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Q: drug path. intestines to lymphatic system. through liver? ( Answered 5 out of 5 stars,   1 Comment )
Question  
Subject: drug path. intestines to lymphatic system. through liver?
Category: Health > Medicine
Asked by: saregamapa-ga
List Price: $10.00
Posted: 07 Jun 2005 21:09 PDT
Expires: 07 Jul 2005 21:09 PDT
Question ID: 530669
If a drug passes from the intestines into the lymphatic system - how
does it eventually reach the blood?  Does it have to pass through the
liver first?
Answer  
Subject: Re: drug path. intestines to lymphatic system. through liver?
Answered By: crabcakes-ga on 07 Jun 2005 23:41 PDT
Rated:5 out of 5 stars
 
Hi saregamapa,

  When a drug is taken orally, it passes through the digestive
system... mouth, stomach, intestines. As you will see further down in
my answer, the drug molecules enter the bloodstream directly from the
intestinal tract. From the bloodstream, the drug molecules are carried
to muscle, lymph, and other tissues.

What is not utilized by tissues, lymph, etc., is excreted by the
kidneys or broken down by the liver to be excreted in the stool.  All
this depends on the kind of drug, of course. Some drugs are excreted
by the kidneys, by-passing the liver. Cells utilize the drug molecules
and excrete metabolites of the drug as waste. This is all a simple
explanation, of course. To read a more detailed explanation of drug
excretion, visit these pages:
http://www.merck.com/mrkshared/mmanual/section22/chapter298/298e.jsp

http://www.nottingham.ac.uk/nursing/sonet/rlos/bioproc/kidneydrug/

http://www.madsci.org/posts/archives/oct98/905537667.Bc.r.html


?The drugs pass through the digestive tract until they reach the
stomach and intestine where they are absorbed into the bloodstream.
Not only do they take longer to act, but the body begins to metabolize
them before they can act on the brain. Enzymes in the stomach,
intestines, and liver begin breaking down the drugs so they can be
cleared from the body.?
http://science.education.nih.gov/supplements/nih2/addiction/guide/lesson3-1.htm

This site is discussing food absorption, but medicine is absorbed the
same way, when taken orally.
?The lining of the intestines is more like a plush carpet than a
smooth sheet. Here's why. Trillions of microscopic projections, called
villi, grow out from the cells of the intestinal lining. This
increases the cell's surface area, thus increasing the contact between
the food and the cells. The more contact these cells (and their rich
blood supply) have with the food, the more nutrients can be absorbed.
The intestinal lining is only one cell thick, which is a good news /
bad news phenomenon. The good news is that because the lining is thin,
nutrients are easily absorbed. They come in the front door of the cell
and go out the back door into the bloodstream.?
http://www.askdrsears.com/html/4/T042000.asp

?The drug molecules move from an area of high drug concentration?the
bloodstream?to an area of low drug concentration?the tissues?until a
balance between the two areas is reached. This process is known as
diffusion. When a drug reaches its highest concentration in the
tissues, the body begins to eliminate the drug and its effect on the
body begins to diminish. The time it takes for the level of a drug to
fall by 50 percent is known as the drug?s half-life. Depending on the
drug, this measurement can vary from a few minutes to hours or even
days. For example, if a drug?s highest concentration level in the
blood is 1 mg/ml and this level falls to 0.5 mg/ml after five hours,
the half-life of the drug is five hours. A drug?s half-life is used to
determine frequency of dosage and the amount of drug administered.?
http://encarta.msn.com/encyclopedia_761560993_3/Drug.html


I find it easier to picture a drug?s itinerary in the body by viewing
illustrations. Here are a few:

This page illustrates drug pathways in the body. Click on the third
image box, entitled ?The Drug Versus the Body Exercise will test your
knowledge of drug absorption in the blood.?
http://www.prescribing.info/pharmacology.htm

http://www.dddmag.com/images/0406/DD46CEM_1_lrg.jpg

Another illustration
http://www.utdallas.edu/~tres/pharm/uptake/display1_02.html

These pictures depict the intestinal villa, fingerlike projections in
the intestine, that increase surface area. The drug molecules, along
with nutrient molecules, from digested foods enter the bloodstream
through capillaries in these villae.
http://www.nature.com/nrd/journal/v2/n4/slideshow/nrd1067_F2.html

http://www.eurospital.it/immagini/jejenum.gif

Drug excretion through the liver
http://www.healthsci.utas.edu.au/pharmacy/kinetics/kinetics/08/

http://web.vet.cornell.edu/public/pharmacokinetics/excretion/enterohepatic.gif


After the drug works, it is eliminated from the body:
?Most drugs, once they have performed their function, are removed from
the body through a process called metabolism. This involves the
chemical modification of the drug molecule by a range of enzymes
present mainly in the liver. The activity of these enzymes varies
considerably within the population, and these differences can be a
major reason why people respond to drugs differently. Arguably the
most important group of human drug metabolizing enzymes is the
cytochrome P450 family. Many factors in both lifestyle and genetic
makeup affect the activity of these enzymes and in turn the rate at
which a drug is eliminated from the body.?
http://jchemed.chem.wisc.edu/Journal/Issues/2000/Mar/abs349.html

There you go! If  this is not the information you were seeking, please
request an Answer Clarification, before rating. This will allow me to
assist you further, if possible.

