PGx Final Exam Ques ons and answers Newest RATED
A+ 2025/2026
Considering the founda on material and this specific case, an individual such as James, with a
poor metabolizer phenotype status (CYP2C19 PM), would be expected to have which of the
following had he been prescribed clopidogrel?
A. Longer half-life of the ac ve drug
B. Reduced risk of major adverse cardiac events
C. Increased risk of a major bleed
D. Decreased exposure (area under the curve) of the ac ve drug
E. Increased risk of an elevated INR - Answers D
Fluconazole is considered a CYP2C19 inhibitor. Addi on of fluconazole to James's medica on
list would result in which of the following?
A. Reduce the ac vity of CYP2C19 in James
B. Increase the ac vity of CYP2C19 in James
C. Not change the ac vity of CYP2C19 in James - Answers C
If James had a CYP2C19*2/*17 genotype, would the clinical recommenda on have changed?
A. No, because CPIC guidelines suggest avoiding clopidogrel for CYP2C19 IM phenotype.
B. Yes, because the FDA package insert only lists the CYP2C19 PM phenotype in the black box
warning.
C. No, because the *2 allele (listed first) is primarily expressed, and the *17 allele (listed last) is
not expressed.
D. Yes, because the *17 allele (listed last) is primarily expressed, and the *2 allele (listed first) is
not expressed. - Answers A
In the case of a CYP2C19*1/*2 genotype, one op on supported by CPIC would be to double the
dose of clopidogrel so as to overcome the lack of metabolism.
,A. True
B. False - Answers B
If James were 67 years of age, and all other clinical considera ons were consistent, what other
therapeu c possibili es should have been reasonably considered?
A. Prasugrel would have fewer concerns related to the black box warning informa on.
B. Clopidogrel 150 mg PO daily could be used due to expected drug metabolism changes.
C. Ticagrelor 90 mg PO b.i.d as a maintenance dose.
D. Aspirin should have been increased to 325 mg. - Answers C
Considering the founda on material and this specific case, and individual such as John, with a
decreased func on phenotype (OATP1B1), receiving simvasta n, a substrate for OATP1B1,
would be expected to have which of the following?
a. Reduced systemic exposure (lower AUC)
b. Increase volume of distribu on of the drug
c. Increased dosage requirement of the drug
d. Increased systemic exposure (high AUC) - Answers D
Considering the founda on material and specifically this case of John M, which of the following
diplotypes results in OATP1B1 decreased hepa c transporter func on?
a. *1a / *1a
b. *1a / *15
c. *1a / *1b
d. *1b / *1b - Answers B
For the case of John M, the pharmacist considering the individuals pa ent's PGx tes ng results
represents which component of the PPCP?
, a. Collect
b. Assess
c. Plan
d. Implement
e. Follow up - Answers B
U liza on of evidence-based guidelines in PGx, such as those from CPIC, can support clinical
decision-making. What recommenda on would be supported for an individual who has a
SLCO1B1 diplotype of *1b / *15, rela ve to simvasta n dosing, and an elevated LDL-cholesterol
a. Ini ate therapy with recommended maximum dose
b. Consider a dose reduc on of the recommended star ng maximum dose. The pa ents would
be at high risk for myopathy
c. Consider a dose reduc on of the recommended star ng maximum dose. The pa ent is at
moderate increased risk of myopathy
d. Consider using fenofibrate - Answers C
Which of the following could result in simvasta n- related myopathy, even in a pa ent who is
homozygous for the wild-type SLCO1B1?
a. A pa ent taking 80mg of simvasta n
b. A pa ent also receiving gemfibrozil
c. A pa ent also receiving strong CYP3A4 inhibitors
d. All the above are associated with an increased risk of simvasta n-related myopathy -
Answers D
Considering the founda on material and this specific case, an individual such as Mae J, with an
intermediate metabolizer phenotype status (CYP2C9 IM), receiving a drug such as warfarin
metabolized by CYP2C9, would be expected to have which of the following?
a. Shorter half-life of the drug
A+ 2025/2026
Considering the founda on material and this specific case, an individual such as James, with a
poor metabolizer phenotype status (CYP2C19 PM), would be expected to have which of the
following had he been prescribed clopidogrel?
