PGx Final Exam Review Part 2 (MCQ)

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Practice your PGx knowledge for the final exam!

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PGx Final Exam Review Part 2 (MCQ)


PGx Final Exam Review Part 2 (MCQ)Version en ligne Practice your PGx knowledge for the final exam! par Jessie Tsai 1 Which of the following statements are true? Select all that apply. Choose one or more answers a A genotype is an observable trait b An allele is a different variant of a gene c A single nucleotide polymorphism can be a replacement, addition, or deletion d CYP2D6 polymorphism can involve gene duplication e Allelic variation that occur at a frequency > 1% in a given population is a mutation 2 Which of the following order is correct in terms of NSAID half life going from shortest to longest half life (left to right)? a Ibuprofen < meloxicam < piroxicam b Ibuprofen < tenoxicam < meloxicam c Celecoxib < meloxicam < flurbiprofen d Tenoxicam < celecoxib < ibuprofen 3 Which of the following NSAIDs are NOT impacted by CYP2C9? Select all that apply. Choose one or more answers a Aspirin b Ibuprofen c Tenoxicam d Naproxen e Diclofenac f Meloxicam 4 CS's genotype for CYP2C9 is 1/3. What are your recommendations for selecting an NSAID for him? Select all that apply. Choose one or more answers a Initiate meloxicam at 50% of the recommended dose b Do not use tenoxicam c Do not use meloxicam d Use ibuprofen at 25-50% of the recommended dose e Do not use indomethacin 5 EH just got discharged for ACS and one of his medication is called clopidogrel. His PGx report indicates he has the CYP2C19 3/3 (poor metabolizer) genotype. Which of the following statements are true? Select all that apply. Choose one or more answers a He has a high risk of bleeding b He has a high risk of another heart attack on clopidogrel c There will be a high concentration of the clopidogrel d There will be a high concentration of the active metabolite of clopidogrel e We should consider using prasugrel or ticagrelor as an alternative f There is no concern taking clopidogrel and no alternative is needed 6 NH's pharmacogenomics report shows that he is CYP2C1917/17 (ultrarapid metabolizer). What are your recommendations if he is looking to initiate omeprazole and voriconazole? Select all that apply. Choose one or more answers a An alternative agent such as isavuconazole, liposomal amphotericin B, or posaconazole should be used instead of voriconazole b Increase omeprazole starting dose by 50% c Increase omeprazole starting dose by 100% d Initiate voriconazole with the recommended starting dose 7 Which of the following antidepressants are metabolized by CYP2C19? Select all that apply. Choose one or more answers a Citalopram b Nortriptyline c Amitriptyline d Doxepin e Sertraline f Desipramine 8 Calculate the CYP2D6 activity score if the patient has the genotype 27/50xN. The 27 allele has a score of 1 and the 50 allele has a score of 0.5. a Activity score is 1 or 1.5 b Activity score is 1.5 or 2.25 c Activity score is 2 or 2.5 d Activity score is 2.25 or 2.5 9 FS is getting Tylenol #3 after his wisdom teeth extraction. He has a CYP2D6 activity score of 0 (poor metabolizer). Which of the following statements are true regarding his treatment? Select all that apply. Choose one or more answers a Tylenol #3 will likely be effective b Tylenol #3 will likely be ineffective, but he may switch to tramadol c Tylenol #3 will likely be ineffective, but he may switch to morphine d Tylenol #3 will likely cause excessive respiratory depression in this patient e Tylenol #3 will likely be ineffective, but he may switch to hydromorphone 10 EB is starting on ondansetron in the hospital for post-operative nausea after her procedure. Her pharmacogenomics report says she has a CYP2D6 activity score of 2.5 (ultrarapid metabolizer). What is your recommendation? a EB should use granisetron instead because she has a