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Q1:1. Identify main metabolic enzymes involved in elimination of clozapine. a) Tabulate median clozapine maximal plasma concentrations (Cmax), area under plasma concentration-time curve (AUC) and clearance (Dose/AUC) in non-smokers vs. heavy smokers (>20 cigarettes/day). Assess percent change in these parameters in smoker vs. non-smoker patients. Explain reasons for potential differences in parameters between smokers and non-smokers. b) Comment whether you would recommend a change in clozapine dose in heavy smokers and why.See Answer
Q2:3. Explain whether you expect clozapine Cmax to change following the initiation of smoking cessation and whether there would be any consequences of smoking cessation on the patient's safety and efficacy of this drug. What effect would nicotine replacement therapy have on clozapine metabolism?See Answer
Q3:4. Identify another drug example where pharmacokinetics of a drug differs between smokers and non- smokers. List either clearance, AUC or t1/2 for that drug in smokers vs. non-smokers, explain reasons for these differences and include relevant reference. Comment on any therapeutic implications/ clinical action for that drug example for i) the patient starting smoking and for ii) the patient stopping smoking.See Answer
Q4: 1. What is the role of community pharmacy in patient education?See Answer

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