Question 1

Which of the following is required for effective use of pharmacogenomics in predicting outcomes of drug therapy?&#10;A) An understanding of how the drug is metabolized&#10;B) An understanding of how the genetic variation influences the drug's pharmacokinetics&#10;C) An understanding of how the genetic variation influences the drug's pharmacodynamics&#10;D) High positive predictive value for the test&#10;E) All of the above

Accepted Answer

High positive predictive value for the test

Question 2

Genetic variation in VKORC1 can be used to determine dosing requirements for which medication?&#10;A) Codeine&#10;B) Halothane&#10;C) Succinylcholine&#10;D) Primaquine&#10;E) Warfarin

Accepted Answer

VKORC1 is a gene that encodes for Vitamin K epoxide reductase, an enzyme that is targeted by Warfarin. Genetic variations in VKORC1 can significantly affect an individual's response to Warfarin, thus influencing dosing requirements.

Question 3

What step in drug metabolism do the cytochromes p450 perform?&#10;A) Addition of a sugar group&#10;B) Addition of an acetyl group&#10;C) Addition of a polar group&#10;D) Removal of an acetyl group&#10;E) Removal of a polar group

Accepted Answer

Cytochromes P450 are involved in the addition of a polar group to drugs, which generally increases their solubility in water, facilitating their excretion from the body.

Question 4

Which of the following is a severe adverse reaction to anesthesia caused by elevations in ionized calcium in the sarcoplasm of the muscle?&#10;A) Malignant hyperthermia&#10;B) Hemolytic anemia&#10;C) Prolonged postoperative paralysis&#10;D) Drug-induced hypertension&#10;E) Disseminated intravascular coagulation

Accepted Answer

Malignant hyperthermia is a severe reaction to certain drugs used for anesthesia, characterized by a rapid increase in body temperature and severe muscle contractions. This condition is caused by an increase in ionized calcium in the muscle cells, leading to increased muscle metabolism and heat production.

Question 5

Individuals with deficiency for which enzyme should avoid fava beans?&#10;A) CYP2D6&#10;B) NAT2&#10;C) G6PD&#10;D) RYR1&#10;E) CYP2C9

Accepted Answer

Individuals with Glucose-6-phosphate dehydrogenase (G6PD) deficiency should avoid fava beans because consuming them can trigger hemolytic anemia in these individuals.

Question 6

When prescribed medications, individuals who are ultrafast metabolizers based on their cytochrome p450 genotype are at risk of which of the following?&#10;A) Toxic buildup of medications&#10;B) Underdosing of the medication&#10;C) Hypersensitivity to a medication&#10;D) A and C&#10;E) B and C

Accepted Answer

Ultrafast metabolizers break down medications more quickly than normal, which can lead to underdosing as the medication is metabolized before it can exert its full therapeutic effect. This rapid metabolism does not typically result in toxic buildup. Hypersensitivity is not directly related to the rate of metabolism but to the immune system's response to a medication.

Question 7

Variation in which gene is associated with prolonged paralysis in response to anesthesia?&#10;A) CYP2D6&#10;B) CYP2C19&#10;C) UGT1A1&#10;D) NAT2&#10;E) BCHE

Accepted Answer

BCHE gene variations are associated with prolonged paralysis in response to anesthesia, particularly due to the metabolism of muscle relaxants such as succinylcholine and mivacurium. The BCHE gene encodes butyrylcholinesterase, an enzyme that hydrolyzes these drugs. Variants in this gene can lead to decreased enzyme activity and prolonged drug action.

Question 8

Variation in which gene is associated with failure of a once weekly dose of isoniazid for tuberculosis treatment?&#10;A) CYP2D6&#10;B) CYP2C19&#10;C) UGT1A1&#10;D) NAT2&#10;E) BCHE

Accepted Answer

NAT2 (N-acetyltransferase 2) gene variation is associated with the failure of a once-weekly dose of isoniazid for tuberculosis treatment. Variations in the NAT2 gene affect the acetylation rate of isoniazid, leading to differences in drug metabolism and, consequently, its efficacy and toxicity.

Question 9

Primaquine is likely to induce hemolytic anemia in which population in the United States?&#10;A) European Americans&#10;B) African Americans&#10;C) Asian Americans&#10;D) Amish&#10;E) Native Americans

Accepted Answer

Primaquine can induce hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition more prevalent in African Americans among the options provided.

Question 10

What enzyme is largely responsible for the conversion of codeine to morphine in the body?&#10;A) CYP2D6&#10;B) CYP1A2&#10;C) CYP2C19&#10;D) CYP3A4&#10;E) CYP1A1

Accepted Answer

CYP2D6 is the enzyme primarily responsible for the conversion of codeine into morphine in the body through the process of O-demethylation.

Deck 18: Application of Genomics to Medicine and Personalized Health Care