Case
Pharmacology Drug Workshop
- Course
- DENT D204
Workshop 1 in Nervous System & Pain course. Several questions/cases regarding a patient and some negative side effects they are facing due to drug-drug interactions.
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Pharmacology Drug Workshop (worth 2.25% of final grade)Please make sure to turn in your own copy of answers for this workshop. You can work in groups to
complete the problems. Please reference any publications, websites, or sources that you used in
answering these questions. These problems will be discussed in class on Wednesday, June 14 th from 11-
12PM. These problems must be turned in on Wednesday, June 14th by 10AM. Failure to do this will
result in a “0” for the workshop.
1. A patient was placed on cyclosporin A after a recent kidney transplantation to help decrease the
chance of auto-rejection of the “new kidney.” Before and during the procedure of organ
transplantation, the patient was suffering from depression and decided to take St. John’s Wort without
the physician’s knowledge. A few weeks after the transplantation, the patient is rushed to the hospital
due to issues surrounding organ rejection. The patient’s cyclosporin levels were measured versus a
patient that was not taking St. John’s Wort (graph below). Discuss the mechanism of action (MOA) for
St. John’s Wort in treating depression and the pharmacokinetic issues surrounding this supplement and
its use with cyclosporin A (0.45 points).
Without St.
John’s Wort
Cyclosporin A
With St.
John’s Wort
Answer: Some studies have shown that St. John’s Wort (SJW) has helped individuals suffering from
mild to moderate depression. However, other studies have demonstrated that the use of SJW does
not do more than a placebo effect, so it’s use in treating depression is unclear. St. John’s Wort is an
inducer of CYP3A4, and increases the expression of P-glycoprotein efflux pumps. This is important in
the metabolism of cyclosporine A, because SJW and cyclosporine A taken together causes a decreased
blood concentration of cyclosporine A. This, in turn, decreases the absorbance of cyclosporine A, and
increases the rate of clearance of cyclosporine A (due to drug efflux pumps).
Sources: https://www.mayoclinic.org/drugs-supplements-st-johns-wort/art-20362212
Barone, G. W., Gurley, B. J., Ketel, B. L., Lightfoot, M. L., & Abul-Ezz, S. R. (2000).
Drug interaction between St. John's wort and cyclosporine. The Annals of
pharmacotherapy, 34(9), 1013–1016. https://doi.org/10.1345/aph.10088
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