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Pharm Presentation: Excretion
- 1. Cassandra Batista, Kristi Buster, Mariah Richards
- 5. Excretion by the Intestines Many metabolites are transferred from the blood to the liver through metabolism. Metabolism
- 6. After liver metabolism, drugs are then secreted into the bile. Because hepatocytes are transported across the biliary epithelium against a concentration gradient, active secretory transport is required.
- 7. Following the secretion into bile, metabolites are dumped from the gall bladder and passed into the duodenum.
- 8. From here, the drug is either: Eliminated by feces or Reabsorbed back to the liver
- 9. The intestinal reabsorption of the drug is known as the Enterohepatic cycle.
- 10. LIVER BLOOD STREAM ALVEOLAR CELLS “Milk Producing Cells”
- 12. Resources Excretion. (n.d.). Learn next. Retrieved from http://www.learnnext.com/nextgurukul/wiki/con cept/CBSE/X/Science/Excretion.html Le, J. (2014). Drug Excretion. Retrieved from http://www.merckmanuals.com/professional/clin ical-pharmacology/pharmacokinetics/drug- excretion. O'Connor, M. (1998). Breastfeeding & Drugs: Does the medication pass into the breast milk?. Retrieved from http://breastfeedingbasics.org/cgi- bin/deliver.cgi/content/Drugs/pre_pass.html
Editor's Notes
- Excretion is the process of removing drugs from the body. It can happen in many different ways
- The majority of drug excretion happens through the kidneys. Drugs can first be filtrated in the the glomerular capillaries from the blood stream into urine to exit the body. Drugs can also be reabsorbed by moving out of the tubule of the kidney and back into the blood stream. This happens mostly with lipid soluble drugs that move freely across the cell membrane. Lastly drugs are moved out of the blood stream and into the tubule of the kidney by active transport pumps and are then excreted through the urine.
- Renal excretion can be affected by age. Newborn’s kidneys are not fully developed and therefore have limited capability of excreting drugs Once a patient has reached old age, their renal function has declined and renal function is decreased. A Patients with renal insufficiency also has trouble excreting drugs through the kidneys In all of these scenarios dosages must be altered to avoid drug toxicity
- The main organs involved in biliary excretion include the stomach, gall bladder, liver and intestines.
- After they are metabolized into the liver, the drug is conjugated in bile.
- Bile is stored in gallbladder and secreted by hepatocytes. Specific active transport sites within the liver cell membranes are factors that can determine elimination.
- Reabsorption is more common. When reabsorption occurs, the drug is later excreted by kidneys into urine.
- This cycle is called the enterohepatic cycle, and eventually results in the drug back into the blood. The cycle may be repeated several times, and can significantly prolong the body’s exposure to the drug. Warnings: Drug toxicity is a risk when treating patients with poor bile flow or gall bladder disease
- Drug excretion via Breast Milk begins in the liver, travels through the blood stream, and once it reaches the Alveolar cells, Also known as the Milk Producing Cells, it passes through the alveolar space via diffusion or active transport then finally enters the milk. Drug excretion via breast milk is more likely to happen if the drug is lipid soluble and more alkaline. No more than 2% of the ingested dose is usually transferred. WARNING: drugs that can be excreted through breast milk in high doses can cause harm to the nursing infant
- Other forms of excretion include the Lungs, Sweat, and Saliva. Inhaled general anesthesia is excreted by exhaling. Elimination depends on the solubility of the drug, the hearts function, and breathing. Excretion via sweat and saliva are of minor importance to most drugs.