Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Echizen and Eichelbaum (Clin Pkin 1986; 11:425-49) and Kleinbloesem et al (Clin Pcol Therap 1986; 40: 21-8)
reviewed the pharmacokinetics of Nifedipine. While the drug is not routinely given by IV bolus and does not strictly
conform to a one compartment model, let's treat the data as if those problems can be ignored. The following data is
offered for evaluation:
TABLE 1-1. Nifedipine IV Bolus Profile
Time (hr) Cp (mcg/L) Cm1 (mcg/L) Xm1f (mg) Xm1u (mg) Xm2f (mg) Xm2u (mg)
0.5 24.7
1 44.4
2 139 71.8 .14 .59
4 65.6 96.5 .44 1.83 .028 .11
6 31.1 100 .77 3.25 .073 .29
8 14.6 94.7 1.1 4.65 .135 .54
12 76.5 1.69 7.10 .291 1.15
24 34 2.77 11.63 .75 2.95
7 days 3.6 15.1 1.3 5.0
Brand Generic
Route IV Oral Capsule Oral Capsule
Dose (mg) 25 10 10
AUC (ug/L*hr) 785 236 204
AUMC (ug/L*hr2 ) 2093 866 816
TABLE 1-4
Cpmax 14.35
7) What is the maximum acceptable dosing interval for normal patients (hr)?
a) 8 b) 12 c) 18 d) 24 e) 25.5
9) If you dosed this patient 500 mg BID with the brand name product, what would be your maximum concentration at
steady state (mg/L)?
a) 87.3 b) 70.9 c) 65.2 d) 52.8 e) 45.8
12) What loading dose would you give to get to Cpss right away (mg)?
a) 250 b) 500 c) 750 d) 1000 e) 1500
13) If you changed the dosage regimen to 250 mg QID, what would happen to the Cpssmax, Cpssave, Cpssmin?
a) Cpssmax - up, Cpssave - up, Cpssmin - up
b) Cpssmax - down, Cpssave - down, Cpssmin - down
c) Cpssmax - same, Cpssave - same, Cpssmin - same
d) Cpssmax - up, Cpssave - same, Cpssmin - down
e) Cpssmax - down, Cpssave - same, Cpssmin - up
In patients who are also currently on phenobarbital their intrinsic clearance of valproate increases by 50% as the phe-
nobarbital induces the enzymes which metabolize valproate. Further questions refer to this condition.
25) What dosage regimen would you recommend to try to maintain his plasma concentrations within 110% of the max-
imum and 90% of the minimum concentrations attained when he was normal?
a) 750 mg BID b) 500 mg TID c) 750 mg TID d) 250 mg QID e) 500 mg QID
Brand
IV Name Generic
Dose (mg) 10 20 20
AUC (ug/ml*hr) 0.20 0.04 0.035
AUMC (ug/ml*hr2 0.32 0.14 0.1225
15.4 Verapamil
Verapamil is a calcium channel blocker with vasodilatory and antiarrhythmic effects. It is about 95% metabolized by
the liver with the metabolites showing up in the urine and feces.
Hepatic blood flow in normals is 1.6 L/min
Renal blood flow in normals is 1.2 L/min
TABLE 1-7 Verapamil Data
Brand Generic
13) Hepatic Extraction Ratio 30) Cpssavg for this patient at this dosing
regimen (ug/L)
14) Absolute bioavailability for the brand
name tablet 31) Cpssmin for this patient at this dosing
regimen (ug/L)
15) MRT (oral brand name tablet) (hr)
You want to maintain his plasma con-
16) MAT (oral brand name tablet) (hr) centrations between 110% of Cpssmax
17) Ka, the apparent absorbtion rate con- and 90% of Cpssmin . How would you
stant, for the brand name tablet (hr-1 ) change the dosage regimen to if your
patient suffered from:
18) Peak time for the brand name tablet
(hr) 32) stenosis of the kidney (Fr = 0.67). (No
change in volume of distribution.)
19) Cpmax , the maximum concentration
of the brand name oral tablet give as a sin- 33) renal failure (Fi = 0.34).(Volume of
gle dose (ug/L) distribution is reduced in this disease to
50% of normal)
20) Absolute bioavailability for the generic
tablet 34) stenosis of the liver (Fr = 0.67) (No
change in volume of distribution)
21) MRT (oral generic tablet) (hr)
35) cirrhosis of the liver (Volume of Dis-
22) MAT (oral generic tablet) (hr) tribution and the bioavailability are both
doubled while the half life is quadrupled )
QH = 24 mL/min/Kg Blood
QR = 19 mL/min/Kg Blood
Your patient is controlled by 10 mg TID of the brand name oral tablet when he is
healthy. For This patient and this dosage regimen, what is his:
28) N ?
