Metabolism of acetaminophen (Ac) to harmless conjugates or to toxic metabolites. Acetaminophen glucuronide, acetaminophen sulfate, and the mercapturate conjugate of acetaminophen all are nontoxic phase II conjugates. Ac* is the toxic, reactive phase I metabolite. Transformation to the reactive metabolite occurs when hepatic stores of sulfate, glucuronide, and glutathione (GSH, Gs) are depleted or overwhelmed or when phase I enzymes have been induced.
Checklist
When you complete this chapter, you should be able to:
List the major phase I and phase II metabolic reactions.
Describe the mechanism of hepatic enzyme induction and list 3 drugs that are known to cause it.
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