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Most drugs undergo chemical alteration by various bodily systems to create compounds that are more easily excreted from the body. These chemical alterations occur primarily in the liver and are known as biotransformations. Understanding the chemical alterations drugs undergo as they are metabolized is relevant when planning individual pharmacological interventions for patients. This activity reviews drug metabolism, biotransformations, and polypharmacy. The role of the interprofessional team in caring for patients using multiple medications is discussed. Objectives: Differentiate between phase I (oxidation, reduction, hydrolysis) and phase II (conjugation) reactions. Assess the impact of drug metabolism on treatment response and drug interactions, considering the potential for drug toxicity or therapeutic failure. Screen patients for factors affecting drug metabolism, such as genetic polymorphisms, drug-drug interactions, and organ dysfunction. Coordinate with healthcare teams to ensure the integration of drug metabolism information into treatment plans, promoting personalized and evidence-based care. Access free multiple choice questions on this topic.

Most drugs are xenobiotics, ie, chemical substances not naturally produced by the body. Xenobiotics undergo various body processes for detoxification, thus reducing their toxicity and allowing them to be readily available for excretion. These processes allow for the chemical modification of drugs into their metabolites and are known as drug metabolism or metabolic biotransformation.[1][2] These metabolites are the byproducts of drug metabolism and can be characterized by active, inactive, and toxic metabolites. Active metabolites are biochemically active compounds with therapeutic effects, whereas inactive metabolites are biochemically inactive compounds with neither a therapeutic nor toxic effect. Toxic metabolites are biochemically active compounds similar to active metabolites but have various harmful effects.[3] Drug metabolism occurs at a specific location in the body, resulting in a low concentration of active metabolites in the systemic circulation. This phenomenon is called first-pass metabolism because it limits drug bioavailability. First-pass metabolism primarily occurs in the liver; however, metabolizing enzymes can be found throughout the body.[2][3] Understanding these alterations in chemical activity is crucial in utilizing the optimal pharmacological intervention for any patient. This is a topic of interest to any provider who routinely treats patients with medications.[1][2][3][4]

Drug metabolism is an essential clinical concern for the interprofessional healthcare team. Clinicians and pharmacists must work together to prevent clinically significant drug interactions that could affect patients' health. In a hospital setting, nursing staff monitors for signs of a toxic buildup of metabolites or active drugs. This is especially significant in renal or hepatic insufficiency. In many cases, drugs such as aminoglycoside antibiotics, warfarin, and fluoroquinolones are dosed and monitored by pharmacists, who monitor serum levels of the drugs and renal function. An interprofessional approach to drug dosing and administration in light of the effects of drug metabolism on patients, whether through impaired metabolism, drug-drug interactions, enzymatic induction, or other factors, provides the best potential for optimal patient care. The interprofessional care approach results in better therapeutic results with fewer adverse events.

Interprofessional interventions and monitoring are critical for positive outcomes. Literature suggests that interprofessional interventions are effective when teams are open and willing to collaborate, communicate, share decision-making, and coordinate care, ultimately leading to the integration of the team’s competencies.[16] Interprofessional team interventions are an effective part of medication management through interventions and monitoring. Medications affect people differently, as mentioned above. As a result, patients may be at an increased risk of adverse events if appropriate measures are not taken. Teams must monitor and intervene when medications are not safe for patients to take or administer or if patients are taking them inappropriately. The goal should always be patient safety. Reporting adverse events is crucial for interprofessional team monitoring. To properly conduct monitoring and interventions, clinical teams should also undergo training. Training can be conducted on topics such as identifying medication errors to prevent adverse events, effective communication amongst teams, and standardization of medication dispensing. Continuing Medication Credits should be geared toward intervention and monitoring as well. Communication is a critical part of healthcare delivery. Interprofessional teams must continue to advance their approaches to following patients through the continuum of care. In addition, effective interprofessional training allows for increased quality of care, promotion of collaboration, promote interdisciplinary awareness, respect, and acceptability of the role each discipline plays. However, one should also consider the challenges as well. Each discipline has its own culture and methodology. They have differences in routines, regulations, qualifications, accountability, and professional language. As a result, it makes it difficult to standardize any interventions or monitoring of medications. However, the first step in change is awareness of these challenges. Once these challenges are addressed and each discipline, whether nurses, pharmacists, or physicians, is trained appropriately, they will be able to effectively intervene and monitor medications for improved health outcomes at any stage of treatment.[17]