Case Study: Pharmacogenetic Testing and Antidepressant Selection
Über den Vortrag
Der Vortrag „Case Study: Pharmacogenetic Testing and Antidepressant Selection“ von Melissa Kalensky, FNP-BC, PMHNP-BC, CNE ist Bestandteil des Kurses „Hormonal and Genetic Influences in Psychopharmacology“.
Quiz zum Vortrag
What clinical threshold typically warrants ordering genetic testing before selecting a third antidepressant in an adolescent with major depressive disorder?
- Two medication failures with at least four weeks of adequate therapy in each trial
- One medication trial lasting at least two weeks with documented adverse effects
- Three medication trials lasting at least two weeks each with minimal response
- Any adolescent with a family history of depression and one medication failure
- Two medication failures lasting at least two weeks each with moderate symptoms
A patient is heterozygous for the short allele of the SLC6A4 gene. What does this genetic finding suggest about the response to SSRIs?
- Reduced sensitivity to SSRIs with potential difficulty achieving therapeutic effects
- Enhanced sensitivity to SSRIs with faster symptom improvement and lower doses
- Normal sensitivity to SSRIs but increased risk of gastrointestinal side effects
- Increased metabolism of SSRIs requiring higher than typical doses for efficacy
- Delayed onset of action requiring extended trial periods of eight to ten weeks
A patient has CYP2C19 rapid metabolizer status and CYP2D6 intermediate metabolizer status. When considering escitalopram for this patient, why is the distribution of metabolism across multiple pathways clinically advantageous?
- If one metabolic pathway is impaired, the drug can still be processed through alternative pathways
- Rapid metabolism at CYP2C19 will automatically compensate for intermediate metabolism at CYP2D6
- Multiple pathways guarantee consistent drug levels regardless of individual metabolizer status
- The drug will be eliminated more quickly from the body, reducing overall side effects
- Multiple pathways reduce the likelihood of drug-drug interactions with other medications
In a pharmacogenetic report, which antidepressants are typically classified in the green category with no significant gene-drug interactions?
- Bupropion, mirtazapine, and vilazodone
- Escitalopram, citalopram, and bupropion
- Paroxetine, venlafaxine, and fluvoxamine
- Duloxetine, escitalopram, and mirtazapine
- Sertraline, fluoxetine, and citalopram
A patient's HTR2A gene shows increased sensitivity. When prescribing an SSRI like escitalopram for this patient, what clinical strategy addresses this pharmacodynamic finding?
- Start at a reduced dose of 2.5 mg and maintain it for four to six weeks with close monitoring.
- Initiate standard dosing of 10 mg and increase weekly until therapeutic effects are achieved.
- Begin at 5 mg and rapidly titrate to maximum dose within two weeks for faster response.
- Use standard dosing but add an adjunctive medication to counteract increased sensitivity.
- Prescribe half the standard dose and increase to full dose after two weeks of treatment.
Why should paroxetine and tricyclic antidepressants be avoided in a patient with CYP2D6 intermediate metabolizer status?
- Paroxetine has significant gene-drug interactions at CYP2D6, and tricyclic antidepressants pose safety concerns.
- Both medications require extensive CYP3A4 metabolism, which may be impaired in this patient.
- Paroxetine causes severe withdrawal symptoms, and tricyclic antidepressants have narrow therapeutic windows.
- These medications interact with CYP2C19 rapid metabolism, causing excessive drug accumulation.
- Both medications have high binding affinity at CYP2D6, leading to competitive inhibition.
Dozent des Vortrages Case Study: Pharmacogenetic Testing and Antidepressant Selection
Melissa Kalensky, FNP-BC, PMHNP-BC, CNE
Dr. Melissa Kalensky, FNP-BC, PMHNP-BC, CNE is dual-certified as a Family Nurse Practitioner and a Psychiatric Mental Health Nurse Practitioner.
She specializes in primary care, community health, and integrated behavioral healthcare. Her expertise spans trauma-informed care and psychiatry across all age groups, from children to adults.
At Lecturio, she teaches psychopharmacology to advanced practice providers, helping to bridge the gap between psychiatric and primary care practice.
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