You want to maintain his plasma concentrations between 120% of Cpssmax and 80% of
Cpssmin . How would you change the dosage regimen to if your patient suffered from:
15.7 Remoxipride
Remoxipride (MW 296 - Unionized Base pKa 9.4) is a new antipsychotic of the benzamide type (See figure 1). The
pharmacokinetics were studied by Movin-Osswald and Hammarlind-Udenaes (Brit. J Clin Pcol 1991 32(3) 355ff).
Their results are summarized in table 1. The HCl salt of the drug was given (MW 332.5) to these patients in this study
but the drug concentration was reported as the free base in the plasma. In this study, 25% of the Remoxipride was
excreted unchanged, 75% was metabolized. The hepatic and renal blood flow in these patients was 1.5 and 1.2 L/min
respectively. REMEMBER TO PAY ATTENTION TO UNITS.
Tp (hr) 3.6
Cpmax (mg/L) .8
f .75
3. Cp 0 = 0.88mg ⁄ L
4. Vd = 50L
5. T1 ⁄ 2 = 4.8hr
6. Cl = 7.28L ⁄ hr
7. Cl r = 1.8L ⁄ hr
8. Cl h = 5.46L ⁄ hr
9. Er = 0.025
10. Eh = 0.06
22. Tablet B is not bioequivalent to Tablet A because peak time and Cp max are out of
federal guidelines.
ss
24. Cp max = 3.88mg ⁄ L
ss
25. Cp avg = 1.85mg ⁄ L
ss
26. Cp min = 0.685mg ⁄ L
27. The change in physiological status that would result in the most significant change
in TBC of remoxipride is (C) - changes
which effect the function of the liver.
28. New renal clearance = no change
15.8 Naproxen
Naprosyn@ (naproxen) is a nonsteroidal anti-inflammatory drug (NSAID) with
analgesic properties. It is well absorbed (f = 0.95) and highly protein bound (98%)
with a volume of distribution of about 10 L and a half-life of 13 hours in normal
adults. It is almost entirely cleared by hepatic function (CLr = 1%) with about one-
third being metabolized to the 6-o-desmethylnaproxen (which is further metabo-
lized by conjugation) and two-thirds being conjugated directly. Both the 6-o-des-
methyl metabolites as well as the conjugates are inactive.
Normal dosing is 500 mg Naproxen BID. You stock 200 and 500 mg tablets in
your HMO.
In chronic renal failure (Fir = 0.1) the protein binding is reduced (94%) because of
uremia. This results in a marginal increase in half-life (14 hr.)
For each of the conditions, (with Probenecid, chronic renal failure, arthritic, and
elderly), please recommend a dosage regimen which would give approximately the
same plasma concentrations of free naproxen obtained in the normal case (+ 10%.)
Constants:
L - renal blood perfusion ⋅ 70kg ⋅ 60min
Q r = 0.0191 ------------------- L
--------- ≈ 80 -----blood
min ⋅ kg hr hr
L min L
Q H = 0.0238 -------------------- hepatic blood perfusion ⋅ 70kg ⋅ 60--------- ≈ 100 -----blood
min ⋅ kg hr hr
Extraction ratios are calculated for normals and considered to be constant through-
out.
