CYP Enzyme Presentation for Medical Residents

[Cgreg21]

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Hello everyone, I am a 4th year pharmacy student tasked with giving a group of medical residents a presentation about CYP enzyme interactions. I am reaching out to see if anyone has any recommendations about potential topics to cover? I am not certain how much education the medical students receive on CYP enzymes overall and therefore don't know what would be beneficial to a group of medical residents.
I figured this would be a good place to start assessing what topics I should cover.

I don't want to grind through every particular interaction and put the residents to sleep presenting information that they would have to look up (or ask a pharmacist) in a real-world setting anyway. I guess I am just stuck as to what direction to pursue and am looking for any recommendations that anyone here might have.

Topics I am thinking about covering include:
- General overview of inducers vs. inhibitors
- Some of the more common, and specific genetic mutations occurring at CYP-2C9 (affects warfarin and phenytoin), CYP-2C19 (affects clopidogrel activation), CYP-2D6 (opioids mainly and some SSRIs)
- maybe some drug transporter polymorphisms which lead to affects on simvastatin and other statins.
- CPIC Guidelines - maybe just a general overview of the available guidelines?
- clinical application of available genetic tests

I should note that I have a 30 minute presentation time slot.
I am open to any and all ideas! Hopefully this will be a clinically useful presentation once I am done.

Thank you!

 

[SCRph2014]

I think your general outline looks good! For presenting to medical residents, I would focus on slides of the major inducers/inhibitors, things they will see pretty commonly i.e. fluconazole, ciprofloxacin, carbamazepine, clarithromycin, etc. The main thing to remember is that they might not specifically remember if it induces or inhbits or what drugs it specifically interacts with but if you point out the big ones, they are more likely to think "I remember seeing in a presentation this interacts with a lot of things..." which will (hopefully) prompt them to look further into the patient's drug profile. Gotta realize that MDs have to know a little bit about a LOT of things, so I think they'll appreciate that format and be able to translate it to their future practice.

 

[rxkrafted]

I'm assuming they are internal med residents? I wouldn't focus too much on genetic mutations too much. You want to tailor the information to interactions they come across and perhaps asking the pharmacists what drug interaction interventions they make the most are. They won't really pay attention or grasp the information that you tell them unless they are gonna apply it often in practice. Just some things to think about to make your presentation more worth while.

 

[zelman]

I'm assuming they are internal med residents? I wouldn't focus too much on genetic mutations too much. You want to tailor the information to interactions they come across and perhaps asking the pharmacists what drug interaction interventions they make the most are. They won't really pay attention or grasp the information that you tell them unless they are gonna apply it often in practice. Just some things to think about to make your presentation more worth while.

Except codeine. They should tell them not to prescribe codeine to kids.

 

[Xarelto-10]

Your format is good. As pointed out by others above- focus ones that are pertinent.

Recommended changing therapy vs absolute contraindications vs monitoring recommended.

Then hammer it on the absolute contraindications while providing alternative treatment approaches.

In real life avoiding certain drugs may not be possible and in that case what to look for and how to monitor therapy in optiming outcomes while potentially decreasing possible treatment failure or adverse events.
Good luck.

 

[RxPreceptor]

Although the interactions are important, I think explaining some of the management strategies for dealing with said interactions would be insightful/helpful as opposed to just giving the impression to avoid certain med combinations (ex) simvastatin 40mg (3A4 Major) + verapamil -> use dose equivalent Rosuvastatin 10mg (2C9/3A4 minor) instead of simvastatin).

Maybe mention some real world practical information...like the PIA of having to do PA because insurance will only cover Omeprazole...& patient is on Clopidogrel (only generic P2Y12-Inhibitor) despite there being numerous generic PPIs and having to compromise, step back to an H2-Antagonist (true story)

 

[radio frequency]

Although the interactions are important, I think explaining some of the management strategies for dealing with said interactions would be insightful/helpful as opposed to just giving the impression to avoid certain med combinations (ex) simvastatin 40mg (3A4 Major) + verapamil -> use dose equivalent Rosuvastatin 10mg (2C9/3A4 minor) instead of simvastatin).

Maybe mention some real world practical information...like the PIA of having to do PA because insurance will only cover Omeprazole...& patient is on Clopidogrel (only generic P2Y12-Inhibitor) despite there being numerous generic PPIs and having to compromise, step back to an H2-Antagonist (true story)

The clopidogrel/omeprazole interaction is a hassle, but cardiologists I’ve talked to about this combo usually let it go now. The data is kind of shaky on whether or not it’s truly significant and the studies to back it up aren’t great.

 

[Sine Cura]

FYI prasugrel went generic late 2017

 

[RxPreceptor]

Yes, it was a long time ago pre prasugrel; many cardiologists in my area don't really care about the interaction either. Main gripe with this interaction is the overuse/questionable need of PPIs; drug that keeps vessels from narrowing/stent open seems much more important than a god damn acid reflux med vast majority of the time