Pharmacokinetics Overview

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Questions and Answers

Which of the following factors influence drug absorption?

  • Drug formulation
  • Route of administration
  • Solubility
  • All of the above (correct)

What is the primary site of drug metabolism in the body?

  • Kidney
  • Liver (correct)
  • Intestine
  • Brain

Which of the following is NOT a route of drug excretion?

  • Urine
  • Lungs (correct)
  • Sweat
  • Bile

What does the term 'bioavailability' (F) refer to in pharmacokinetics?

<p>The fraction of drug reaching systemic circulation (D)</p> Signup and view all the answers

Which pharmacokinetic parameter describes the apparent distribution of a drug within the body?

<p>Volume of Distribution (Vd) (D)</p> Signup and view all the answers

What does the term 'Tmax' represent on a plasma concentration-time curve?

<p>The time taken to reach the maximum plasma concentration (A)</p> Signup and view all the answers

Which of the following statements about Cmax is correct?

<p>Cmax indicates the highest concentration of a drug in the plasma after administration (D)</p> Signup and view all the answers

Which of the following terms describes the extent of drug absorption?

<p>AUC (A)</p> Signup and view all the answers

What is the hepatic extraction ratio (ER) defined as?

<p>The fraction of drug removed by the liver during a single pass through the hepatic circulation. (A)</p> Signup and view all the answers

What is the relationship between hepatic extraction ratio (ER), hepatic clearance (ClH), and blood flow (Q)?

<p>ClH = ER * Q (B)</p> Signup and view all the answers

Which of the following drug characteristics are important for passive diffusion?

<p>Size, concentration, polarity, degree of ionization, and surface area of absorption site. (A)</p> Signup and view all the answers

Which of the following drugs would likely have a high oral bioavailability?

<p>Diazepam (C)</p> Signup and view all the answers

What is the approximate bioavailability (F) of morphine, considering its ER is 0.75?

<p>0.25 (B)</p> Signup and view all the answers

Why do drugs with high ER require higher oral doses or alternative routes of administration?

<p>Because they are rapidly metabolized by the liver, reducing their bioavailability. (A)</p> Signup and view all the answers

What is the main difference between paracellular and transcellular absorption of drugs?

<p>Paracellular absorption occurs through tight junctions between cells, whereas transcellular absorption occurs through the cells themselves. (B)</p> Signup and view all the answers

Which of the following is an example of a drug that utilizes a carrier protein for facilitated diffusion?

<p>Metformin (D)</p> Signup and view all the answers

Which of the following statements is TRUE regarding active transport in drug absorption?

<p>Active transport can move drugs against their concentration gradient. (A)</p> Signup and view all the answers

What is the primary mechanism by which P-gp affects oral drug absorption?

<p>P-gp actively pumps drugs back into the intestinal lumen. (B)</p> Signup and view all the answers

What is the effect of inducing P-gp expression on drug bioavailability?

<p>Decreased bioavailability due to reduced drug absorption (A)</p> Signup and view all the answers

Which of the following is an example of a drug that induces P-gp, thereby lowering the absorption of another drug?

<p>Rifampin (C)</p> Signup and view all the answers

What is the effect of inhibiting P-gp activity on drug plasma concentrations?

<p>Increased plasma concentrations due to reduced drug elimination (B)</p> Signup and view all the answers

Which of the following is an example of a drug that inhibits P-gp, leading to increased absorption of another drug?

<p>Cyclosporine (C)</p> Signup and view all the answers

What is the primary mechanism by which grapefruit juice affects drug absorption?

<p>Grapefruit juice inhibits intestinal CYP3A4 and OATP transporters. (A)</p> Signup and view all the answers

Which of the following drugs is an example of a calcium channel blocker whose plasma concentration can be significantly increased by grapefruit juice?

<p>Felodipine (B)</p> Signup and view all the answers

How do dairy products influence the absorption of certain drugs?

