CYP Enzyme Presentation for Residents

[Cgreg21]

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.

In pharmacy school, we are taught which isoforms of cytochrome P450 metabolize which drugs and therefore can identify interactions based on the route of metabolism. 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 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 some common 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!

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[Psai]

I would like to know what are the most common medications and how to adjust doses accordingly. How medications are affected by things like renal failure, liver failure

Like a real life application would be knowing to go down on simva in someone taking amlodipine or something like that

 

[futuredo32]

I would include that a lot of antipsychotics and antidepressants (They are in all of the classes) as well as oral contraceptives and maybe antiretrovirals for HIV as well as cimetidine , the antifungals, grapefruit juice, antibiotics that are going to have a BIG impact . I'm currently a psychiatrist and Fluvoxamine has TONS of interactions which is one reason I rarely prescribe it. The CYP 450 system is a huge topic to cover in 30 minutes.
I did my residency at 2 separate programs and taught myself. Perhaps it was covered at both programs when I wasn't there? Although I am a psychiatrist, a lot of people are on a psych med at some time in their lives. I might just mention the big ones in psych and mention that the SSRIS and Antipsychotics are in other groups of CYP and are substrates inducers and inhibitors.
Good luck.

 

[d2305]

Has anyone actually seen a real reaction with simvastatin or fluvoxamine? The only complaint with fluvoxamine was decreased libido. Muscle pain or gi upset with simvastatin. Maois are more problematic.