Final answer:
The clearance of a drug with high hepatic extraction is decreased in shock due to the reduced liver blood flow, impacting the drug's metabolism and removal from the body.
Step-by-step explanation:
The clearance of a drug with a high hepatic extraction will be affected by states that alter the blood flow to the liver. In conditions such as shock, where there is a significant decrease in blood pressure and resulting decrease in blood flow to the liver, the clearance of such a drug will be decreased. This is due to the fact that a high hepatic extraction drug relies on liver blood flow to be efficiently metabolized and cleared from the body. In contrast, high output states often involve increased blood flow, potentially leading to increased clearance, but this is not always straightforward as the liver's metabolic capacity must also be considered.