Anaes SAQs · Applied cardiovascular & respiratory physiology
Pharmacogenetics and variability in drug response
Primary — sources of variability (genetic, age, sex, organ function, interactions); CYP450 poor/intermediate/extensive/ultra-rapid metaboliser phenotypes; CYP2D6 and codeine (poor = no analgesia, ultra-rapid = overdose); butyrylcholinesterase deficiency and prolonged suxamethonium/mivacurium (dibucaine number); TPMT/NUDT15 and thiopurine myelosuppression; G6PD and oxidant-drug haemolysis; warfarin CYP2C9/VKORC1; RYR1 and malignant hyperthermia.
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Prompt
Outline the sources of variability in drug response, with emphasis on genetics. Describe the CYP450 metaboliser phenotypes and give four anaesthesia-relevant examples of pharmacogenetic variation.
Question
Outline the sources of variability in drug response, with emphasis on genetics. Describe the CYP450 metaboliser phenotypes and give four anaesthesia-relevant examples of pharmacogenetic variation.
References5ShowHide
- [1]Thamilselvan M, et al. Distribution of Cytochrome P450 Metabolizer Status and Allelic Variants in Individuals with Mental Health Disorders in Ontario, Canada: Répartition du statut métabolique du cytochrome P450 et des variantes alléliques chez les personnes atteintes de problèmes de santé mentale en Ontario, au Canada. Can J Psychiatry, 2026.PMID 42240275
- [3]Kempff-Andersen S, et al. Butyrylcholinesterase activity and prolonged mivacurium. Eur J Anaesthesiol, 2026.PMID 42298973
- [5]Fry J, et al. Severe thiopurine-induced myelosuppression (TPMT and NUDT15). Clin Transl Sci, 2026.PMID 42286409
- [7]Gulen A, et al. Residual risk after familial RYR1 testing: malignant hyperthermia susceptibility. Eur J Hum Genet, 2026.PMID 42321436
- [42321437]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.