Drug Biotransformation Flashcards

1
Q

xenobiotics

A

foreign substances within the body

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2
Q

what drugs are very much in need of biotransformation

A

lipophilic
unionized
large compounds

to terminate and faciliate their elimination

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3
Q

what is a prodrug

A

inactive to active

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4
Q

where are the important sites of biotransformation

A

liver

GI tract, lungs, skin and kidneys

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5
Q

where are enzymes located involved in biotransformation

A
ER
mitochondria
cytosol 
lysosomes 
nuclear envelope 
plasma membrane
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6
Q

what is first pass

A

oral drugs are absorbed in the small intestine and transported to the liver via hepatic portal system where they undergo extensive metabolism

drugs that are given parenterally DO NOT undergo first pass

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7
Q

what does GI flora do to estrogens

A

increase enterohepatic cycling thereby increasing bioavailability

that is why antimicrobial drugs reduce estrogen efficacy

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8
Q

what do phase I rxns result in

A

biological inactivation

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9
Q

what do phase II rxns result in

A

metabolite with improved water solubility and increased molecular weight -> facilitates elimination

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10
Q

phase 1 rxns
enzymes?
types of rxns…

A

catabolic

convert parent drug to more polar metabolite by introducing or unmasking a functional group

oxidation, reduction, hydrolysis

cytochrome P450’s

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11
Q

phase 1 produces are generally more what… compared to parent drug

A

more reactive and more toxic

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12
Q

where are phase 1 enzymes located

A

lipophilic ER membranes of liver

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13
Q

phase II reactions

rxns

A

form a conjugate of the parent drug
conjugate is polar and large inactive

occurs faster than phase I

usually happens in the liver

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14
Q

what are the most important CYP’s (P450’s)

A
CYP1A2
CYP2A6
CYP2D6
CYP2E1
CYP3A4***
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15
Q

how do P450’s work

A

use O2 and H+ derived from the cofactor-reduced NADPH to carry out oxidation –> add one oxygen atom per drug molecule which makes it more water soluble (polar)

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16
Q

individuals with a genetic defect in pseudocholiesterase can do what…

A

metabolize succinylcholine at 50% the rate as normal individuals

succ–> depolarizing neuromuscular blocking drug

so in the ER if a patient is not responding to succ, then consider genetic defect

17
Q

what is the slow acetylator phenotype

A

autosomal recessive

have a DECREASE in N-acetyltransferase levels (rather than a mutated enzyme) in the liver

so when given isoniazid to treat TB, hydralazine (to treat HTN) or caffeine, these are metabolized at a slower rate

can lead to hepatotoxicity !! hepatitis

occurs in 50% US population
83% of French
less in Asians

18
Q

what are examples of inducers of P450?

A
phenytoin - anticonvulsant
chronic ethanol (CYP2E1)
aromatic hydrocarbons like benzoapyrene (tobacco) 
rifampin (anti-TB)
phenobarbital- anesthesia
19
Q

what is the effect of P450 inducers

A

enhance the rate of enzyme synthesis or reduce the rate of enzyme degradation

leads to acceleration of substrate metabolism

20
Q

what effect does grapefruit juice have?

A

irreversibly inhibit intestinal CYP3A4 –> leads to increased levels of drugs taken orally

21
Q

what is the relationship b/w allopurinol and mercaptopurine

A

allopurinol is used for gout treatment
allopurinol inhibits xanthine oxidase

xanthine oxidase is a key enzyme in biotrasnfomring the immunosuppressive agent mercaptopurine (used during cancer treatment)

coadministration of mercaptopurine and allopurinol –> prolongs the duration of mercaptopurine action –> enhances its effects (both chemotherapeutically and toxically)

doses of mercaptopurine must be reduced in patients receiving allopurinol

22
Q

why does hyperbilirubinemia occur in the newborn

A

metabolism of fetal hemoglobin –> bilirubin levels rise and accumulate in blood

newborns have immature hepatic metabolic pathways and are unable to conjugate bili with UDP glucuronic acid so they can’t excrete bili

23
Q

what is a classic example of biotransformation to more toxic products

A

acetaminophen - induced hepatotoxicity

when acetaminophen exceeds therapeutic dose –> hepatic GSH is depleted faster than it is regenerated

toxic metabolites accumulate–> hepatotoxicity