<p>Dairy products form insoluble complexes with certain drugs, reducing absorption. (B)</p> Signup and view all the answers

Which class of drugs in the BCS system is characterized by slow dissolution and high permeability?

<p>BCS Class II (Low solubility, High permeability) (B)</p> Signup and view all the answers

What is the primary challenge associated with improving the bioavailability of BCS Class II drugs?

<p>Enhancing solubility to accelerate dissolution. (A)</p> Signup and view all the answers

Which of the following accurately describes a drug's high permeability?

<p>A significant portion of the administered dose is absorbed into the systemic circulation. (C)</p> Signup and view all the answers

Which in vitro method is commonly used to assess the permeability of a drug substance?

<p>Caco-2 cell permeability study. (D)</p> Signup and view all the answers

Which of the following drugs are considered examples of BCS Class I or III drugs?

<p>Metoprolol and Propranolol. (D)</p> Signup and view all the answers

What is the pH range used in solubility testing to simulate gastric and intestinal conditions?

<p>1.2 - 6.8 (B)</p> Signup and view all the answers

For a drug substance to be considered highly soluble, what percentage of the highest dose strength must dissolve in ≤ 250 mL of aqueous media?

<p>100% (B)</p> Signup and view all the answers

Why are modified-release formulations not eligible for biowaivers, according to the content provided?

<p>They are designed to release the active drug over an extended period, affecting dissolution and absorption. (A)</p> Signup and view all the answers

Which of the following is a characteristic of passive absorption?

<p>Follows Fick's Law of diffusion (C)</p> Signup and view all the answers

Which of the following is NOT a factor influencing paracellular absorption?

<p>Lipophilicity of the drug molecule (D)</p> Signup and view all the answers

Which of the following is an example of active transport?

<p>Transport of glucose into a cell using a protein transporter (B)</p> Signup and view all the answers

What property of a drug is MOST important in determining its ability to cross a cell membrane via transcellular diffusion?

<p>Lipophilicity (D)</p> Signup and view all the answers

What does the term "saturable" mean in the context of active transport?

<p>The rate of transport reaches a maximum and cannot increase further (A)</p> Signup and view all the answers

Which of the following is a characteristic of BOTH passive and active absorption?

<p>Movement across the cell membrane (D)</p> Signup and view all the answers

Why is the paracellular route of absorption limited in tissues like the CNS?

<p>These tissues have a highly selective barrier like the blood-brain barrier (B)</p> Signup and view all the answers

Which of the following is an example of a drug that is actively transported across membranes?

<p>L-Dopa (D)</p> Signup and view all the answers

Which of these factors contributes to pre-systemic elimination in the gastrointestinal lumen?

<p>Enzymatic degradation of the drug in the stomach (B)</p> Signup and view all the answers

What is the primary function of efflux transporters in pre-systemic elimination?

<p>To actively pump drugs back out of cells, reducing their absorption into the bloodstream (C)</p> Signup and view all the answers

Which of the following is NOT a site where pre-systemic elimination occurs?

<p>Kidney (D)</p> Signup and view all the answers

What is the primary reason why drugs are metabolized in the liver during the hepatic first-pass effect?

<p>To inactivate the drug and prevent it from causing side effects (D)</p> Signup and view all the answers

Which of the following routes of drug administration bypasses the first-pass effect entirely?

<p>Intravenous (D)</p> Signup and view all the answers

How does the sublingual route of administration help to avoid the first-pass effect?

<p>Drugs are absorbed directly into the bloodstream from the mouth, bypassing the digestive system. (C)</p> Signup and view all the answers

Which of the following is NOT a reason why a drug might have poor oral bioavailability?

<p>Rapid excretion from the body by the kidneys (C)</p> Signup and view all the answers

Which route(s) of administration can be used to avoid some of pre-systemic elimination?

<p>Topical (B), Rectal (C), Intravenous (E), Sublingual/Buccal (F)</p> Signup and view all the answers

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Flashcards

Absorption

Transfer of a drug from site of administration into bloodstream.

