Pharmacogenetics Flashcards

(41 cards)

1
Q

What are genes?

A

Unit of information encoding a specific trait

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2
Q

What is inheritance?

A

Transmission of traits from parent offspring

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3
Q

What is phenotype?

A

Physical manifestation of genetic information

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4
Q

What is pharmacogenetics?

A

The study of the genetic basis for the difference between individuals

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5
Q

What is polymorphism?

A

Genetic variation that occurs with a frequency >1% in ethnically diverse population

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6
Q

What are the different types of polymorphisms?

A

SNPs

Repetitive DNA sequences

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7
Q

What does polymorphism alter?

A

The expression level or conformation of a drug-related protein

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8
Q

What does the outcome of genetic variation depend on?

A

Where in the genome changes

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9
Q

What do SNPs result in?

A

Alteration in amino acid sequence of protein

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10
Q

What could happen to protein structures if a SNP occurs?

A

Phenotypic differences between the subjects, such as variation in response to medication

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11
Q

What does SNP stand for?

A

Single nucleotide polymorphism

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12
Q

Why is pharmacogenetics important for pharmacy?

A

Patients can suffer adverse effects due to genetics
Adverse reactions can cause death
Severe adverse effects = withdrawal of blockbuster drugs

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13
Q

At what stages can genetic variation affect a patient’s response to a drug?

A

Metabolism
Target response
Catabolism + excretion

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14
Q

Why can metabolism be affected by genetic variation?

A

2 phases of drug metabolism
Phase 1 = cytochrome P450 enzymes
Phase 2 = enzymes controlling drug excretion

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15
Q

Why can target response be affected by genetic variation?

A

Process or pathway targeted responds differently

eg. Tyrosine kinase inhibitors

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16
Q

Why can catabolism + excretion be affected by genetic variation?

A

Individuals differ in the rate at which they clear active drug, can lead to adverse drug reactions

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17
Q

What are cytochrome P450s?

A

Major enzymes involved in drug metabolism + bioactivation

18
Q

What are differences in metabolism due to?

A

CY2D6 polymorphisms

19
Q

What codeine?

A

Commonly used opioid
Prodrug
Must be metabolised into morphine for activity

20
Q

Where is cytochrome P450 metabolising enzyme?

21
Q

What does a prodrug need to work?

22
Q

What is an active drug inactivated by?

23
Q

What happens if a prodrug has a poor metaboliser phenotype?

A

Poor efficacy

Possible accumulation of prodrug

24
Q

What happens if an active drug has a poor metaboliser phenotype?

A

Good efficacy
Accumulation of active drug can produce adverse effects
May need lower dose

25
What happens if a prodrug has a ultra-rapid metaboliser phenotype?
Good efficacy | Rapid effect
26
What happens if an active drug has a ultra-rapid metaboliser phenotype?
Poor efficacy | Needs greater dose or slow release formulation
27
What is the main rate limiting step in TCA metabolism mediated by?
CY2D6 isoenzyme
28
What happens if you have a functional impairment of CY2D6 isoenzyme?
Lead to toxic levels occurring
29
What is the most widely prescribed oral anticoagulant drug?
Warfarin
30
How is Warfarin activated?
By a coagulation test to ensure adequate yet safe dose is taken
31
What serious adverse effects of Warfarin can occur?
Levels too high = haemorrhage | Levels too low = thrombosis or embolism
32
What is Warfarin a mix of?
S- and R-warfarin | BOTH isoforms are active
33
What is S-warfarin catalysed by?
Mainly CYP2C9
34
What is R-warfarin catalysed by?
CYP1A2 + CYP3A4
35
What are the 2 common CYP2C9 polymorphisms?
Arg144Cys | IIe358Leu
36
What is genetic variation of Warfarin associated with?
Decreased CYP2C9 activity
37
When is it more common to have decreased CYP2C9 activity?
Patients requiring a lower dose of Warfarin (increased risk of haemorrhage), shown to have 1 or more of these alleles
38
What do the FDA recommend for before giving Warfarin?
Genotyping for CYP2C9 + VKORC1
39
Describe azathioprine metabolism
Converted to 6-meracaptopurine | Converted to inactive form by xanthine oxidase + TPMT
40
What is seen as the future of current medicine?
Personalised medicine
41
What are the ethical implications of pharmacogenetics?
Do people want to know? Will treatment be appropriate? How informed does pharmacist need to be? Who would have access to personal genetic info?