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INTRODUCTION

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This chapter will be most useful after having a basic understanding of the material in Chapter 2, Pharmacokinetics in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. This chapter also draws from content in Chapter 5, Membrane Transporters and Drug Response; Chapter 6, Drug Metabolism; and parts of Chapter 7, Pharmacogenetics. The drugs presented in this chapter are used to illustrate general pharmacokinetic principles. The pharmacokinetic, pharmacodynamic, and therapeutic uses of drugs described in Chapter 2 are discussed in more detail in subsequent chapters. Neither a Mechanisms of Action Table nor a Clinical Summary Table is included in this chapter because this information is provided in subsequent chapters.

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In addition to the material presented here, the 12th Edition contains:

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  • A review in Chapter 2 of cell membranes and their physicochemical properties that affect the movement of drugs to their site of action

  • A discussion in Chapter 2 of different routes of drug administration and their relative advantages and disadvantages

  • A detailed discussion in Chapter 2 of renal drug excretion, biliary and fecal excretion, and excretion by other routes

  • A comprehensive discussion of design and optimization of dosage regimens in Chapter 2, including examples of dosing calculations that take into consideration bioavailability, clearance, and distribution

  • Appendix II Design Optimization of Dosage Regimens: Pharmacokinetic Data in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition provides a summary of basic pharmacokinetic data for a number of drugs that are in common clinical use, as well as information that is useful in individualizing dosing in a given patient

  • Chapter 5 contains a detailed review of membrane transporters, including their role in absorption, distribution, and clearance of xenobiotics, and their role in adverse drug responses

  • Table 5-1 Regulation of Transporter Expression by Nuclear Receptors provides detailed information about drug regulation of transporter expression mediated through specific nuclear receptors

  • A description in Chapter 5 of the role of efflux transporters in the blood-brain barrier (BBB) and blood-cerebrospinal fluid (CSF) barrier

  • Chapter 6 provides a comprehensive discussion of drug metabolism enzymes and illustrations that show many of the key chemical reactions catalyzed by these enzymes

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LEARNING OBJECTIVES

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  • Understand key concepts and terms that determine drug pharmacokinetics, including absorption, distribution, metabolism, and excretion.

  • Understand the mechanisms by which drugs cross membranes and the physicochemical factors that influence this transfer.

  • Be able to predict the ionization state of a drug that is a weak acid or base knowing the drug’s pKa and the pH of the fluid.

  • Describe the role of membrane transporters in drug absorption, distribution, and clearance.

  • Know the major mechanisms by which drugs are metabolized and excreted from the body.

  • Understand the major pharmacokinetic mechanisms that can result in drug interactions.

  • Know the pharmacokinetic mechanisms that give rise to interpatient variability in drug response and toxicity.

  • Understand the clinical pharmacokinetic principles used to calculate dosing required ...

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