high risk of QT prolongation b There is limited evidence for her activity score. Initiate as recommended c EB should use granisetron instead because she has a high risk of therapeutic failure 11 DK's pharmacogenomics testing shows the only atypical result being a CYP2D6 activity score of 0 (poor metabolizer). He wants to start PO aripiprazole tablets. He currently takes clarithromycin and amitriptyline. What are your recommendations? Select all that apply. Choose one or more answers a Administer half of the usual dose of aripiprazole b Administer a quarter of the usual dose of aripiprazole c There is a higher chance of side effects with amitriptyline. Consider using nortriptyline d There is a higher chance of side effects with amitriptyline. Consider using citalopram 12 FN's medication list includes the following: esomeprazole, ibuprofen, sertraline, efavirenz, and phenytoin. Which of the following genetic tests would be important to evaluate? Select all that apply. Choose one or more answers a CYP2B6 b HLA-B15:02 c CYP2C19 d HLA-A31:01 e CYP2D6 f CYP2C9 13 Which of the following efavirenz regimens is appropriate for a patient with the only atypical result in their pharmacogenomic report being CYP2B6 6/6 (poor metabolizer)? a Atripla (efavirenz 600 mg/emtricitabine 200 mg/TDF 300 mg) b Symfi Lo (efavirenz 400 mg/lamivudine 300 mg/TDF 300 mg) c Symfi (efavirenz 600 mg/lamivudine 300 mg/TDF 300 mg) 14 Which of the following statement is true regarding tacrolimus dose in a patient with CYP3A5 1/1 (normal metabolizer)? a Decrease the starting dose due to risk of overexpsoure b Increase the starting dose due to risk of underexposure c Initiate at standard recommended dose d Do not use tacrolimus 15 GD's pharmacogenomics testing comes back to show that he has the genotype UGT1A1 6/6 (poor metabolizer). He is looking to start atazanavir for treatment of HIV. Which of the following statements are true? Select all that apply. Choose one or more answers a He has a high risk of Gilbert Syndrome, characterized by jaundice b Atazanavir is metabolized by UGT1A1 c Atazanavir is an inhibitor of UGT1A1 d Consider an alternative agent 16 In a patient starting 6-MP for malignancy who is TPMT normal metabolizer and NUDT15 poor metabolizer, which of the following statements are true? Select all that apply. Choose one or more answers a Consider an alternative agent b Reduce 6-MP starting dose to 10 mg/m^2/day c Reduce 6-MP starting dose by 10 fold d The patient has a higher risk of bone marrow suppression, leukopenia, thrombocytopenia, and anemia if given a normal starting dose e The patient has a higher risk of therapeutic failure 17 VY will be initiating 5-FU for treatment of breast cancer. Her DPYD activity score is 1.5 (intermediate metabolizer). Which of the following statements are true? Select all that apply. Choose one or more answers a Reduce the dose by 25-50% b The patient should switch to capecitabine instead of using 5-FU c The patient has increased risk of toxicity with 5-FU d The enzyme that is involved in 5-FU metabolism is called DPYD 18 DF has a new medication called simvastatin. In her pharmacogenomics report, she has the genotype of SLCO1B1 1/5 (decreased function). Which of the following statements about her therapy are true? Select all that apply. Choose one or more answers a She has increased myopathy risk b Do not initiate simvastatin. Instead, use lovastatin c Do not initiate simvastatin. Instead, use pravastatin d She has increased risk of therapeutic failure e We must also check her genotype for ABCG2 for simvastatin 19 Which of the following are correct drug-gene pairs? Select all that apply. Choose one or more answers a Warfarin - VKORC1, CYP2C9, CYP4F2 b Sertraline - CYP2C9 and CYP2B6 c Amitriptyline - CYP2C19 and CYP2D6 d Abacavir - HLA-B57:01 20 AL, who is HLA-B15:02 negative and CYP2C9 3/3 (poor metabolizer), wants to be initiated on phenytoin. Which of the following