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First-pass metabolism may occur in the liver (for propranolol, lidocaine, clomethiazole, and nitroglycerin) or in the gut (for benzylpenicillin and insulin). [4] The four primary systems that affect the first pass effect of a drug are the enzymes of the gastrointestinal lumen, [5] gastrointestinal wall enzymes, [6] [7] [8] bacterial enzymes [5] and hepatic enzymes.
Drug metabolism is the metabolic breakdown of drugs by living organisms, usually through specialized enzymatic systems. More generally, xenobiotic metabolism (from the Greek xenos "stranger" and biotic "related to living beings") is the set of metabolic pathways that modify the chemical structure of xenobiotics, which are compounds foreign to an organism's normal biochemistry, such as any drug ...
Many drugs that are absorbed through the GI tract are substantially metabolized by the liver before reaching general circulation. This is known as the first pass effect . As a consequence, certain drugs can only be taken via certain routes.
Enterohepatic circulation of drugs describes the process by which drugs are conjugated to glucuronic acid in the liver, excreted into bile, metabolized back into the free drug by intestinal bacteria, and the drug is then reabsorbed into plasma.
Rate of extent of absorption of the drug from different routes. Effect of digestive juices and the first pass metabolism of drugs. Condition of the patient. In acute situations, in emergency medicine and intensive care medicine, drugs are most often given intravenously. This is the most reliable route, as in acutely ill patients the absorption ...
Various factors affect the rate of glucuronidation, which in turn will affect these molecules' clearance from the body. Generally, an increased rate of glucuronidation results in a loss of potency for the target drugs or compounds.
Food such as fructose can increase the rate of alcohol metabolism. The effect can vary significantly from person to person, but a 100 g dose of fructose has been shown to increase alcohol metabolism by an average of 80%. In people with proteinuria and hematuria, fructose can cause falsely high BAC readings, due to kidney-liver metabolism. [106]
Albumin, carries thyroid hormones and other hormones, particularly fat soluble ones, fatty acids to the liver, unconjugated bilirubin, many drugs and Ca 2+ Ceruloplasmin, carries copper; Transcortin, carries cortisol, aldosterone and progesterone; Haptoglobin, carries free hemoglobin released from erythrocytes