objectives for today problems / questions & review concerning chemical distribution …? a...
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Objectives for Today•Problems / Questions & Review concerning
Chemical Distribution …?
•A Physiologic View of Chemical Clearance from the Body
• Develop a definition for Clearance.
ClearanceFrom A Physiologic Perspective
Chemical Clearance from the Body
Clearance
With time, where does the drug go?
Why are drugs lost from the body?How are drugs lost from the body?
Based on random flow?Like the elimination of an
coloured gas or odour from a roomor …?
Blood Flows1
1. Spector, WS. Handbook of Biological Data2. Includes only arterial flow; total equals about 1500 mL/min. (25%)3. Cardiac Output / 70 kg = 5-6 L/min [85 mL/min/kg]
Tissue Weight % Blood % Cardiac or (kg) of Flow Output3
Organ IBW (mL/min)Kidneys 0.16 0.23 1200 23Adrenals 0.011 0.02 65 1.2Thyroid 0.03 0.04 165 3.2Brain 1.35 1.93 729 14Liver 1.5 2.14 3002 5.8Muscle 28 40 850 16Skin 18 26 260 5.0Fat 10 15 105 2.0
ClearanceWith time, where does the drug go?
Organs are strategically arranged (liver – to deal with entry & elimination
of compounds and are well perfused tissues.
If a drug is eliminated by an organ (kidney or liver),
the organ will have access to a greater amount of drug if a larger percentage of drug
is found in the blood / plasma or serum.
Theophylline 9.8%Levo: 3.5% / 4.2%
Cipro: 2.9 %Cyclosporin: 0.15%
ClearanceWith time, where does the drug go?
Organs are strategically arranged (liver – to deal with entry & elimination
of compounds and are well perfused tissues.
The blood emerging from an eliminating organ has a lower concentration
than the blood entering the organ.
This effectively dilutes the drug concentration
in the primary storage area … the rest of the body.
Focus on an Eliminating Organ
PumpClearing Chamber
Blood leaving the organ has a lower drug concentration than drug entering.
Drug is “cleared” by the organ.The efficiency of Removal is
quantified by the Extraction Ratio [ER].
Focus on an Eliminating Organ
Extraction Ratio can be viewed as the proportion of drug removed during passage through the organ.
CaCv
Focus on an Eliminating Organ
Extraction Ratio can be viewed as the proportion of drug removed during passage through the organ.
At constant concentration (steady – state)
extraction can be estimated from thedifference between arterial and venous concentrations.
ER = [ (Ca – Cv) / Ca ]
where Ca is the concentration in the artery on entry to the organ and and Cv is the concentration
in the vein on exit from the organ
CaCv
Focus on an Eliminating Organ
PumpClearing Chamber
Clearance of drug is dependant on 2 factors:Efficiency of Removal [ER]
andThe rate at which drug can be
delivered to the organ [Flow Rate: Q].Clearance = Q x ER (mL/min)
Focus on an Eliminating Organ
At constant concentration (steady – state) clearance can be estimated from blood flow
and the difference between arterial and venous concentrations.
ClH = Q [ (Ca – Cv) / Ca ] = Q*ERor
Cl = Q x ER
where ER is the Extraction Ratioand Q is organ blood flow.
When we focus on a single organ, Hepatic Clearance would be symbolized by ClH
and Renal Clearance by CLR
Focus on an Eliminating Organ
When we focus on a single organ, Hepatic Clearance would be symbolized by ClH
and Renal Clearance by CLR …ClTOTAL = ClHEPATIC + ClRENAL + ClLUNG
Clearance as the units of Volume per time(mL/min)
Definition:Clearance:The volume of distribution volume of the sampled fluid from which drug is irreversibly removed per unit time.
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Creatinine?
Cardiac Output = 85 mL/kg/min 70 kg maleCreatinine Clearance = ~ 120 mL/min (serum)
QRBLOOD = 25% CO
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Creatinine?
Cardiac Output = 85 mL/kg/min 70 kg maleCreatinine Clearance = ~ 120 mL/min (serum)
QRBLOOD = 25% CO
= 0.25 (85)= 21.25 mL/min/kg
QRSERUM = QR
BLOOD
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Creatinine?
Cardiac Output = 85 mL/kg/min 70 kg maleCreatinine Clearance = ~ 120 mL/min (serum)
QRBLOOD = 25% CO
= 0.25 (85)= 21.25 mL/min/kg
QRSERUM = QR
BLOOD (0.55)(70)= 820 mL/min (serum)
ER =
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Creatinine?