recommendations is true? a She may use the typical loading dose, but for subsequent doses, she must use 50% less than the typical maintenance dose b She may use the typical loading dose, but for subsequent doses, she must use 25% less than the typical maintenance dose c We need more information to assess this patient d Do not initiate phenytoin e Initiate phenytoin with approved recommended dose f For the loading dose decrease by 50%, but for subsequent doses she may use the approved recommended dose Feedback 1 Correct answers: An allele is a different variant of a gene, A single nucleotide polymorphism can be a replacement, addition, or deletion, CYP2D6 polymorphism can involve gene duplication Explanation: A phenotype is an observable trait, not a genotype. Allelic variation that occur at a frequency < 1% in a given population is a mutation. If the frequency > 1%, it is polymorphism 2 Correct answer: Ibuprofen < meloxicam < piroxicam Explanation: correct order for other options are ibuprofen < meloxicam < tenoxicam; flurbiprofen = celecoxib < meloxicam; ibuprofen = celecoxib < tenoxicam 3 Correct answers: Aspirin, Naproxen, Diclofenac Explanation: Ibuprofen is metabolized by CYP2C9 and has a short half life, tenoxicam is metabolized by CYP2C9 and has the longest half life, meloxicam is metabolized by CYP2C9 and has a longer half life 4 Correct answers: Initiate meloxicam at 50% of the recommended dose, Do not use tenoxicam Explanation: Meloxicam would not be used if the patient was 2/3 or 3/3 (activity score 0.5 or 0). Ibuprofen would be used at 25-50% of the recommended dose if the patient was 2/3 or 3/3 (activity score 0.5 or 0). Indomethacin is not affected by CYP2C9 polymorphism 5 Correct answers: He has a high risk of another heart attack on clopidogrel, There will be a high concentration of the clopidogrel, We should consider using prasugrel or ticagrelor as an alternative Explanation: He will not have a high risk of bleeding since clopidogrel is a prodrug, and its active metabolite has the antiplatelet activity. With him being a poor metabolizer, he will not metabolize the prodrug to the active metabolite as effectively. He would have a low concentration of the active drug since he is a poor metabolizer. Since he is a poor metabolizer, clopidogrel will not be very efficacious and he needs an alternative antiplatelet 6 Correct answers: An alternative agent such as isavuconazole, liposomal amphotericin B, or posaconazole should be used instead of voriconazole, Increase omeprazole starting dose by 100% Explanation: If the patient was rapid or normal metabolizer, where we would consider increasing omeprazole dose by 50-100%. If the patient was normal or intermediate metabolizer, we would start voriconazole at the recommended starting dose, but for rapid and ultrarapid metabolizer, an alternative must be used 7 Correct answers: Citalopram, Amitriptyline, Doxepin, Sertraline Explanation: Nortriptyline and desipramine are secondary amine TCAs, which are only metabolized by CYP2D6, not CYP2C19 8 Correct answer: Activity score is 2 or 2.5 Explanation: AS: (1x2)+0.5 = 2.5 and 1+(0.5x2) = 2 9 Correct answers: Tylenol #3 will likely be ineffective, but he may switch to morphine, Tylenol #3 will likely be ineffective, but he may switch to hydromorphone Explanation: Tylenol #3 contains codeine, whose metabolite is more active than codeine itself. Since the patient is a poor metabolizer, it would be less effective. Tylenol #3 will likely be less effective, but tramadol would also likely be less effective since it is also metabolized by CYP2D6 and similar to codeine, has a metabolite that is more active. Since Tylenol #3 has a metabolite more active than codeine itself and the patient is a poor metabolizer, there would be less active metabolite and increased toxicity would not be a concern 10 Correct answer: EB should use granisetron instead because she has a high risk of therapeutic