A Textbook of Clinical Pharmacology and Therapeutics

30 DRUG METABOLISM Case history A 46-year-old woman is brought to the hospital Accident and Emergency Department by her sister, ...

●Introduction 31 ●Glomerular filtration 31 ●Proximal tubular secretion 31 ●Passive distal tubular reabsorption 32 ●Active tubula ...

32 RENAL EXCRETION OF DRUGS the renal plasma in a single pass through the kidney (i.e. dur- ing intravenous infusion of PAH its ...

ACTIVE TUBULAR REABSORPTION This is of minor importance for most therapeutic drugs. Uric acid is reabsorbed by an active transpo ...

pancreatic secretions and bile flow, can impair the absorption of fat-soluble vitamins. Significant reductions in the absorption ...

RENALDISEASE 35 DISTRIBUTION Drug distribution is altered by cardiac failure. The apparent volume of distribution (Vd) of, for e ...

and other plasma proteins. This alters the pharmacokinetics of many drugs, but is seldom clinically important. Phenytoin is an e ...

Detailed recommendations on dosage reduction can be found in textbooks of nephrology. These are useful for getting treatment und ...

38 EFFECTS OF DISEASE ON DRUG DISPOSITION demonstrated, and such indices of hepatic function serve mainly to distinguish the sev ...

DIGOXIN Myxoedematous patients are extremely sensitive to digoxin, whereas unusually high doses are required in thyrotoxicosis. ...

40 EFFECTS OF DISEASE ON DRUG DISPOSITION FURTHER READING Carmichael DJS. Chapter 19.2 Handling of drugs in kidney disease. In: ...

●Introduction 41 ●Role of drug monitoring in therapeutics 41 ●Practical aspects 41 ●Drugs for which therapeutic drug monitoring ...

have occurred. Greater care is therefore required in the timing and labelling of specimens for drug concentration determina- tio ...

for atrial dysrhythmias (0.5–1.5 mg/L). The clinical utility of predicting toxicity by measuring a metabolite (desethyl amiodaro ...

44 THERAPEUTIC DRUG MONITORING Johannessen SI, Tomson T. Pharmacokinetic variability of newer antiepileptic drugs – When is moni ...

●Introduction 45 ●Harmful effects on the fetus 45 ●Recognition of teratogenic drugs 46 ●Pharmacokinetics in pregnancy 47 ●Prescr ...

FERTILIZATION AND IMPLANTATION Animal studies suggest that interference with the fetus before 17 days gestation causes abortion, ...

vagina in girls in their late teens whose mothers had been givendiethylstilbestrolduring the pregnancy. Exposure tostilbestrolin ...

PRESCRIBING IN PREGNANCY The prescription of drugs to a pregnant woman is a balance between possible adverse drug effects on the ...

an anti-analgesic effect when combined with pethidine), and naloxone(an opioid antagonist) must always be available. Respiratory ...