● Hydroxylation

● Demethylation

● Oxidation

● Sulfoxide formation

The basic purpose of drug metabolism is to form more polarmetabolites (water soluble), which are more readily excreted in the urine or bile. Most drugs are extensively biotransformed prior to elimination, but some undergo simple conjugation with glucuronic acid [15], which can occur in most organs, not just the liver. Other medications are excreted unmetabolized.

Some drugs induce the metabolism of other drugs as wellas themselves (autoinduction). Other drugs inhibit specific liver enzymes. The rate of drug conversion depends on the rate of delivery to the liver, which is determined by arterial flow [15]. After a drug enters the systemic circulation, cardiac left ventricular function delivers blood back to the liver. Diseases that directly or indirectly affect liver function such as liver disease, metabolic disorders, and cardiac disease can affect medication metabolism [15]. For example, beta-blockers decrease arterial flow and may slow the metabolism of medications that undergo extensive liver biotransformation.