k (hr-1) 5 31 55 79 103
T 1/2 (hr) 6 32 56 80 104
AUC (mg/L*hr) 7 33 57 81 105
% Cl h 8 34 58 82 106
% Cl r 9 35 59 83 107
Cl h (L/hr) 11 37 61 85 109
Cl r (L/hr) 12 38 62 86 110
Eh 13
Er 14
Cl h (L/hr) 15 39 63 87 111
int
Cl r (L/hr) 16 40 64 88 112
int
FR h 17 41 65 89 113
FI h 18 42 66 90 114
FR r 19 43 67 91 115
FI r 20 44 68 92 116
FCL 21 45 69 93 117
τ (hr) 22 46 70 94 118
N 23 47 71 95 119
ss µg 24 48 72 96 120
Cp -------
-
max free mL
ss µg 25 49 73 97 121
Cp --------
avg free mL
ss µg 26 50 74 98 122
Cp -------
-
min free mL
Answer Pool
S M L XL XXL XXXL
k (hr-1) 5. 0.0533 31. 0.0182 55. 0.0495 79. 0.061 103. 0.533
T 1/2 (hr) 6. 13 32. 38.1 56. 14 80. 11.3 104. 13
AUC (mg/L*hr) 7. 891 33. 1044 57. 303 81. 595 105. 356
% Cl h 8. 99 34. 97 58. 99.97 82. 99 106. 99
Cl tot (L/hr) 10. 0.533 36. 0.182 60. 1.57 84. 0.798 108. 0.533
Cl h (L/hr) 11. 0.528 37. 0.177 61. 1.57 85. 0.790 109. 0.528
Cl r (L/hr) 12. 0.005 38. 0.005 62. 0.005 86. 0.008 110. 0.005
Eh 13. 0.005
Er 14. 0.000067
Cl h (L/hr) 15. 26.5 39. 8.84 63. 26.5 87. 26.5 111. 13.26
int
Cl r (L/hr) 16. 0.267 40. 0.267 64. 0.00889 88. 0.267 112. 0.133
int
N 23. 0.923 47. 0.315 71. 0.857 95. 1.06 119. 0.615
ss µg- 24. 2.01 48. 1.94 72. 2.01 96. 2.1 120. 2.2
Cp -------
max free mL
ss µg- 25. 1.5 49. 1.74 73. 1.5 97. 1.5 121. 1.78
Cp -------
avg free mL
ss µg 26. 1.06 50. 1.55 74. 1.1 98. 1.01 122. 1.42
Cp -------
-
min free mL
15.8.3
1. Dose = 500 mg (given)
2. Bioavailability (f) = 0.95 (given)
3. Unbound Fraction = 0.02 (given)
4. V d = 10L (given)
0.693 –1
5. k = ------------- = 0.0533hr
t1 ⁄ 2
6. t 1 ⁄ 2 = 13hr (given)
f ⋅ Dose
7. AUC = ------------------- = 891L
k ⋅ Vd
9. %Cl r = 1 (given)
Cl
13. E h = -------h- = 0.00528
Qh
Cl
14. E r = --------r = 0.000067
Qr
Q ⋅ Cl h
------------------
Q – Cl
15. Cl h = ------------------h- = 26.5L ⁄ hr
int
fu
Q ⋅ Cl
-----------------r-
Q – Cl
16. Cl r = ------------------r = 0.267L ⁄ hr
int
fu
17. FR h = 1 (given)
18. FI h = 1 (given)
19. FR r = 1 (given)
20. FI r = 1 (given)
21. F Cl = 1 (given)
τ
23. N = --------- = 0.923
t1 ⁄ 2
ss fu ⋅ S ⋅ f ⋅ D 1 µg-
24. Cp = -------------------------- ⋅ -------------------- = 2.0 -------
N
1 – ---
max free V 1 mL
2
ss f u ⋅ S ⋅ f ⋅ D fu ⋅ S ⋅ f ⋅ D µg-
25. Cp = -------------------------- = ------------------------------ = 1.5 -------
avg free V⋅K⋅τ V ⋅ 0.693 ⋅ N mL
N
1---
ss fu ⋅ S ⋅ f ⋅ D 2 µg-
26. Cp = -------------------------- ⋅ -------------------- = 1.1 -------
N
1 – 1---
min free V mL
2
27. Dose = mg
28. Bioavailability (f) = 0.95 (no change)
29. Unbound Fraction = 0.02 (no change - given)
0.693
31. k = ------------- = 0.0533hr
–1
t1 ⁄ 2
f ⋅ Dose
33. AUC = ------------------- = 891L
k ⋅ Vd
Q ⋅ Cl h
------------------
Q – Cl
39. Cl h = ------------------h- = 26.5L ⁄ hr
int
fu
Q ⋅ Cl
-----------------r-
Q – Cl
40. Cl r = ------------------r = 0.267L ⁄ hr
int
fu
41. FR h = 1 (given)
42. FI h = 1 (given)
43. FR r = 1 (given)
44. FI r = 1 (given)
45. F Cl = 1 (given)
τ
47. N = --------- = 0.923
t1 ⁄ 2
ss fu ⋅ S ⋅ f ⋅ D 1 µg-
48. Cp = -------------------------- ⋅ -------------------- = 2.0 -------
N
1 – 1---