Cardiac Output = 85 mL/kg/min 70 kg maleCreatinine Clearance = ~ 120 mL/min (serum)
QRBLOOD = 25% CO
= 0.25 (85)= 21.25 mL/min/kg
QRSERUM = QR
BLOOD (0.55)(70)= 820 mL/min (serum)
ER = 120/820 = 0.146 or 14.6%
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Ciprofloxacin?
Cardiac Output (Renal)= 820 mL/min (serum)Cipro Clearance = 35 L/hour (serum)
=
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Ciprofloxacin?
Cardiac Output (Renal)= 820 mL/min (serum)Cipro Clearance = 35 L/hour (serum)
= 583 mL/min
QRSERUM = QR
BLOOD
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Ciprofloxacin?
Cardiac Output (Renal)= 820 mL/min (serum)Cipro Clearance = 35 L/hour (serum)
= 583 mL/min
QRSERUM = QR
BLOOD (0.55)(70)= 820 mL/min (serum)
ER =
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Kidney in removing Ciprofloxacin?
Cardiac Output (Renal)= 820 mL/min (serum)Cipro Clearance = 35 L/hour (serum)
= 583 mL/min
QRSERUM = QR
BLOOD (0.55)(70)= 820 mL/min (serum)
ER = 583/820 = 0.71or 71%
Very efficient
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Physiologic Approach to Cipro Pharmacokinetics
Male with PneumoniaGiven the clearance of ciprofloxacin, how much drug is required each day to maintain an average concentration of 2 mg/L? (peaks of 3-4; troughs ~0.5)Age: 45 yrWeight: 80 kgDrug: CiprofloxacinSerum ciprofloxacin concentrations average 2 g/mL (mg/L)Cipro Volume: 1.5 L/kgCipro Am’t in body:
Cipro Clearance:
Male Acute Community Acquired Pneumonia
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Physiologic Approach to Cipro Pharmacokinetics
Male with PneumoniaGiven the clearance of ciprofloxacin, how much drug is required each day to maintain an average concentration of 2 mg/L? (peaks of 3-4; troughs ~0.5)Age: 45 yrWeight: 80 kgDrug: CiprofloxacinSerum ciprofloxacin concentrations average 2 g/mL (mg/L)Cipro Volume: 1.5 L/kgCipro Am’t in body: = 80 x 1.5 x 2
= 240 mgCipro Clearance: = 35 L/hr
= 840 L/day
Male Acute Community Acquired Pneumonia
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Physiologic Approach to Cipro Pharmacokinetics
Male with PneumoniaGiven the clearance of ciprofloxacin, how much drug is required each day to maintain an average concentration of 2 mg/L? (peaks of 3-4; troughs ~0.5) Age: 45 yrWeight: 80 kg
Cipro Clearance: = 840 L/dayAverage concentration over a day
2 mg/LDose required to maintain [ ]
= 2 (840) mg= 1680 mg/day
Male Acute Community Acquired Pneumonia
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Liver in removing Theophylline?
Cardiac Output = 6.0 L/minProportion of CO to the Liver = 25%
Liver Blood Flow = 1.5 L/minProportion of Blood as Serum = 55% Liver Serum (plasma) Flow = 1.5 L/min
= 0.82 L/minOR = 820 mL/min
Cardiac Output = 85 mL/kg/min 70 kg maleProportion of Blood as Serum = 55%Liver Serum (plasma) Flow
= 85 * 70 * 0.55 * 0.25= 818.12 mL/min
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Liver in removing Theophylline?Cardiac Output = 6.0 L/min (Blood)Liver Plasma Flow = 820 mL/min/70 kg male
Theophylline: 85% metabolized15% excreted unchanged
Total clearance ~ 0.7 mL/min/kg= 50 mL/min (serum)
Hepatic Clearance ClH =
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Liver in removing Theophylline?Cardiac Output = 6.0 L/min (Blood)Liver Plasma Flow = 820 mL/min/70 kg male
Theophylline: 85% metabolized15% excreted unchanged
Total clearance ~ 0.7 mL/min/kg= 50 mL/min (serum)
Hepatic Clearance ClH = 50(0.85)= 42.5 mL/min
QHBLOOD = 820 mL/min (serum)
ER =
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q
Focus on an Eliminating Organ
How Efficient is a Normal Liver in removing Theophylline?Cardiac Output = 6.0 L/min (Blood)Liver Plasma Flow = 820 mL/min/70 kg male
Theophylline: 85% metabolized15% excreted unchanged
Total clearance ~ 0.7 mL/min/kg= 50 mL/min (serum)
Hepatic Clearance ClH = 50(0.85)= 42.5 mL/min
QHBLOOD = 820 mL/min (serum)
ER = 42.5/820 = 0.052or 5.2%
Equations
Conc = Dose / V
V = Dose/Conc
Cl = Q x ER
ER = Cl / Q