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[资源] Human Drug Metabolism

Human Drug Metabolism  


1 Introduction 1
1.1 Therapeutic window 1
1.2 Consequences of drug concentration changes 4
1.3 Clearance 6
1.4 Hepatic extraction and intrinsic clearance 8
1.5 First pass and plasma drug levels 9
1.6 Drug and xenobiotic metabolism 11
2 Drug Biotransformational Systems – Origins and Aims 13
2.1 Biotransforming enzymes 13
2.2 Threat of lipophilic hydrocarbons 14
2.3 Cell communication 14
2.4 Potential food toxins 17
2.5 Sites of biotransforming enzymes 18
2.6 Biotransformation 19
3 How Phase I Systems Metabolize Substrates 23
3.1 Introduction 23
3.2 Capture of lipophilic molecules 23
3.3 Cytochrome P450s classification and basic structure 24
3.4 CYPs – main and associated structures 26
3.5 CYP substrate specificity and regulation 30
3.6 Main human CYP families 30
3.7 Cytochrome P450 catalytic cycle 36
3.8 Real-life operations 39
3.9 How CYP isoforms operate in vivo 40
3.10 Aromatic ring hydroxylation 42
3.11 Alkyll oxidations 44
3.12 ‘Rearrangement’ reactions 48
3.13 Other oxidation processes 53
3.14 Reduction reactions 55
3.15 Control of CYP metabolic function 56
4 Induction of Phase I Systems 57
4.1 Introduction 57
4.2 Causes of accelerated clearance 60
4.3 Enzyme induction 61
4.4 Mechanisms of enzyme induction 62
4.5 Induction – general clinical aspects 70
5 Phase I Enzyme Inhibition 75
5.1 Introduction 75
5.2 Inhibition of metabolism – general aspects 78
5.3 Mechanisms of inhibition 79
5.4 Cell transport systems and CYP3A inhibitors 89
5.5 Clinical consequences of drug inhibition 91
5.6 Use of inhibitors for positive clinical intervention 95
6 Phase II and III Processes 101
6.1 Introduction 101
6.2 Glucuronidation 103
6.3 Sulphation 113
6.4 The GSH system 116
6.5 Glutathione S-transferases 119
6.6 Epoxide hydrolases 123
6.7 Acetylation 124
6.8 Methylation 126
6.9 Esterases/amidases 126
6.10 Amino acid conjugation (glycine or glutamate) 127
6.11 Phase III transport processes 127
7 Factors Affecting Drug Metabolism 131
7.1 Introduction 131
7.2 Genetic polymorphisms 132
7.3 Effects of age on drug metabolism 148
7.4 Effects of diet on drug metabolism 151
7.5 Gender effects 154
7.6 Smoking 155
7.7 Effects of ethanol on drug metabolism 156
7.8 Effects of disease on drug metabolism 161
7.9 Summary 161
8 Role of Metabolism in Drug Toxicity 163
8.1 Adverse drug reactions: definitions 163
8.2 Reversible drug adverse effects: Type A 164
8.3 Irreversible toxicity (Type B) 171
8.4 Type B1 necrotic reactions 176
8.5 Type B2 reactions: immunotoxicity 187
8.6 Type B3 reactions: role of metabolism in cancer 198
8.7 Summary of biotransformational toxicity 214
viii CONTENTS
Appendix A Methods in Drug Metabolism 215
A.1 Introduction 215
A.2 Human liver microsomes 216
A.3 Human hepatocytes 218
A.4 Heterologous systems 218
A.5 Toxicological metabolism-based assays 219
A.6 In silico studies 222
Appendix B Metabolism of Major Illicit Drugs 225
B.1 Introduction 225
B.2 Opiates 225
B.3 Cocaine 230
B.4 Hallucinogens 232
B.5 Amphetamines: ecstasy (MDMA) 236
B.6 Cannabis 240
B.7 PCP 243
Appendix C Examination Techniques 247
C.1 Introduction 247
C.2 A first-class answer 247
C.3 Preparation 248
C.4 The day of reckoning 251
Appendix D Summary of Major CYP Isoforms and Their
Substrates, Inhibitors and Inducers 253
Suggested Further Reading 255
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