max free V mL
2
ss f u ⋅ S ⋅ f ⋅ D fu ⋅ S ⋅ f ⋅ D µg-
49. Cp = -------------------------- = ------------------------------ = 1.5 -------
avg free V⋅K⋅τ V ⋅ 0.693 ⋅ N mL
N
1---
ss fu ⋅ S ⋅ f ⋅ D 2 µg-
50. Cp = -------------------------- ⋅ -------------------- = 1.1 -------
N
1 – 1---
min free V mL
2
51. Dose = mg
52. Bioavailability (f) = 0.95 (no change)
53. Unbound Fraction = 0.02 (no change - given)
0.693 –1
55. k = ------------- = 0.0533hr
t1 ⁄ 2
f ⋅ Dose
57. AUC = ------------------- = 891L
k ⋅ Vd
Q ⋅ Cl h
------------------
Q – Cl
63. Cl h = ------------------h- = 26.5L ⁄ hr
int fu
Q ⋅ Cl
-----------------r-
Q – Cl
64. Cl r = ------------------r = 0.267L ⁄ hr
int fu
65. FR h = 1 (given)
66. FI h = 1 (given)
67. FR r = 1 (given)
68. FI r = 1 (given)
69. F Cl = 1 (given)
τ
71. N = --------- = 0.923
t1 ⁄ 2
ss fu ⋅ S ⋅ f ⋅ D 1 µg-
72. Cp = -------------------------- ⋅ -------------------- = 2.0 -------
1 – 1---
max free V N mL
2
ss f u ⋅ S ⋅ f ⋅ D fu ⋅ S ⋅ f ⋅ D µg-
73. Cp = -------------------------- = ------------------------------ = 1.5 -------
avg free V⋅K⋅τ V ⋅ 0.693 ⋅ N mL
1--- N
ss fu ⋅ S ⋅ f ⋅ D 2 µg-
74. Cp = -------------------------- ⋅ -------------------- = 1.1 -------
1 – 1---
min free V N mL
2
75. Dose = mg
76. Bioavailability (f) = 0.95 (no change)
77. Unbound Fraction = 0.02 (no change - given)
0.693 –1
79. k = ------------- = 0.0533hr
t1 ⁄ 2
f ⋅ Dose
81. AUC = ------------------- = 891L
k ⋅ Vd
Q ⋅ Cl h
------------------
Q – Cl
87. Cl h = ------------------h- = 26.5L ⁄ hr
int fu
Q ⋅ Cl
-----------------r-
Q – Cl
88. Cl r = ------------------r = 0.267L ⁄ hr
int fu
89. FR h = 1 (given)
90. FI h = 1 (given)
91. FR r = 1 (given)
92. FI r = 1 (given)
93. F Cl = 1 (given)
τ
95. N = --------- = 0.923
t1 ⁄ 2
ss fu ⋅ S ⋅ f ⋅ D 1 µg-
96. Cp = -------------------------- ⋅ -------------------- = 2.0 -------
N
1 – ---
max free V 1 mL
2
ss f u ⋅ S ⋅ f ⋅ D fu ⋅ S ⋅ f ⋅ D µg-
97. Cp = -------------------------- = ------------------------------ = 1.5 -------
avg free V⋅K⋅τ V ⋅ 0.693 ⋅ N mL
N
1---
ss fu ⋅ S ⋅ f ⋅ D 2 µg-
98. Cp = -------------------------- ⋅ -------------------- = 1.1 -------
N
1 – 1---
min free V mL
2
99. Dose = mg
100. Bioavailability (f) = 0.95 (no change)
101. Unbound Fraction = 0.02 (no change - given)
0.693 –1
103. k = ------------- = 0.0533hr
t1 ⁄ 2
f ⋅ Dose
105. AUC = ------------------- = 891L
k ⋅ Vd
Q ⋅ Cl h
------------------
Q – Cl
111. Cl h = ------------------h- = 26.5L ⁄ hr
int
fu
Q ⋅ Cl
-----------------r-
Q – Cl
112. Cl r = ------------------r = 0.267L ⁄ hr
int
fu
113. FR h = 1 (given)
114. FI h = 1 (given)
115. FR r = 1 (given)
116. FI r = 1 (given)
117. F Cl = 1 (given)
τ
119. N = --------- = 0.923
t1 ⁄ 2
ss fu ⋅ S ⋅ f ⋅ D 1 µg-
120. Cp = -------------------------- ⋅ -------------------- = 2.0 -------
N
1 – 1---
max free V mL
2
ss fu ⋅ S ⋅ f ⋅ D f u ⋅ S ⋅ f ⋅ D µg-
121. Cp = -------------------------- = ------------------------------ = 1.5 -------
avg free V⋅K⋅τ V ⋅ 0.693 ⋅ N mL
N
1---
ss fu ⋅ S ⋅ f ⋅ D 2 µg-
122. Cp = -------------------------- ⋅ -------------------- = 1.1 -------
N
1 – 1---
min free V mL
2