Metronidazole is cleared by both renal and hepatic clearance mechanisms and inhibits several enzymes including CYP2C9, CYP3A4 and aldehyde dehydrogenase. Based on the following information, which of the following people would be most likely to suffer toxicity when undergoing treatment with metronidazole?

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The question asks which individual would be most likely to suffer toxicity from metronidazole, given its clearance pathways and enzyme inhibition.
Option a: Homer, a middle-aged man that is a chronic alcoholic. This choice is most plausible for toxicity because chronic alcohol use is commonly associated with liver disease and impaired hepatic function, which can reduce hepatic clearance of drugs like metronidazole. Metronidazole also inhibits several enzymes (CYP2C9, CYP3A4, and aldehyde dehydrogenase), and concurrent liver impairment can increase drug exposure and risk of adverse effects.
Option b: Bart, a healthy 10-year-old boy. In a healthy child, renal and hepatic clearance are typically more robust than in an adult with chronic liver disease, so the risk of metronidazole toxicity due to organ impairment would be lower compared to someone with hepatic compromise.
Option c: Selma, a middle-aged lady that smokes heavily. Smoking status can influence certain enzyme activities, but there is no specific indication here that would cause significant hepatic impairment or reduced metronidazole clearance beyond normal adult variation. Therefore, this option does not predict a high toxicity risk over someone with known liver disease.
Option d: Apu, a middle-aged man of Asian origin. Ethnicity alone does not reliably predict metronidazole toxicity risk unless tied to a pharmacogenetic profile or organ dysfunction. Without evidence of hepatic or renal impairment, this option is less likely to result in marked toxicity.
In summary, the key factors for toxicity with metronidazole in this scenario are impaired hepatic clearance and potential enzyme inhibition in a patient with chronic alcohol-related liver disease, making Homer the most likely to experience toxicity among the choices provided.

PHR1022 S2 2025 PA Practice Test for progress test 1

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