Parsons Lec Qs - madę up

When taking Metroprolol the patient experienced cardiac arrest and how would u prevent it and if the sme patient is gonna take tamoxifen what could be a consequence for the pt.

1. Metropol is metabolised by CYP2D6

2. pt experience cardiac arrest as the pt is poor metaboliser or deficent in CYP2D6

3. Leading to increased concentration of the drug → cardiac arrest

4. tamoxifen is metabolised in two steps to endoxifen and one of the steps includes metabolic with CYP2D6

5. If the pt has deficient CYP2D6 there will be less endoxifen → no therapeutic effect

A white British Pt is on warfarin. what are the consequence of metabolism of warfarin ?

Wafarin is metabolised by CYP2C9

1. White are generally a poor metaboliser therefore leading to increased warfarin in the blood → increasing risk of bleeding therefore doses given is reduced

What drugs should the pt be aware in regards to NAT2 pharmacogenetics. Pt comes in saying that they have very bad back pains and the dr suspects tht it could be kidney stones? y could it be ?

Drugs: Sulponamides , sulphates , isonzid

1. Pt can be slow / fast acetylator

2. Pt is fast aceylator the compound becomes hydrophobic and aggregate in urine causing kidney stone

3. Pt is slow aceylator you can have spontaneous reaction where it will be bind to the protein causing kidney stone leading to toxicity

what are the consequence of mutation in TPMT gene.What drug should be aware

TPMT gene codes for enzyme ( Thiopurine S-methyltranserferase )

Drug: Azathiroprine

1. Homozygous mutation ( 2 allele )→ poor metaboliser → FATAL MYLOSUPRESSION as there high concentration of the drug .

   Therefore needs a reduced dose compared to heterozygous mutation (1 allele difference )

How does polygenitic mutation effect drug response?

THINK PROTEIN in different part of the body

1. metaboliser

2. Concentration in the body

3. The receptor mutuation

4. Effect on efficacy

5. Effect on Toxicity

Explain why the committee on safety of medicines was set up and what do they look over

Committee of safety of medicine was et ip after the thalidomide tragedy where found that the drug was tetragenoic due to many babies were born with deform limbs.

• part of MHRA

• involved in drug licensing

• Inform the public anbou the safety alert

• deal with medical devices

After the thalidomide tragedy what changes were made to the preclinicla testin

• reproductive testing

• Test conducted with rats and non - rodent species

• as thalidomide showed no effect on rats but limb defect i some rabbits

what is NOEL ? does all drug have noel

concentration below where there is no adhered effects observed

• No - in some drug is there no safe dose like the botox compound