failure Explanation: Since the patient is an ultrarapid metabolizer, there is a high risk of therapeutic failure instead of toxicity (QT prolongation). Ondansetron would be initiated as recommended for intermediate and poor metabolizers due to limited evidence 11 Correct answers: Administer a quarter of the usual dose of aripiprazole, There is a higher chance of side effects with amitriptyline. Consider using citalopram Explanation: Half of the usual dose of aripiprazole would be used if the patient was not taking a strong CYP3A4 inhibitor (clarithromycin) concomitantly. There is a higher chance of side effects with amitriptyline, but this also goes for nortriptyline since it is also metabolized by CYP2D6 12 Correct answers: CYP2B6, HLA-B15:02, CYP2C19, CYP2C9 Explanation: HLA-A31:01 testing would be done for carbamazepine. None of the medications on the list are impacted by CYP2D6 polymorphism 13 Correct answer: Symfi Lo (efavirenz 400 mg/lamivudine 300 mg/TDF 300 mg) Explanation: Atripla or Symfi would be used if the patient was an ultrarapid, rapid, or normal metabolizer 14 Correct answer: Increase the starting dose due to risk of underexposure Explanation: There is no recommendation from CPIC to decrease the starting dose for any genotype and there is no recommendation to avoid tacrolimus completely. The standard recommended starting dose would be used if the patient was poor metabolizer 15 Correct answers: He has a high risk of Gilbert Syndrome, characterized by jaundice, Atazanavir is an inhibitor of UGT1A1, Consider an alternative agent Explanation: Atazanavir is an inhibitor of UGT1A1, it is not metabolized by UGT1A1. UGT1A1 is an enzyme involved in glucuronidation of bile instead, and since atazanavir inhibits it, polymorphism in UGT1A1 may be concerning 16 Correct answers: Reduce 6-MP starting dose to 10 mg/m^2/day, The patient has a higher risk of bone marrow suppression, leukopenia, thrombocytopenia, and anemia if given a normal starting dose Explanation: An alternative would be used if the indication was for non-malignancy. The starting dose would be reduced by 10 fold if the drug in question was AZA. The patient has a higher risk of toxicity, not therapeutic failure, since he is a NUDT15 poor metabolizer 17 Correct answers: Reduce the dose by 25-50%, The patient has increased risk of toxicity with 5-FU Explanation: Capecitabine is metabolized into 5-FU, which is then metabolized by DPD. Both are affected by DPYD polymorphism, so switching therapy would not make a difference. DPD is the enzyme and DPYD is the gene 18 Correct answers: She has increased myopathy risk, Do not initiate simvastatin. Instead, use pravastatin Explanation: Lovastatin, similar to simvastatin, should not be used in SLCO1B1 decreased function or poor function. She has increased risk of side effects (myopathy) since SLCO1B1 is involved in hepatic uptake of statins, which she has a decreased function in. All statins are impacted by SLCO1B1 polymorphism, but only rosuvastatin is impacted by ABCG2 polymorphism 19 Correct answers: Warfarin - VKORC1, CYP2C9, CYP4F2, Amitriptyline - CYP2C19 and CYP2D6, Abacavir - HLA-B57:01 Explanation: Sertraline - CYP2C19 (not CYP2C9) and CYP2B6 20 Correct answer: She may use the typical loading dose, but for subsequent doses, she must use 50% less than the typical maintenance dose Explanation: The maintenance dose would be decreased by 25% (with a normal loading dose) if the patient was CYP2C9 intermediate metabolizer with activity score of 1. For phenytoin, the relevant genotypes would just be HLA-B15:02 and CYP2C9. Phenytoin would not be initiated if the patient was HLA-B*15:02 positive. The approved recommended dose would be used if the patient was CYP2C9 intermediate metabolizer with activity score of 1.5 or normal metabolizer with activity score of 2. In adjusting phenytoin dose, loading dose will be unchanged but the maintenance dose will be changed

