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Etymology: Gk, en + zyme, ferment; L, inducere, to lead in
the increase in the rate of a specific enzyme synthesis from basal to maximum level caused by the presence of a substrate or substrate analog that acts as an inducer. The inducer may be a substance that inactivates a repressor chemical in the cell.
therapeutic drug monitoringClinical pharmacology The regular measurement of serum levels of drugs requiring close 'titration' of doses in order to ensure that there are sufficient levels in the blood to be therapeutically effective, while avoiding potentially toxic excess; drug concentration in vivo is a function of multiple factors Common TDM drugs Carbamazepine, digoxin, gentamycin, procainamide, phenobarbital, phenytoin, theophylline, tobramycin, valproic acid, vancomycin
Therapeutic drug levels in vivo–factors involved
Patient compliance Ingestion of drug in the doses prescribed
Bioavailability Access to circulation, interaction with cognate receptor(s); ionized and 'free', or bound to a carrier molecule, often albumin
Pharmacokinetics Drug equilibrium requires 4-6 half-lives of drug clearance (a period of time for1/2 of the drug to 'clear', either through metabolism or excretion, multiplied by 4-6); the drug is affected by
• Interaction with foods or other drugs at the site of absorption, eg tetracycline binding to cations or chelation with binding resins, eg bile acid-binding cholestyramine that also sequesters warfarin, thyroxine and digitoxin or interactions of various drugs with each other, eg digitalis with quinidine resulting in a 3-fold ↓ in digitalis clearance
• Absorption may be changed by GI hypermotility or large molecule size
• Lipid solubility, which affects the volume of distribution; highly lipid-soluble substances have high affinity for adipose tissue and a low tendency to remain in the vascular compartment, see Volume of distribution.
• Biotransformation, with 'first pass' elimination by hepatic metabolism, in which polar groups are introduced into relatively insoluble molecules by oxidation, reduction or hydrolysis; for elimination, lipid-soluble drugs require the 'solubility' steps of glucuronidation or sulfatation in the liver; water-soluble molecules are eliminated directly via the kidneys, weak acidic drugs are eliminated by active tubular secretion that may be altered by therapy with methotrexate, penicillin, probenecid, salicylates, phenylbutazone and thiazide diuretics
First order kinetics Drug elimination is proportional to its concentration
Zero order kinetics Drug elimination is independent of the drug's concentration
• Age Lower doses are required in both infants and the elderly, in the former because the metabolic machinery is not fully operational, in the latter because the machinery is decaying, with ↓ cardiac and renal function, enzyme activity, density of receptors on the cell surfaces and ↓ albumin, the major drug transporting molecule
• Enzyme induction, which is involved in a drug's metabolism may reduce the drug's activity; enzyme-inducing drugs include barbiturates, carbamazepine, glutethimide, phenytoin, primidone, rifampicin
• Enzyme inhibition, which is involved in drug metabolism, resulting in ↑ drug activity, prolonging the action of various drugs, including chloramphenicol, cimetidine, disulfiram (Antabuse), isoniazid, methyldopa, metronidazole, phenylbutazone and sulfonamides
Genetic factors play an as yet poorly defined role in therapeutic drug monitoring, as is the case of the poor ability of some racial groups to acetylate drugs
Concomitant disease, ie whether there are underlying conditions that may affect drug distribution or metabolism, eg renal disease with ↓ clearance and ↑ drug levels, or hepatic disease, in which there is ↓ albumin production and ↓ enzyme activity resulting in a functional ↑ in drug levels, due to ↓ availability of drug-carrying proteins
enzyme inductionthe process in which a structural gene coding for an enzyme of a catabolic pathway is activated by the substrate of that pathway (or a derivative of that pathway) binding with a repressor. The substrate is an INDUCER, which inactivates the repressor, allowing TRANSCRIPTION to proceed and in turn production of the enzyme that will catalyse the metabolism of the substrate. see OPERON MODEL.
any protein that acts as a catalyst, increasing the rate at which a chemical reaction occurs. The animal body probably contains about 10,000 different enzymes. At body temperature, very few biochemical reactions proceed at a significant rate without the presence of an enzyme. Like all catalysts, an enzyme does not control the direction of the reaction; it increases the rates of the forward and reverse reactions proportionally.
one that activates a given amino acid by attaching it to the corresponding transfer ribonucleic acid.
several enzymes are important in clinical pathology. Enzymes characteristic of a tissue are released into the blood when the tissue is damaged, and enzyme levels in the blood can aid in the diagnosis or monitoring of specific diseases. Lipase and amylase levels are useful in pancreatic diseases; alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in liver diseases; and lactate dehydrogenase (LD), AST and creatine kinase (CK) in muscle disease. ALP is also released in bone diseases. Many enzymes have different forms (isoenzymes) in different organs. The isoenzymes can be separated by electrophoresis in order to determine the origin of the enzyme. Isoenzymes of LD, CK and ALP have the most clinical utility.
brancher enzyme, branching enzyme
amylo-(1,4→1,6)-transglycosylase; important in the synthesis of the branched glycogen molecule. Absence of the enzyme causes an increase in the length of the glucose chains and a decrease in the number of branch points in the glycogen molecules.
congenital enzyme deficiency
in humans hundreds of genetic diseases that result from deficiency of a single enzyme are now known. Many of these diseases fall into two large classes. The aminoacidopathies, e.g. phenylketonuria (PKU), result from deficiency of an enzyme in the major pathway for the metabolism of a specific amino acid. The amino acid accumulates in the blood, and it or its metabolites are excreted in the urine. The lysomal storage diseases, e.g. gangliosidosis, mannosidosis, result from deficiency of a lysomal enzyme and the accumulation of the substance degraded by that enzyme in lysosomes of cells throughout the body. The stored material is usually a complex substance, such as glycogen, a sphingolipid or a mucopolysaccharide. Many similar diseases are now identified in animals and are to be found under the specific name of each disease.
one produced by a microorganism regardless of the presence or absence of the specific substrate acted upon.
the smallest aggregate of an enzyme's subunits that has enzymatic activity.
debrancher enzyme, debranching enzyme
dextrin-1,6-glucosidase: an enzyme that acts to move glucose residues of the glycogen molecule, and is important in glycogenolysis.
induced enzyme, inducible enzyme
one whose production requires or is stimulated by a specific small molecule, the inducer, which is the substrate of the enzyme or a compound structurally related to it.
the effect some compounds such as phenobarbitone and phenytoin have in increasing the activity of microsomal hepatic enzymes. This may cause alterations in the metabolism of concurrently administered drugs.
those associated with the endoplasmic reticulum of cells, particularly of the liver.
one that catalyzes the hydrolysis of proteins and various split products of proteins, the final product being small peptides and amino acids.
one whose rate of production is decreased as the concentration of certain metabolites is increased.
enzymes of the mitochondria, e.g. cytochrome oxidase, which serve as catalysts for cellular oxidations.