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Acetaminophen genera
Tox lecture 6
Acetaminophen | Answer |
---|---|
Absorption | 30 – 60 minutes |
Half-life: | 1-3.5 hours |
Metabolism/Excretion | Renal unchanged acetaminophen Phase II: (Conjugation) sulfate/glucuronide conjugate Phase I: (CYP 2E1) conjugation with glutathione |
Metabolism/Excretion Phase II: | (Conjugation) sulfate/glucuronide conjugate |
Metabolism/Excretion Renal | unchanged acetaminophen |
Metabolism/Excretion Phase I | (CYP 2E1) conjugation with glutathione |
Overdose Risk Factors | Dose When history is reliable Increased frequency of APAP dosing Prolonged duration Increased capacity for CYP2E1 activation Decreased glutathione availability Decreased capacity for glucuronidation and/or sulfation |
Impact in overdose | Delayed absorption Saturation of normal non-toxic metabolic routes |
Mechanism of Toxicity (see diagram in book) Normal metabolic pathway | Not many drug interactions Note many things metabolized the same way |
Mechanism of Toxicity (see diagram in book) Formation of toxic metabolite: | A/-acetyl-p-benzoquinoneimine (NAPQI) RoleofCYP2E1 Importance of glutathione Local formation of NAPQI in tissues |
Local formation of NAPQI in tissues | Liver Kidneys Pancreas, heart, CNS |
Other manifestations Early | metabolic acidosis/coma Rule out other causes Associated with higher initial [APAP]? Uncommon |
Other manifestations Renal function abnormalities | -25% with significant hepatotoxicity |
Other manifestations Rarely other manifestation | Pancreatitis |