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In the presence of renal insufficiency, however, absorption of even small amounts may cause an increase in plasma levels of counter ions (e. g. , magnesium intoxication with paralysis and cardiac disturbances). Precipitation in the gut lumen is responsible for other side effects, such as reduced absorption of other drugs due to their adsorption to the surface of precipitated antacid.
Certain opioid analgesics, such as codeine and tramadol, may be prescribed in the usual manner, because of their lesser potential for abuse and development of dependence. Differences between opioids regarding efficacy and potential for dependence probably reflect differing affinity and intrinsic activity profiles for the individual receptor subtypes.


Some agonists attain a maximal effect even when they occupy only a small fraction of receptors (B, agonist A). Other ligands (agonist B), possessing equal affinity for the receptor but lower activating capacity (lower intrinsic activity), are unable to produce a full maximal response even when all receptors are occupied: lower efficacy. Ligand B is a partial agonist
In this manner, an unbroken phospholipid layer is formed (yellow area in the schematic drawing, bottom left) and acts as a continuous barrier between the two spaces separated by the cell layer in the case of the gut, the intestinal lumen (dark blue) and the interstitial space (light blue).


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