Bioavailability (F)

Fraction of a drug reaching systemic circulation after administration.

Distribution

Transport of a drug from bloodstream to tissues and organs.

Volume of Distribution (Vd)

Describes the apparent distribution of a drug in the body.

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Metabolism (Biotransformation)

Chemical alteration of a drug, mainly in the liver.

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Phase I reactions

Oxidation, reduction, hydrolysis reactions involving CYP450 enzymes.

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Cmax

Maximum plasma concentration of a drug after administration.

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Tmax

Time required to reach Cmax, indicating absorption rate.

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Transport Protein

A protein that moves substances across cell membranes, often against a concentration gradient.

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Endocytosis

Process used by cells to engulf large molecules, like Vitamin B12, into itself.

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Paracellular Absorption

Drug passage through tight junctions between cells, affected by junction size and drug size.

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Transcellular Absorption

Drug passage through the cell itself, dependent on drug lipophilicity and permeability.

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Factors of Diffusion

Elements that govern how drugs move across membranes, including concentration gradient and size.

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Fick's Law

Describes the rate of diffusion of a drug across a membrane based on its properties.

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Saturable Transport

Characteristic of active transport, where limited transporters mean a maximum rate.

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Lipophilicity

A measure of a drug's ability to dissolve in fats, crucial for membrane permeability.

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First-Pass Metabolism

The process where a drug's concentration is significantly reduced before it enters systemic circulation.

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Hepatic Extraction Ratio (ER)

The fraction of drug removed by the liver, calculated as (CA - Cv) / CA.

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Hepatic Clearance (ClH)

Volume of plasma cleared of drug by the liver per unit time, determined by blood flow and ER.

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Fraction Absorbed (Bioavailability, F)

The proportion of a drug that enters systemic circulation after administration.

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High ER Drugs

Drugs with an extraction ratio higher than 0.8, indicating lower oral bioavailability.

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Low ER Drugs

Drugs with an extraction ratio below 0.2, indicating high oral bioavailability.

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Passive Diffusion

The process where drugs diffuse across membranes without energy, from high to low concentration.

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Active Transport

Carrier-mediated drug movement that requires energy (ATP) for absorption.

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P-glycoprotein (P-gp)

A transport protein that limits drug absorption by pumping drugs back into the intestine.

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P-gp induction

Increased P-gp expression leading to decreased drug absorption and lower bioavailability.

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P-gp inhibition

Decreased P-gp activity resulting in increased drug absorption and higher plasma concentrations.

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Rifampin

A P-gp inducer that reduces the absorption of digoxin.

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Cyclosporine

A P-gp inhibitor that increases the absorption of paclitaxel.

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Grapefruit juice effect

Inhibits CYP3A4 and OATP transporters, affecting drug absorption.

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Felodipine interaction

Grapefruit juice increases plasma concentration, risking hypotension.

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Calcium and drug absorption

Calcium in dairy can chelate with drugs, reducing their absorption.

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Gastric Acid Instability

Variation in gastric acid can affect drug stability, such as penicillin G.

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Limited Membrane Permeability

Some drugs, like certain peptides, struggle to cross cell membranes.

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Efflux Transporters

P-glycoprotein and other transporters can reduce drug absorption.

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Chemical Degradation

Drugs can be inactivated by stomach pH or enzymes, example: omeprazole.

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Alternative Administration Routes

Methods to bypass poor oral bioavailability include IV, sublingual, and patches.

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Pre-Systemic Elimination

Loss of drug before reaching systemic circulation, occurring in GI, liver, lungs, and plasma.

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Hepatic First-Pass Effect

Reduction of drug bioavailability during its first pass through the liver post-absorption.

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High permeability

≥ 85% of the dose is absorbed in humans.

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Rapid dissolution

≥ 85% of a drug dissolves within 30 minutes in standard media.

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Narrow therapeutic index (NTI) drugs

Drugs with a small range between effective and toxic doses, e.g., Warfarin.

