Calculations, EBP & Pharmacogenomics

Question 1

1 inch

Answer 1

2.54 cm

Question 2

1 tsp –> ml

Answer 2

5 ml

Question 3

1000 mcg –> mg

Answer 3

1 mg

Question 4

1:20

Answer 4

1 g of solute in 20 ml of solution

Question 5

0.02%

Answer 5

0.02g in 100 ml

Question 6

1 kg

Answer 6

2.2 lbs

Question 7

1 lb –> oz

Answer 7

16 oz

Question 8

1 tbsp –> tsp

Answer 8

3 tsp

Question 9

1 oz –> ml

Answer 9

30 ml

Question 10

3 principles of EBM

Answer 10

make decisions from the best available evidence

not all evidence is equal

evidence alone is never enough

Question 11

3 components of EBP decision making

Answer 11

evidence
circumstances
values

within context

Question 12

evidence-based approach to medication questions

Answer 12

1. define the question (PICO)
2. systematically search for relevant info
3. critically evaluate the literature
4. apply findings to patient/case/question

Question 13

pharmacogenetics

Answer 13

study of how genetic differences in a SINGLE gene influence variability in drug response (ex efficacy and toxicity

ex. B1-adrenergic receptors on carvedilol

Question 14

pharmacogenomics

Answer 14

study of how genetic differences in MULTIPLE genes influence variability in drug response (ex efficacy and toxicity)

ex B1 and B2 a2-adrenergic receptors and CYP2D6 on carvedilol

Question 15

gene

Answer 15

series of codons that forms a protein

Question 16

allele

Answer 16

sequence of nucleic acid bases at a given gene chromosomal locus

Question 17

homozygous genotype

Answer 17

two identical alleles

Question 18

heterozygous genotype

Answer 18

two different alleles

Question 19

phenotype

Answer 19

outward expression of genotype

Question 20

mutation

Answer 20

alteration in DNA code occuring <1% of time in the population

Question 21

polymorphisms

Answer 21

alterations in the DNA code occuring >1% of the time in the population

Question 22

single-nucleotide polymorphism (SNP)

Answer 22

single base pair difference in DNA occurring on every chromosome

Question 23

what phase of metabolism is CYP 450?

Answer 23

phase I

Question 24

examples of drugs metabolized by CYP2D6

Answer 24

codeine
nortriptyline
tamoxifen

Question 25

codeine w CYP2D6 metabolism

Answer 25

codeine is a prodrug! poor metabolism - no pain relief but AEs ultrarapid metabolism - pain control with AEs

Question 26

nortriptylene w CYP2D6 metabolism

Answer 26

nortriptylene is an active drug! poor metabolism - depression relief w/ adverse effects ultrarapid - no depression relief, no AEs

Question 27

tamoxifen w CYP2D6 metabolism

Answer 27

poor metabolism - deceased efficacy, increased risk of cancer recurrence

Question 28

CYP2D6 inhibitors

Answer 28

SSRIs prozac, paxil, zoloft - these should all be avoided w tamoxifen due to risk of recurrence!!!

Question 29

examples of drugs metabolized by CPY2D19

Answer 29

omeprazole - & all PPIs | clopidogrel

Question 30

omeprazole w CPY2C19 metabolism

Answer 30

rapid and intermediate metabolizers have decreased ulcer cure rates

Question 31

clopidogrel w CYP2C19 metabolism

Answer 31

clopidogrel is a prodrug! poor or intermediate metabolizers have poor efficacy --> recommend other platelet inhibitors (ticagrelor or prasugrel)

Question 32

CYP2C19 inhibitors

Answer 32

proton pump inhibitors decreased efficacy of clopidogrel -> not converted to active drug -> risk for clotting avoid omeprazole and clopidogrel! prefer H2 antagonists/antacids (famotidine)

Question 33

examples of drugs metabolized by DPD

Answer 33

5-FU cepecitabine tegafur (chemotherapy drugs)

Question 34

DPD deficiency results in

Answer 34

decreased efficacy of chemotherapy agents & risk for toxicities severe AEs! ex. myelosuppression, mucositis, neurotoxicity, hand-and-foot syndrome, diarrhea

Question 35

example of drug metabolized by UGT 1A1

Answer 35

ironetecan - tx for colon cancer

Question 36

AEs with irenotecan UGT1A1 metabolism

Answer 36

diarrhea | neutropenia

Question 37

examples of drugs metabolized by thiopurine S-Methyltransferase (TPMT)

Answer 37

azathioprine 6-MP 6- thioguanine anticancer/immunologics

Question 38

G6PD deficiency causes

Answer 38

excessive hemolysis of RBCs

Question 39

example of drugs metabolized by G6PD

Answer 39

carbamazepine | ribavirin

Question 40

carbamazepine w G6PD deficiency

Answer 40

risk of stevens johnsons syndrome and TEN

Question 41

why do we need to be cautious with warfarin?

Answer 41

narrow therapeutic range due to CYP2C9 and VKORC1

Question 42

what resource provides authoritative info regarding drugs for breastfeeding?

Answer 42

lactmed

Question 43

what resource provides comprehensive information regarding drug use during pregnancy and lactation?

Answer 43

Brigg's

Question 44

what is an authoritative reference for antibiotic prescribing and dosing?

Answer 44

john hopkins abx guide