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Last edited: 8/12/2022

PHARMACOKINETICS | DRUG EXCRETION

Pharmacokinetics | Drug Excretion Medical Editor: Sohani Kashi Puranic

I) REVIEW QUESTIONS WITH ANSWERS

QUESTIONS ANSWERS

1) Excretion of drugs is MOST affected in which c) Chronic Kidney Disease

condition?
a) Gastritis
b) Inflammatory Bowel Disease
c) Chronic Kidney Disease
d) Pneumonia

2) What is the effect on excretion of a drug if it has b) Decreased

increased binding to albumin?
▪ Increased binding to albumin
a) Increased
b) Decreased
c) Remains the same
d) First increases, then decreases

a) Bleeding tendency
3) A patient has been prescribed Warfarin (99% plasma
protein bound) and Aspirin (80% plasma protein [ when 2 drugs with protein binding are administered together,
bound). What side effect could MOST LIKELY be seen they compete with each other to bind to plasma proteins. When a
in this patient? drug cannot bind to plasma protein, it is free in plasma, and can
a) Bleeding tendency exert its effects]
b) Clotting tendency Warfarin and Aspirin compete with each other to bind to
c) Both a & b plasma proteins. Since warfarin binds more, aspirin is present
d) None of the above in the free (unbound) state. Aspirin thus exerts its anti-platelet
activity, causing bleeding tendency.

4) A patient with previous history of Myocardial b) Hypoglycemia

Infarction was prescribed with prophylaxis of Aspirin
Aspirin and Tolbutamide compete with each other to bind to
(80% plasma protein bound). During a recent check- plasma proteins. Since aspirin binds more, it leads to
up, he was diagnosed with Diabetes Mellitus, and was presence of more tolbutamide in unbound (free) state.
prescribed with an oral hypoglycemic drug, Tolbutamide thus exerts its activity by increasing insulin
Tolbutamide, which acts by increasing insulin secretion, causing hypoglycemia.
secretion (60% plasma protein bound). Which side
effect could this patient MOST LIKELY present with?
a) Bleeding tendency
b) Hypoglycemia
c) Hyperglycemia
d) Both a & b

5) Which combination of characteristics of a drug will c) Water soluble, ionized

help in promoting its excretion?
(Hydrophilic and polar)
a) Water soluble, unionized
b) Lipid soluble, unionized
c) Water soluble, ionized
d) Lipid soluble, ionized

6) Which combination of characteristics of a drug will b) Lipid soluble, non-polar

help in promoting its reabsorption from DCT?
a) Water soluble, non-polar
b) Lipid soluble, non-polar
c) Water soluble, polar
d) Lipid soluble, polar
7) A patient diagnosed with depression was prescribed d) Chloride
with amitriptyline. He doesn’t take his medication
Amitriptyline a TCA is a weak basic drug.
regularly. He got fired from his job as he refused to
meet deadlines and due to lack of focus. This
triggered him into taking 20 of his tablets. His wife Weak bases
noticed this and immediately drove him to the (i) Drugs
hospital. After ensuring his vitals are stable, what is Amphetamines, tricyclic antidepressants (TCA)
the MAIN component that should be given in his
fluids?
a) Bicarbonate
b) Phosphate
c) Sulphate
d) Chloride

(i) Reaction
BH+ ⇄ B + H+

Polar Non-polar

(ii) Shift reaction to left

Increase concentration of protons

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a) To reduce tubular reabsorption of phenobarbital
8) Alkalization of urine by giving bicarbonate is used to
treat patients presenting with phenobarbital (weak
acid) overdose. Which of the following best describes
the rationale for alkalization of urine in this setting?
a) To reduce tubular reabsorption of phenobarbital
b) To decrease ionization of phenobarbital
c) To increase glomerular filtration of phenobarbital
d) To decrease proximal tubular secretion
e) To increase tubular reabsorption of phenobarbital