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BIOPHARMACEUTICS
&
PHARAMCOKINETICS
PHARMACOKINETICS VARIATIONS
IN
DISEASE STATES
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Contents
Definitions
General Introduction
Effect of Liver Disease on PK
Effect of Kidney Disease on PK
Effect of Cardiac Disease on PK
Effect of Burns on
PK Biopharmaceutics
Definition:
Pharmacodynamics
Definition:
The study of biochemical & physiological effects of drugs & the mechanism of their actions
including the correlation of their action & effect with their chemical structure.
Bioavailability means that rate and extent to which the active ingredients or active moiety
reaches the systemic circulation and becomes available at the site of action.
Bioequivalence
Definition:
Rate and extent of the absorption of test drug that do not show significant difference from
the rate and extent of absorption of the reference drug when administered at same molar
doses of therapeutic ingredient under similar experimental conditions in either single or
multiple dose.
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Structure of Pharmacokinetics
Pharmacokinetic consist of 4 major parts of its basic structure:
Absorption
Distribution
Metabolism
Excretion
Liver
Acute liver impairment interferes with drug metabolism and elimination.
Chronic liver impairment affects all parameters of pharmacokinetic.
Because most drugs are metabolized by the liver, it is susceptible to drug toxicity.
Impaired liver function greatly increases the risks of adverse drug effects.
Many drugs change liver function tests without clinical signs of liver dysfunction.
Hepatotoxicity is potentially life threatening.
Liver is able to function with as little as 10% of undamaged hepatic cells.
With severe hepatic impairment, extrahepatic metabolism becomes more important.
Patient at risk for impaired liver function include:
Primary liver disease (e.g. hepatitis, cirrhosis).
Diseases that impair blood flow to the liver (heart failure, shock, major surgery,
or trauma).
Hepatotoxic drugs.
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Metabolism in Liver
Most drugs are metabolized by enzymes in the liver.
They are called the cytochrome P450 [CYP] or the microsomal enzymes.
Drugs Effect on Liver
With chronic administration, some drugs increase metabolizing enzymes in the liver:
enzyme induction.
Enzyme induction accelerates drug metabolism and larger doses is required.
Rapid metabolism also increases the production of toxic metabolites.
Enzyme induction does not occur for 1-3 weeks because new enzymes must
be synthesized.
Enzyme inducers consist of: phenytoin, rifampin, phenobarbital, ethanol,
and cigarette smoking.
Tolerance and cross-tolerance are attributed to activation of liver
metabolizing enzymes.
They also are attributed to decreased sensitivity or numbers of receptor sites.
Metabolism can be decreased in a process called enzyme inhibition.
It occurs with co-administration of drugs that compete for the same
metabolizing enzymes.
In this case, smaller doses of the slowly metabolized drug is needed to avoid toxicity.
Enzyme inhibition occurs within hours or days of starting an inhibiting agent.
Enzyme inhibitors consist of: Cimetidine, fluoxetine, and ketoconazole.
Kidney
Kidney is the major organ of excretion.
Other organs also play important role in the excretion.
If the kidney is compromised its can affect the all parameter of pharmacokinetics.
In the presence of renal diseases some metabolic functions seem to be
impaired. What Kind Of Drugs Can Be Excreted Through Kidney!!!???
Renal route of drug elimination is the major route for drugs that are:
o Polar drugs
o Water soluble drugs
o Low molecular weight drugs
o Slowly bio transformed/metabolizing drugs
Renal Impairment
Use of drugs in renal impairment can give rise to problems for several reasons:
Failure to excrete a drug or its metabolites may produce toxicity.
Sensitivity to some drugs is increased even if elimination is impaired.
Many side effects are tolerated poorly in patients with renal impairment.
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Result:
o Reduced absorption of many drugs
Uremia slows the rate of phase I metabolism due to this there is decreased
hydrolysis & oxidation & also in phase II metabolism.
Even if drug is metabolized in liver the excretion of metabolites depends upon
the renal excretion.
Renal Impairment & Excretion
Renal handling of drugs depends upon:
o Glomerular Filtration
o Tubular Secretion
o Tubular Reabsorption
o GFR decrease than renal clearance decrease due to which plasma half-life increases.
Cardiac System
Complex progressive disorder.
Heart unable to pump sufficient amount of blood.
Result:
Erratic absorption of drug
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Result
o Decrease clearance of drugs
References
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