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PGx Quiz 2 Psychiatric Meds

Terms in this set (19)

Fluoxetine
- has active metabolite so pgx does not matter

- potent 2D6

- no recommendations in any guideline
Citalopram UM
lower exposure -> will fail treatment
Citalopram PM
higher exposure -> need to reduce dose by 50%

*this is an FDA recommendation due to QTc prolongation*
Escitalopram PM
17/17

PM = d/c therapy due to higher exposure effects (high Cmax and AUC)

recommendation: decrease dose by 50%

*this is a CPIC guideline, NOT an FDA like citalopram*
Escitalopram UM
17/17

UM = d/c therapy due to no effect (low concentrations)

recommendation: decrease dose by 50%

*this is a CPIC guideline, NOT an FDA like citalopram*
Which metabolizers have strong recommendation to initiate sertraline therapy with recommended starting dose?
extensive/rapid metabolizer (EM)
and
intermediate metabolizer (IM)
Which metabolizer has an optional recommendation to initiate sertraline therapy with recommended starting dose?
Ultrarapid metabolizer
Which metabolizer has an optional recommendation to initiate sertraline therapy with 50% reduction of recommended starting dose?
poor metabolizer
Paroxetine and Fluvoxamine PM recommendation
reduce dose by 25-50%
Paroxetine and Fluvoxamine IM/UM recommendation
no adjustments
Which drug is potent 2D6 inhibitor and can make NM look like PM?
Fluoxetine
Almost half of this 2D6 drug is converted to PM
aripiprazole
Aripiprazole PM recommendation (FDA labeling)
reduce dose by 50%

(higher risk of high concentrations)
Haloperidol 2D6 PM
increased side effects
(does not mention decreasing dose)
Which 2D6 drug has 10 fold higher exposure in PM
atomoxetine
atomoxetine UM/NM
escalate dose quickly + check exposure 1-2 hours after dose
atomoxetine IM/PM
need more time to get to steady state + check exposure 1-2 weeks after starting initial dose
Strong CYP2D6 inhibitors
fluoxetine, paroxetine, bupropion
Moderate/weak CYP2D6 inhibitors
duloxetine, sertraline, escitalopram
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