A 61 year old woman with cirrhosis due to hepatitis C develops severe nausea after chemotherapy. She is given a usual oral dose of a medication that is extensively metabolized in the liver before reaching the systemic circulation. Soon afterward she develops excessive sedation compared with prior treatment. Blood pressure is 108/66 mm Hg and pulse is 74 per minute. Which of the following best explains the increased drug effect in this patient?
- A)Decreased volume of distribution
- B)Increased plasma protein binding
- C)Decreased first pass metabolismGABARITO
- D)Induction of cytochrome P450 enzymes
- E)Increased renal secretion
Explicação
Orally administered drugs with high hepatic extraction undergo first pass metabolism before entering the systemic circulation. Cirrhosis decreases hepatic functional mass and blood flow, so less drug is metabolized during the first pass and more reaches the bl... Ver explicação completa e trilha adaptativa →