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Table 2 Example if-then rules.

From: Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support

Approximate decision support rule

Inpatient/

Outpatient DB

Laboratory DB

Supportive Knowledge

Information/

Recommendation/

Warning

IF the patient has ASM AND the patient has a tumor with a D816V c-Kit mutation THEN recommended dose of Gleevec is 400 mg/day

Medication –

Imatinib mesylate

(Gleevec®)

Disease status – ASM, DFSP, or GIST

Tumor/Pathogen genotype – gastrointestinal stromal tumor c-Kit expression

N/A

Recommendation

IF the patient has a CYP2C9 variant AND the variant causes poor metabolism THEN the dose of Celecoxib should be reduced by 50%

Medication – Celecoxib

CYP2C9 variant status

CYP2C9 variants causing poor metabolism

Recommendation

IF the patient has a CYP2C19 variant AND the variant causes poor

metabolism THEN the dose adjustment for Clopidogrel is unknown for the patient

Medication –

Clopidogrel

(Plavix®)

CYP2C19

variant status

CYP2C19 variants causing poor metabolism

Information

IF the patient has hepatic impairment OR the patient is taking a medication that is a strong CYP2D6 inhibitor OR the patient is a CYP2D6 poor metabolizer THEN the dose of Atomoxetine should be adjusted

Disease status – hepatic impairment

Medication – Atomoxetine

Medication list

CYP2D6

variant status

Medications

that are CYP2D6 inhibitors

CYP2D6 variants causing poor metabolism

Information

IF the patient will be taking Fluoxetine AND the patient is taking other drugs that are metabolized by CYP2D6, THEN coadministration should be approached with caution

Medication –

Fluoxetine HCL

(Prozac®)

Medication list

N/A

Medications

metabolized

by CYP2D6

Warning

  1. Example if-then rules for PGx clinical decision support.