Case description- FORMAT in AMA references

Upon presentation: 

Manny Garcia, 32-year-old male, is presenting to his primary care physician for a routine physical and prescription refills of both Enalapril and EpiPen® Auto-Injector.  He has a history of hypertension, managed with enalapril, and is otherwise in good health. 

What is Enalapril?

Enalapril is an anti-hypertension “prodrug” (i.e., a drug precursor) that is inactive until the ethyl ester is hydrolyzed by esterases present in blood plasma. The active drug is the dicarboxylic acid (“enalaprilat”) that results from this hydrolysis reaction.  

 

Answer these questions:

  • 1. Describe the reaction catalyzed by an esterase and classify it as one of the 6 classes of enzymes and propose why this conversion is necessary for drug activity.
  • 2. Based on this information, explain what type of interaction is occurring between enalapril and ACE

History: 

Manny is an architect who works from home and enjoys hiking with his family.  He tells you he was recently stung by a bee while working in his yard and needed to use his EpiPen for immediate treatment.  He reports he did not need to go to the emergency department. 

Answer these questions:

  • 1. Based on this information, predict blood glucose values immediately after epinephrine injection (increase, decrease or no change). Justify your answer.  
  • 2. What is the mechanism of action of epinephrine, including its signaling mechanism(s), target organs and metabolic impacts?
  •  
  • You ask Manny if he is taking any non-prescription drugs before refilling his prescriptions.  He tells you he recently started taking a coenzyme Q10 supplement based on a recommendation from a friend.  
  •  

Interactive Case: Assignment Prompt

Describe the biochemical role of coenzyme Q10 and how supplementation may impact metabolism. Be sure to address the key terms listed below as part of your discussion; you may address additional etiologies as well.

  • coenzyme Q
  • Complex I
  • Complex II
  • Complex III
  • ubiquinone
  • ubiquinol
  • Electron transport chain
  • Oxidative phosphorylation
  • Reactive oxygen species
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