Regards, Crabcakes

Search Terms
Drug metabolism
Drug excretion

Request for Answer Clarification by saregamapa-ga on 08 Jun 2005 20:59 PDT
More specifically, I am interested in knowing how a water-insoluble
drug, which is a lipid molecule, will get absorbed in the intestine
and be able to trace its movement from the gut to the bloodstream and
eventually the tissues.  Please pay special attention to the
importance, if any, of the lymphatic pathway as well.  Thanks.

Clarification of Answer by crabcakes-ga on 09 Jun 2005 13:28 PDT
Hi again saregamapa,

  Even though your clarification asks a different question than your
original question, I have attempted to supply you with a better
understanding of the lymphatic system and drug transport into the
lymphatic system.

?Small quantities of very small fatty acids are able to directly enter
the intestinal capillaries of the villi of the small intestine and
hence enter the blood stream in this way. However, the majority of
fatty acids are long chained and are absorbed quite differently.
Within the intestinal lumen, bile salts form aggregates called
micelles that are water soluble. Fatty acids and monoglycerides are
aggregated into the centres of the micelles. The micelles transport
the fatty acids and monoglycerides to the brush borders of the villi.

  From here, the fatty acids and monoglycerides diffuse into the
epithelial cells of the villi. The micelles continue their ferrying
function in the intestinal lumen. Within the epithelial cells, the
fatty acids and monoglycerides are resynthesised into triglycerides.
The triglycerides combine with cholesterol, lipoprotein, and
phospholipids to form globules called chylomicrons. The chylomicrons
leave the epithelial cells and enter into the lacteal of the villus.
Lymphatic vessels then carry the chylomicrons to the venous blood of
the left subclavian vein via the thoracic duct.?
http://www.jdaross.mcmail.com/lymphatic_system.htm

?Absorption from solid forms: Most drugs are given orally as tablets
or capsules primarily for convenience, economy, stability, and patient
acceptance. These products must disintegrate and dissolve before
absorption can occur. Disintegration greatly increases the drug's
surface area in contact with GI fluids, thereby promoting drug
dissolution and absorption. Disintegrants and other excipients (eg,
diluents, lubricants, surfactants, binders, dispersants) are often
added during manufacture to facilitate these processes. Surfactants
increase the dissolution rate by increasing the wetability,
solubility, and dispersibility of the drug. Disintegration of solid
forms may be retarded by excessive pressure applied during the
tableting procedure or by special coatings applied to protect the
tablet from the digestive processes of the gut. Hydrophobic lubricants
(eg, magnesium stearate) may bind to the active drug and reduce its
bioavailability.

Dissolution rate determines the availability of the drug for
absorption. When slower than absorption, dissolution becomes the
rate-limiting step. Overall absorption can be controlled by
manipulating the formulation. For example, reducing the particle size
increases the drug's surface area, thus increasing the rate and extent
of GI absorption of a drug whose absorption is normally limited by
slow dissolution. Dissolution rate is affected by whether the drug is
in salt, crystal, or hydrate form. The Na salts of weak acids (eg,
barbiturates, salicylates) dissolve faster than their corresponding
free acids regardless of the pH of the medium. Certain drugs are
polymorphic, existing in amorphous or various crystalline forms.
Chloramphenicol palmitate has two forms, but only one sufficiently
dissolves and is absorbed to be clinically useful. A hydrate is formed
when one or more water molecules combine with a drug molecule in
crystal form. The solubility of such a solvate may markedly differ
from the nonsolvated form; eg, anhydrous ampicillin has a greater rate
of dissolution and absorption than its corresponding trihydrate.?
http://www.merck.com/mrkshared/mmanual/section22/chapter298/298b.jsp

?The plasma lipoprotein distribution of potential drug candidates is
not commonly studied. For some hydrophobic drug candidates, attainment
of similar plasma free drug levels has not been associated with
uniform production of pharmacological activity in different animal
species. It is well known that plasma lipoprotein lipid profiles vary
considerably between different animal species. In addition, human
disease states can significantly influence plasma lipoprotein
profiles, resulting in altered drug therapeutic outcomes. A plausible
explanation for these findings may be a result of lipoprotein drug
transport within the systemic circulation. Elucidation of the
mechanisms that dictate the lipoprotein binding of drugs may yield
valuable insight into the factors governing the pharmacological
activity and potential toxicity of these compounds. Furthermore,
utilizing these factors to target compounds specifically to one
lipoprotein subclass over another potentially could improve the drug's
efficacy and safety.?
http://www.pharmacy.ubc.ca/faculty_staff/faculty/pharm_bio/pharm_bio_kishor_wasan.html