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BCS Class II drugs

Low solubility and high permeability; absorption limited by dissolution.

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Specifications for high solubility

Highest dose dissolves completely in ≤ 250 mL of aqueous media at pH 1.2 - 6.8.

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Specifications for high permeability

≥ 85% of the administered dose must be absorbed; involves extensive metabolism.

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Permeability testing methods

Includes human mass balance studies and Caco-2 cell permeability studies.

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Example of highly soluble drugs

Drugs like Metoprolol, Propranolol, and Atenolol that dissolve easily.

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Study Notes

Pharmacokinetics

  • Pharmacokinetics is the study of how drugs move through the body
  • Absorption is the transfer of a drug from the administration site into the bloodstream
    • Factors affecting absorption include formulation, route, solubility, pH, and food
    • Bioavailability (F) is the fraction of drug reaching systemic circulation
  • Distribution is the process of transporting a drug from the bloodstream to tissues and organs
    • Affected factors include lipophilicity, plasma protein binding, blood flow, and membrane permeability
    • Volume of distribution (Vd) is a parameter describing the apparent drug distribution in the body
  • Metabolism (biotransformation) is the chemical alteration of a drug, mostly in the liver
    • Phase I reactions include oxidation, reduction, and hydrolysis (enzymes like CYP450)
    • Phase II reactions involve conjugation (with glucuronic acid, sulfate) making the drug more water-soluble for excretion
    • First-pass metabolism lowers bioavailability of orally administered drugs
  • Excretion is the elimination of drugs and metabolites from the body, primarily through the kidneys
    • Routes include urine (renal excretion), bile, feces, sweat, breath, and breast milk
    • Renal excretion includes glomerular filtration, active tubular secretion, and reabsorption
    • Clearance (CI) measures the efficiency of drug elimination

Plasma Concentration-Time Curve

  • Cmax is the maximum plasma concentration of the drug
  • Tmax is the time required to reach Cmax (rate of absorption)
  • AUC (Area Under the Curve) represents total drug exposure over time
  • AUC describes the extent of absorption; Tmax indicates rate of absorption

Bioavailability

  • Absolute bioavailability (Fabs) compares oral (extravascular) dose to IV dose (always 100% bioavailable)
  • Relative bioavailability (Frel) compares two non-IV formulations

Bioequivalence

  • Bioequivalence compares two drug products (generic/brand) to ensure similar bioavailability
  • Bioequivalent products have similar Cmax, Tmax, and AUC values within the range of 80%-125% of the reference product

Pre-Systemic Elimination

  • Drug loss prior to systemic circulation
  • Occurs in the gastrointestinal (GI) lumen, intestinal wall, and liver (hepatic first-pass effect)

Hepatic First-Pass Effect

  • Drug breakdown in the liver prior to systemic circulation
  • Reduces drug bioavailability

Hepatic Extraction Ratio (ER)

  • Measures the fraction of drug removed by the liver
  • Calculated as (drug concentration in arterial blood - drug concentration in venous blood) / drug concentration in arterial blood
  • Hepatic clearance (ClH) is the product of hepatic blood flow (Q) and ER

Interconversion of Dosage Forms

  • Conversion from one dosage form to another (e.g., oral to IV) requires considering the bioavailability (F) of the drug in each form

Mechanisms of Absorption

  • Passive diffusion: Movement of drugs from high to low concentration across membranes
  • Facilitated diffusion: Movement using carrier proteins (requires no energy)
  • Active transport: Movement against concentration gradient (requires energy)
  • Endocytosis: Uptake of large molecules into cells

Factors Affecting Drug Absorption

  • Lipid solubility
  • Molecular size
  • Ionization and pH (Henderson-Hasselbalch Equation)
  • Membrane permeability
  • Surface area of absorption site
  • Blood flow and perfusion

Biopharmaceutics Classification System (BCS)

  • Categorization of drugs based on solubility and permeability to predict bioavailability

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