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ROUTES OF ELIMINATION
Drugs are excreted mainly by the kidneys into the urine and by the liver into the bile and subsequently into the feces.
Other less common routes of elimination include milk, saliva, tears and sweat. The salivary route of excretion is important in ruminants because they
Further absorption and reabsorption takes place at various points along the nephron. The final product is only ablut 1% of the volume of the original glomerular filtrate. In the kidneys, circulating drugs are cleared from the blood through filtration and active secretion. Reduced renal blood flow decreases filtration of drugs in the glomerulus, resulting in decreased elimination. This is the reason for reduced dosage of the drug in older animals with reduced renal function and in animals with hypotension.
The pore size of the glomerular capillaries is about 40 Ao. The glomerular ultrafiltrate will therefore contain soluble drugs and other molecules including small proteins. Albumin is not filtered and hence drugs that are bound to plasma proteins are also not filtered. The glomerular filtration rate has a major effect on renal clearance of drugs. Increased glomerular filtration results in more rapid removal of drug molecules from the systemic circulation.
In the proximal convoluted tubules, there is active secretion of ionized drugs into the lumen. This ensures that drugs, which are protein-bound are excreted. The transport systems are non-specific and are of two types. One transport system transports organic acids and the other transports organic bases. Secretion of drug molecules requires significant energy. Anything that interferes with cellular energy production reduces the excretion of these drugs from the body. Tubular secretion being an active process, it can be suppressed by competing substances. Drugs excreted by a carrier-mediated process in the proximal tubule include:
Acids
Penicillin G Ampicillin Sulfosoxazole Phenylbutazone Furosemide Probenecid
Bases
Procainamide Dopamine Neostigmine N-methylnicotinamide Trimethoprim
p-aminohippurate
Glucuronic acid conjugates Ethereal sulphates
From the proximal convoluted tubule the drug moves to the loop of Henle, where some drugs are reabsorbed
Highly lipid soluble drugs will be rapidly reabsorbed from the kidney tubule. For this reason excretion of lipid soluble drugs often occur after conversion to more polar metabolite. Even though, many protein bound drugs are actively secreted into the proximal tubule, reabsorption may be favoured especially
In canine the urinary pH range from 5.0-7.0 and in herbivores the urinary pH may range from 7.0-8.0. Excretion can be enhanced for drugs excreted by the kidneys by altering the pH of the urine. For practical purposes this principle can be applied only
reabsorbed.
antibacterial agents are expected to diminish the hydrolytic action of intestinal flora and thus, may prevent effective enterohepatic cycles.
Large polar molecules (molecular weight >300) are often excreted and are not reabsorbed in the
intestine.
The ability to excrete polar compounds in bile with molecular weights between 300 and 500 is good in dog, chicken and rat, moderate in cat and sheep and poor in guinea pig, rabbit, monkey and man.
The pH of plasma and milk are important factors. Since milk is usually more acidic than plasma the basic compounds may be slightly more
concentrated and acidic compounds are less concentrated in milk than plasma.
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