PGx Final Exam Review Part 2 (MCQ)

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Créé par

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PGx Final Exam Review Part 2 (MCQ)Version en ligne

par Jessie Tsai

Which of the following statements are true? Select all that apply.

Which of the following order is correct in terms of NSAID half life going from shortest to longest half life (left to right)?

Which of the following NSAIDs are NOT impacted by CYP2C9? Select all that apply.

CS's genotype for CYP2C9 is *1/*3. What are your recommendations for selecting an NSAID for him? Select all that apply.

EH just got discharged for ACS and one of his medication is called clopidogrel. His PGx report indicates he has the CYP2C19 *3/*3 (poor metabolizer) genotype. Which of the following statements are true? Select all that apply.

NH's pharmacogenomics report shows that he is CYP2C19*17/*17 (ultrarapid metabolizer). What are your recommendations if he is looking to initiate omeprazole and voriconazole? Select all that apply.

Which of the following antidepressants are metabolized by CYP2C19? Select all that apply.

Calculate the CYP2D6 activity score if the patient has the genotype *27/*50xN. The *27 allele has a score of 1 and the *50 allele has a score of 0.5.

FS is getting Tylenol #3 after his wisdom teeth extraction. He has a CYP2D6 activity score of 0 (poor metabolizer). Which of the following statements are true regarding his treatment? Select all that apply.

EB is starting on ondansetron in the hospital for post-operative nausea after her procedure. Her pharmacogenomics report says she has a CYP2D6 activity score of 2.5 (ultrarapid metabolizer). What is your recommendation?

DK's pharmacogenomics testing shows the only atypical result being a CYP2D6 activity score of 0 (poor metabolizer). He wants to start PO aripiprazole tablets. He currently takes clarithromycin and amitriptyline. What are your recommendations? Select all that apply.

FN's medication list includes the following: esomeprazole, ibuprofen, sertraline, efavirenz, and phenytoin. Which of the following genetic tests would be important to evaluate? Select all that apply.

Which of the following efavirenz regimens is appropriate for a patient with the only atypical result in their pharmacogenomic report being CYP2B6 *6/*6 (poor metabolizer)?

Which of the following statement is true regarding tacrolimus dose in a patient with CYP3A5 *1/*1 (normal metabolizer)?

GD's pharmacogenomics testing comes back to show that he has the genotype UGT1A1 *6/*6 (poor metabolizer). He is looking to start atazanavir for treatment of HIV. Which of the following statements are true? Select all that apply.

In a patient starting 6-MP for malignancy who is TPMT normal metabolizer and NUDT15 poor metabolizer, which of the following statements are true? Select all that apply.

VY will be initiating 5-FU for treatment of breast cancer. Her DPYD activity score is 1.5 (intermediate metabolizer). Which of the following statements are true? Select all that apply.

DF has a new medication called simvastatin. In her pharmacogenomics report, she has the genotype of SLCO1B1 *1/*5 (decreased function). Which of the following statements about her therapy are true? Select all that apply.

Which of the following are correct drug-gene pairs? Select all that apply.

AL, who is HLA-B*15:02 negative and CYP2C9 *3/*3 (poor metabolizer), wants to be initiated on phenytoin. Which of the following recommendations is true?

CS's genotype for CYP2C9 is 1/3. What are your recommendations for selecting an NSAID for him? Select all that apply.

EH just got discharged for ACS and one of his medication is called clopidogrel. His PGx report indicates he has the CYP2C19 3/3 (poor metabolizer) genotype. Which of the following statements are true? Select all that apply.

NH's pharmacogenomics report shows that he is CYP2C1917/17 (ultrarapid metabolizer). What are your recommendations if he is looking to initiate omeprazole and voriconazole? Select all that apply.

Calculate the CYP2D6 activity score if the patient has the genotype 27/50xN. The 27 allele has a score of 1 and the 50 allele has a score of 0.5.

Which of the following efavirenz regimens is appropriate for a patient with the only atypical result in their pharmacogenomic report being CYP2B6 6/6 (poor metabolizer)?

Which of the following statement is true regarding tacrolimus dose in a patient with CYP3A5 1/1 (normal metabolizer)?

GD's pharmacogenomics testing comes back to show that he has the genotype UGT1A1 6/6 (poor metabolizer). He is looking to start atazanavir for treatment of HIV. Which of the following statements are true? Select all that apply.

DF has a new medication called simvastatin. In her pharmacogenomics report, she has the genotype of SLCO1B1 1/5 (decreased function). Which of the following statements about her therapy are true? Select all that apply.

AL, who is HLA-B15:02 negative and CYP2C9 3/*3 (poor metabolizer), wants to be initiated on phenytoin. Which of the following recommendations is true?