective; fast: ++ morphine)
4. Fluoxetine, imipramine, desipramine (Anti-depressants)

Question 4

Patients with a thiopurine S-methyltransferase polymorphism can have life threatening reactions to certain drugs. Which ones?

Answer 4

Mercaptopurine & Azathioprine

* Mercap: myelosuppression/life threatening (treat with 1/10th dose)

Question 5

Patients with what type of lung cancer can benefit from gefitinib? Why can they benefit?

Answer 5

NSCLC: a gain of function mutation (mutation in ATP binding site); patients tend to respond better

Question 6

Warfarin has several different applications to pharmacogenomics…

Answer 6

1. Variant alleles of S: decrease levels of Warfarin

2. Vit K epoxide reductase: VKORC1 gene / decrease dose of warfarin

Question 7

Patients with G6PD deficiency can have adverse/idiosyncratic reactions to which drugs?

Answer 7

Sulfonamides, anti-malarials (primaquine, chloraquine), chlormphenicol