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• W4312822058 abstract "PreviousNext No AccessPharmacogenomics: Foundations, Competencies, and the Pharmacists’ Patient Care Process, 2nd EditionChapter 22: Psychiatry: Amitriptyline/CYP2C19, CYP2D6 Casehttps://doi.org/10.21019/9781582123844.ch22Authors:Thomas R. Smith, PharmD, BCPP, RPHThomas R. SmithSearch for more papers by this author SectionsAboutFull TextReferences ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Abstract:Mindy G. is a 5'2, 176-lb, 23-year-old Caucasian (European ancestry group) female who is brought to the emergency department after police were called by a local convenience store where she was being disruptive and claiming to be the store’s chief executive officer. She presents with rapid speech that is tangential, and it is difficult to obtain a clear history. She reports sleeping two or three hours per night for the past week, yet does not complain of fatigue. She requests to leave because she “has a huge client coming who is going to invest in her breakthrough medical technology business.” Records from her primary care physician (PCP) indicate she is an assistant manager at a local department store. Three months ago, Mindy complained of insomnia and was given amitriptyline 25 mg PO, nightly. Two months later, she returned and cited improvement in her insomnia with the medication but developed depressive symptoms related to interpersonal problems. Because she tolerated the amitriptyline well, her PCP increased the dose to utilize it as an antidepressant and avoid duplicative antidepressant therapy. As the clinical pharmacist, you are asked to evaluate her medication profile and make recommendations on adjustments at this time. References1. Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 2014. https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf. Accessed January 17, 2022. Google Scholar, 2. Hicks JK, Sangkuhl K, Ellingrod VL, et al.. Clinical Pharmacogenetics Implementation Consortium guidelines for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants: 2016 update. Clin Pharmacol Ther. 2017;102(1):37–44. Crossref, Medline, Google Scholar, 3. Hicks JK, Sangkuhl K, Ellingrod VL, et al.. Clinical Pharmacogenetics Implementation Consortium guidelines for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants: 2016 update. Supplemental information. https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/. Accessed January 17, 2022. Google Scholar, 4. Clinical Pharmacogenetics Implementation Consortium (CPIC). Level definitions for CPIC genes/drugs. https://cpicpgx.org/prioritization/#cpicLevels. Accessed April 12, 2019. Google Scholar, 5. Whirl-Carrillo M, Huddart R, Gong L. An evidence-based framework for evaluating pharmacogenomics knowledge for personalized medicine. Clin Pharmacol Ther. 2021;110(3):563–572. Crossref, Medline, Google Scholar, 6. Fabbri C, Zohar J, Serretti A. Pharmacogenetic tests to guide drug treatment in depression: Comparison of the available testing kits and clinical trials. Prog Neuropsychopharmacol Biol Psychiatry. 2018;86:36–44. Crossref, Medline, Google Scholar, 7. Pharmacogene Variation Consortium (PharmVar). https://www.pharmvar.org/gene/CYP2D6. Accessed January 1, 2022. Google Scholar, 8. Gaedigk A, Simon SD, Pearce RE, Bradford LD, Kennedy MJ, Leeder JS. The CYP2D6 activity score: Translating genotype information into a qualitative measure of phenotype. Clin Pharmacol Ther. 2008;83(2):234–242. Crossref, Medline, Google Scholar, 9. Clinical Pharmacogenetics Implementation Consortium. Final consensus CYP2D6 genotype to phenotype table: March 2019. https://cpicpgx.org/wp-content/uploads/2019/03/Final-Consensus-CYP2D6-genotype-to-phenotype-table_-final_Mar2019.pdf. Accessed April 12, 2019. Google Scholar, 10. Caudle KE, Dunnenberger HM, Freimuth RR, et al.. Standardizing terms for clinical pharmacogenetic test results: Consensus terms from the Clinical Pharmacogenetics Implementation Consortium (CPIC). Genet Med. 2017;19(2):215–223. Crossref, Medline, Google Scholar, 11. DailyMed. Amitriptyline. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e6d2c80-fbc8-444e-bdd3-6a91fe1b95bd. Accessed April 12, 2019. Google Scholar, 12. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002;159(4 Suppl):1–50. Google Scholar, 13. Sánchez-Iglesias S, García-Solaesa V, García-Berrocal B, et al.. Role of pharmacogenetics in improving the safety of psychiatric care by predicting the potential risks of mania in CYP2D6 poor metabolizers diagnosed with bipolar disorder. Medicine (Baltimore). 2016;95(6):e2473. doi:10.1097/MD. Crossref, Medline, Google Scholar, 14. Puangpetch A, Vanwong N, Nuntamool N, et al.. CYP2D6 polymorphisms and their influence on risperidone treatment. Pharmgenomics Pers Med. 2016;9:131–147. Medline, Google Scholar, PreviousNext Session Activity Recently Viewed Chapter 22: Psychiatry: Amitriptyline/CYP2C19, CYP2D6 Case Thomas R. Smith Recently Searched No search history FiguresReferencesRelatedDetails Published: 4 October 2022ISBN: 1-58212-384-5 Publisher American Pharmacists Association HistoryPublished: 4 October 2022 Citation Information Thomas R. Smith, (2022), Chapter 22: Psychiatry: Amitriptyline/CYP2C19, CYP2D6 Case, Pharmacogenomics: Foundations, Competencies, and the Pharmacists’ Patient Care Process, 2nd Edition https://doi.org/10.21019/9781582123844.ch22 Loading ..." @default.
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