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https://publications.nigms.nih.gov/medbydesign/chapter1.html
Scientists have names for the four basic stages of a medicine's life in the body: absorption, distribution, metabolism, and excretion. The entire process is sometimes abbreviated ADME. The first stage is absorption. Medicines can enter the body in many different ways, and they are absorbed when they travel from the site of administration into the body's circulation. A few of the most common ways to administer drugs are oral (swallowing an aspirin tablet), intramuscular (getting a flu shot in an arm muscle), subcutaneous (injecting insulin just under the skin), intravenous (receiving chemotherapy through a vein), or transdermal (wearing a skin patch). A drug faces its biggest hurdles during absorption. Medicines taken by mouth are shuttled via a special blood vessel leading from the digestive tract to the liver, where a large amount may be destroyed by metabolic enzymes in the so-called "first-pass effect." Other routes of drug administration bypass the liver, entering the bloodstream directly or via the skin or lungs.
Once a drug gets absorbed, the next stage is distribution. Most often, the bloodstream carries medicines throughout the body. During this step, side effects can occur when a drug has an effect in an organ other than the target organ. For a pain reliever, the target organ might be a sore muscle in the leg; irritation of the stomach could be a side effect. Many factors influence distribution, such as the presence of protein and fat molecules in the blood that can put drug molecules out of commission by grabbing onto them.
Drugs destined for the central nervous system (the brain and spinal cord) face an enormous hurdle: a nearly impenetrable barricade called the blood-brain barrier. This blockade is built from a tightly woven mesh of capillaries cemented together to protect the brain from potentially dangerous substances such as poisons or viruses. Yet pharmacologists have devised various ways to sneak some drugs past this barrier.
After a medicine has been distributed throughout the body and has done its job, the drug is broken down, or metabolized. The breaking down of a drug molecule usually involves two steps that take place mostly in the body's chemical processing plant, the liver. The liver is a site of continuous and frenzied, yet carefully controlled, activity. Everything that enters the bloodstream—whether swallowed, injected, inhaled, absorbed through the skin, or produced by the body itself—is carried to this largest internal organ. There, substances are chemically pummeled, twisted, cut apart, stuck together, and transformed.
The biotransformations that take place in the liver are performed by the body's busiest proteins, its enzymes. Every one of your cells has a variety of enzymes, drawn from a repertoire of hundreds of thousands. Each enzyme specializes in a particular job. Some break molecules apart, while others link small molecules into long chains. With drugs, the first step is usually to make the substance easier to get rid of in urine.
Many of the products of enzymatic breakdown, which are called metabolites, are less chemically active than the original molecule. For this reason, scientists refer to the liver as a "detoxifying" organ. Occasionally, however, drug metabolites can have chemical activities of their own—sometimes as powerful as those of the original drug. When prescribing certain drugs, doctors must take into account these added effects. Once liver enzymes are finished working on a medicine, the now-inactive drug undergoes the final stage of its time in the body, excretion, as it exits via the urine or feces.
A drug's life in the body. Medicines taken by mouth (oral) pass through the liver before they are absorbed into the bloodstream. Other forms of drug administration bypass the liver, entering the blood directly.
Drugs enter different layers of skin via intramuscular, subcutan
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