You are working in the ICU and have been asked to step down drug “X” from IV to oral formulation for an elderly patient. You gather from the literature that drug X is extensively metabolized, and that it can be given IV or PO. Examining the monograph, you noticed that drug ‘s IV dose is roughly equivalent to the oral dose, and that its oral bioavailability is relatively high. What would be the correct course of action. Select all correct answers.

Roughly equivalent oral dose can be administered assuming drug X’s kinetics are likely similar in both routes of administrations

You would double the dose because drug X is likely highly extracted by 1^st pass metabolism to compensate for the IV to PO conversion

Drug X is likely a “low E” drug, hence you will need to consider reducing its oral dose as it is likely affected by patient’s reduced hepatic blood flow

Drug X is likely a “high E” drug, hence you will need to consider reducing its oral dose as it is likely affected by patient’s reduced hepatic blood flow

Drug X is likely a “low E” drug, hence you will need to monitor for changes in patient response when an enzyme inhibitor is administered at the same time

Drug X is likely a “high E” drug, hence you will need to monitor for changes in patient response when a protein binding displacement agent is administered at the same time

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