RT Book, Section
A1 Correia, Maria Almira
A2 Katzung, Bertram G.
A2 Vanderah, Todd W.
SR Print(0)
ID 1176969046
T1 Drug Biotransformation
T2 Basic & Clinical Pharmacology, 15e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260452310
LK accessmedicine.mhmedical.com/content.aspx?aid=1176969046
RD 2024/04/19
AB CASE  STUDYA  40-year-old  woman  presents  to  the  emergency  department  of  her  local  hospital  somewhat  disoriented,  complaining  of  midsternal  chest  pain,  abdominal  pain,  shaking,  and  vomiting  for  2  days.  She  admits  to  having  taken  a  “handful”  of  Lorcet  (hydrocodone/acetaminophen,  an  opioid/nonopioid  analgesic  combination),  Soma  (carisoprodol,  a  centrally  acting  muscle  relaxant),  and  Cymbalta  (duloxetine  HCl,  an  antidepressant/antifibromyalgia  agent)  2  days  earlier.  On  physical  examination,  the  sclera  of  her  eyes  shows  yellow  discoloration.  Laboratory  analyses  of  blood  drawn  within  an  hour  of  her  admission  reveal  abnormal  liver  function  as  indicated  by  the  increased  indices:  alkaline  phosphatase  302  (41–133),*  alanine  aminotransferase  (ALT)  351  (7–56),*  aspartate  aminotransferase  (AST)  1045  (0–35),*  bilirubin  3.33  mg/dL  (0.1–1.2),*  and  prothrombin  time  of  19.8  seconds  (11–15).*  In  addition,  plasma  bicarbonate  is  reduced,  and  she  has  ∼45%  reduced  glomerular  filtration  rate  from  the  normal  value  at  her  age,  elevated  serum  creatinine  and  blood  urea  nitrogen,  markedly  reduced  blood  glucose  of  35  mg/dL,  and  a  plasma  acetaminophen  concentration  of  75  mcg/mL  (10–20).*  Her  serum  titer  is  significantly  positive  for  hepatitis  C  virus  (HCV).  Given  these  data,  how  would  you  proceed  with  the  management  of  this  case?*Normal  values  are  in  parentheses.