A. Longer half-life of the ac ve drug
B. Reduced risk of major adverse cardiac events
C. Increased risk of a major bleed
D. Decreased exposure (area under the curve) of the ac ve drug
E. Increased risk of an elevated INR - Answers D
Fluconazole is considered a CYP2C19 inhibitor. Addi on of fluconazole to James's medica on
list would result in which of the following?
A. Reduce the ac vity of CYP2C19 in James
B. Increase the ac vity of CYP2C19 in James
C. Not change the ac vity of CYP2C19 in James - Answers C
If James had a CYP2C19*2/*17 genotype, would the clinical recommenda on have changed?
A. No, because CPIC guidelines suggest avoiding clopidogrel for CYP2C19 IM phenotype.
B. Yes, because the FDA package insert only lists the CYP2C19 PM phenotype in the black box
warning.
C. No, because the *2 allele (listed first) is primarily expressed, and the *17 allele (listed last) is
not expressed.
D. Yes, because the *17 allele (listed last) is primarily expressed, and the *2 allele (listed first) is
not expressed. - Answers A
In the case of a CYP2C19*1/*2 genotype, one op on supported by CPIC would be to double the
dose of clopidogrel so as to overcome the lack of metabolism.
,A. True
B. False - Answers B
If James were 67 years of age, and all other clinical considera ons were consistent, what other
therapeu c possibili es should have been reasonably considered?
A. Prasugrel would have fewer concerns related to the black box warning informa on.
B. Clopidogrel 150 mg PO daily could be used due to expected drug metabolism changes.
C. Ticagrelor 90 mg PO b.i.d as a maintenance dose.
D. Aspirin should have been increased to 325 mg. - Answers C
Considering the founda on material and this specific case, and individual such as John, with a
decreased func on phenotype (OATP1B1), receiving simvasta n, a substrate for OATP1B1,
would be expected to have which of the following?
a. Reduced systemic exposure (lower AUC)
b. Increase volume of distribu on of the drug
c. Increased dosage requirement of the drug
d. Increased systemic exposure (high AUC) - Answers D
Considering the founda on material and specifically this case of John M, which of the following
diplotypes results in OATP1B1 decreased hepa c transporter func on?
a. *1a / *1a
b. *1a / *15
c. *1a / *1b
d. *1b / *1b - Answers B
For the case of John M, the pharmacist considering the individuals pa ent's PGx tes ng results
represents which component of the PPCP?
, a. Collect
b. Assess
c. Plan
d. Implement
e. Follow up - Answers B
U liza on of evidence-based guidelines in PGx, such as those from CPIC, can support clinical
decision-making. What recommenda on would be supported for an individual who has a
SLCO1B1 diplotype of *1b / *15, rela ve to simvasta n dosing, and an elevated LDL-cholesterol
a. Ini ate therapy with recommended maximum dose
b. Consider a dose reduc on of the recommended star ng maximum dose. The pa ents would
be at high risk for myopathy
c. Consider a dose reduc on of the recommended star ng maximum dose. The pa ent is at
moderate increased risk of myopathy
d. Consider using fenofibrate - Answers C
Which of the following could result in simvasta n- related myopathy, even in a pa ent who is
homozygous for the wild-type SLCO1B1?
a. A pa ent taking 80mg of simvasta n
b. A pa ent also receiving gemfibrozil
c. A pa ent also receiving strong CYP3A4 inhibitors
d. All the above are associated with an increased risk of simvasta n-related myopathy -
Answers D
Considering the founda on material and this specific case, an individual such as Mae J, with an
intermediate metabolizer phenotype status (CYP2C9 IM), receiving a drug such as warfarin
metabolized by CYP2C9, would be expected to have which of the following?
a. Shorter half-life of the drug
