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When Healthy Turns Dangerous

Pharmacokinetic Implications of Grapefruit Juice and Statins

By Rachel Rigsby, Jamie Adam

When Healthy Turns Dangerous


 

Abstract

This case study was developed to teach nursing students about the importance of enzyme reactions and inhibition, not only in normal biochemistry, but also in drug metabolism. Students assume the role of an ER nurse as they tend to a patient displaying symptoms of drug toxicity due to interactions between dietary grapefruit juice and a commonly prescribed cholesterol-lowering drug (a statin). Students review the basics of enzyme-catalyzed reactions and are introduced to a key class of clinically relevant enzymes, the cytochromes P450 (CYPs). Through directed questions, students research the biochemistry of the enzymes and inhibition, explain the physician’s diagnosis, and counsel their patient on strategies to improve her health. The case can also be used to reinforce the difference between water- and. fat-solubility and how molecules are excreted in the urine, since P450 enzymes act to add oxygen to their substrates, making them more water-soluble. The case was originally developed for early undergraduate nursing students in a required chemistry course covering principles of general, organic, and biochemistry.

   

Date Posted

11/28/2022

Overview

Objectives

  • Demonstrate an understanding of how enzymes catalyze biological reactions.
  • Describe how molecules can inhibit enzyme activity.
  • Explain how dietary components can affect pharmacokinetics of medications.

Keywords

Enzymes; metabolism; cytochromes; P450; statin; CYP3A; Lipitor; grapefruit; pharmacokinetics; enzyme inhibition; atorvastatin

  

Subject Headings

Nursing

EDUCATIONAL LEVEL

Undergraduate lower division

  

FORMAT

PDF

   

TOPICAL AREAS

N/A

   

LANGUAGE

English

   

TYPE/METHODS

Directed

 

 

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