?The second function of the lymphatic system is the absorption of fats
and fat-soluble vitamins from the digestive system and the subsequent
transport of these substances to the venous circulation. The mucosa
that lines the small intestine is covered with fingerlike projections
called villi. There are blood capillaries and special lymph
capillaries, called lacteals, in the center of each villus. The blood
capillaries absorb most nutrients, but the fats and fat-soluble
vitamins are absorbed by the lacteals. The lymph in the lacteals has a
milky appearance due to its high fat content and is called chyle.?
http://training.seer.cancer.gov/module_anatomy/unit8_1_lymph_functions.html


?The normal process of intestinal digestion can be divided into three
phases (Figure 4). During the intraluminal phase, ingested
carbohydrates, proteins and lipids are hydrolyzed within the
intestinal lumen by enzymes released by the salivary glands, the
stomach and the pancreas. In the intestinal phase, further digestion
of peptides and disaccharides continues at the level of the intestinal
brush border and the resulting amino acids, small peptides,
monosaccharides, monoglycerides and fatty acids are subsequently
absorbed into the enterocyte. The movement of nutrients from the
intestinal epithelial cell into the vascular or lymphatic circulation
defines the delivery phase. The overall absorptive capacity of the
intestinal tract depends upon its length and available surface
epithelium. In addition, some dietary substances have specific
intestinal sites of uptake. Bile acids, for example, are absorbed in
the ileum. Vitamin B12 first binds to intrinsic factor secreted by the
gastric parietal cell and is then absorbed by a specific
receptor-mediated process on ileal enterocytes.?
http://gastroresource.com/GITextbook/en/chapter15/15-7-pr.htm

?Return of excess filtered fluid. Normally, slightly more fluid is
filtered out of the capillaries into the interstitial fluid
(extracellular fluid) than is reabsorbed from the interstitial fluid
back into the plasma.

1.The average rate of flow through the lymph vessels is 3 liters per day.
2. Defense against pathogenic disease as the lymph percolates and is
filtered through the lymph nodes.
3. Transport of lipid (fat). The lymphatic system is important in the
absorption of fat from the small intestine. Dietary fat products are
packaged by the lining of the small intestine into particles which are
too large to gain entry into capillaries, but these particles can
easily access the lymphatics (lacteals = lymph capillaries in the
villi of the small intestine).?
http://www.biosbcc.net/barron/anatomy/pdf/LYMPHATIC%20SYSTEM.pdf



?Closely connected with the blood and circulatory system, the
lymphatic system is an extensive drainage system that returns water
and proteins from various tissues back to the bloodstream. It is
comprised of a network of ducts, called lymph vessels or lymphatics,
and carries lymph, a clear, watery fluid that resembles the plasma of
blood. Some scientists consider this system to be part of the blood
and circulatory system because lymph comes from blood and returns to
blood, and because its vessels are very similar to the veins and
capillaries of the blood system. Throughout the body, wherever there
are blood vessels, there are lymph vessels, and the two systems work
together.?

?This process is crucial because water, proteins, and other molecules
continuously leak out of tiny blood capillaries into the surrounding
body tissues. This lymph fluid has to be drained, and so it returns to
the blood via the lymphatic vessels. These vessels also prevent the
back flow of lymph fluid into the tissues.
The lymphatic system also helps defend the body against invasion by
disease-causing agents such as viruses, bacteria, or fungi. Harmful
foreign materials are filtered out by small masses of tissue called
lymph nodes that lie along the network of lymphatic vessels. These
nodes house lymphocytes (white blood cells), some of which produce
antibodies, special proteins that fight off infection. They also stop
infections from spreading through the body by trapping disease-causing
germs and destroying them.?
http://www.gorhams.dk/html/the_lymphatic_system.html

?For our bodies to function well in homeostasis, we need a lymph
system to carry off wastes, toxins, proteins, viruses, bacteria,
excess water, etc. from the connective tissue. The lymph system is
obliged to remove these substances that cannot be carried by the
venous capillaries, so we describe them as lymph-obligatory-load
(LOL).
Collection of the LOL is a vital function, just as the blood
circulation, nervous system, etc. are vital to our health. The LOL is
picked up by thin-walled, initial lymph vessels that originate in the
connective tissue and funnel LOL into collector lymph vessels. The
lymph vessels are fine, silk-like structures made of consecutive units
called angions. These onion-shaped units can function independently
and shift lymph from one unit to the next through one-way valves. The
larger angions have smooth muscle in their walls which contract and
squeeze the lymph to the next unit.?
http://www.healthtronix.com/overview.htm

You may find these articles interesting as well:

http://www.barnettinternational.com/RSC_PDFUploads/BI448WEB.pdf

http://www.freepatentsonline.com/4725442.html

http://www.drugdeliverytech.com/cgi-bin/articles.cgi?idArticle=10

I hope this extra information has been useful to you!
Sincerely, Crabcakes
saregamapa-ga rated this answer:5 out of 5 stars and gave an additional tip of: $2.00
Excellent!  Thank you very much.

Comments  
Subject: Re: drug path. intestines to lymphatic system. through liver?
From: crabcakes-ga on 09 Jun 2005 18:35 PDT
 
I'm glad I finally found the information for you! Thank you for the
stars and the tip!
Sincerely, Crabcakes

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