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0:00
From the outside, I would like
to acknowledge my co-workers
at my institution who are involved
with me in the study of drug
metabolism in liver disease.
And if there is any
interest, there is
contact information
in terms of my email
and also in terms of a website.
And we move to the next slide.
0:25
During this presentation
I would like
to address a number of questions.
The first question is, do
diseases of different etiology
alter the metabolism
of different drugs
being given to a variable extent?
In other words, is there selectivity
of the effect of the disease
process based on the
underlying etiology?
Second question that
I'd like to address,
is there a differential
effect of liver disease
on different routes of metabolism?
This is the selectivity
with respect to the drug
metabolizing enzymes
or active processes
involved in drug elimination.
Thirdly, does the severity of the
underlying liver disease influence
the magnitude of the change?
Is there a sensitivity
of these processes
to the presence of liver disease?
And then finally, are
the changes sufficiently
large to justify dosage
modification and therefore
be of clinical relevance?
And we move to the next slide.
1:33
From the perspective
of clinical relevance,
I think it's also important
to address the questions,
can the extent of
change be anticipated
in an individual patient when
faced with a therapeutic decision?
And secondly, can
these changes be used,
in fact, to assess hepatic
function as discrete entities?
Thirdly, can we use this
information in predictive rules
if we are faced with giving
drugs that are just being
introduced to the
market, where we know
the disposition in normal people?
Can we anticipate when
there will be change
in the presence of liver disease?
And we move to the next slide.
