1: Pharmacodynamics 2 Flashcards

1
Q

description of intracellular receptors

A
  • lipid-soluble ligand crosses the cell membrane and acts on an intracellular receptor
    ex: corticosteroids, mineralocorticoids, sex steroids, vitamin D, thyroid hormone

-stimulate the transcription of genes in the nucleus by binding to specific DNA sequences near the gene whose expression is to be regulated

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2
Q

therapeutic significance of intracellular receptor binding

A
  • drugs produce their effects after a characteristic lag period
  • cannot be expected to alter a pathologic state w/i minutes
  • effects of these agents can persist after the [agonist] has been reduced to zero due primarily to the relatively slow turnover of most enzymes and proteins (or due to high affinity of receptors for the hormone)
  • no simple temporal correlation b/w plasma levels of the hormone and its effects
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3
Q

protein tyrosine kinases: what type of enzymes are they, what is their mechanism of action, examples

A
  • ligand-regulated transmembrane enzymes
  • adds a phosphate group to substrate
  • ex: insulin, EGF, PDGR
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4
Q

protein tyrosine kinases: describe the receptor

A
  • extracellular hormone-binding domain
  • cytoplasmic enzyme domain with protein tyrosine kinase activity
  • spans lipid bilayer once
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5
Q

protein tyrosine kinases: how do they work

A
  • usually act as dimers
  • hormoen binds to extracellular domain -> conformational change
  • receptor molecules associate -> brings together protein tyrosine kinase domains
  • kinase becomes capable of autophosphorylation
  • tyrosine residues in both cytoplasmic domains are phosphorylated -> activates enzymatic activity -> phosphorylation of substrate proteins
  • P-substrate proteins become signal for the effects of the ligand
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6
Q

how is the process initiated by protein tyrosine kinases turned off/regulated?

A
  • duration and intensity of the action is limited by receptor down regulation
  • upon ligand binding, endocytosis of the receptor is stimulated
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7
Q

how can ligand-gated channels be utilized by drugs?

A

drugs can mimic or block the actions of endogenous ligands that regulate the flow of ions through plasma membrane channels -> transmits signal across by increasing transmembrane conductance of the relevant ion -> alters electric potential across membrane

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8
Q

speed of ligand-gated channel interactions

A

-often milliseconds -> rapidity is crucially important for extremely rapid transfer of signals across synapses

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9
Q

calcium and phosphoinositides

A
  • effector enzyme = PLC
  • releases phosphoinositides and diacylglycerol
  • results in release of Ca2+ –> increase cytoplasmic [Ca2+]
  • diacylglycerol can activate PKC
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10
Q

speed of ligand-gated channel interactions

A

-often milliseconds -> rapidity is crucially important for extremely rapid transfer of signals across synapses

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11
Q

GPCRs action

A

-ligands acts by increasing intracellular concentrations of second messengers
-generally signaling system has 3 components:
-extracellular ligand is detected by cell-surface receptor
-receptor triggers activation of G protein on cytoplasmic
face of plasma membrane
-changes activity of an effector element
-effector changes [second messenger] –> effect

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12
Q

cAMP

A
  • effector enzyme = adenylyl cyclase (ATP –> cAMP)
  • stimulates cAMP-dependent protein kinases (also EPAC)
  • specificity due to distinct substrates of the kinases that are expressed in different cells
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13
Q

definition of therapeutic index/ratio

A
  • relative safety of a drug expressed as LD50/ED50 or TD50/ED50
  • larger the ratio –> greater the relative safety
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14
Q

cGMP

A
  • effector enzyme = guanyl cyclase
  • activates cGMP-dependent protein kinase
  • much more specific than other messenger systems
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15
Q

quantal drug responses vs. graded drug responses

A
  • quantal is all or none (binary response)
  • threshold: minimum effective dose of the drug which evokes an all-or-none response
  • normal frequency distribution
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16
Q

definition of median effective dose (ED50)

A

-the dose required to produce the stated effect in 50% of the population

17
Q

tachyphylaxis

A
  • acute development of tolerance following rapid, repeated administration of a drug
  • the first administration produces a much larger response than subsequent doses, when given after a breif interval
  • CANNOT overcome this type of tolerance with increasing dose
  • ex: ephedrine (NE release - indirect mechanism)
18
Q

drug adverse effect

A

an adverse response to a foreign chemical resulting from previous exposure to the substance

  • involves an immune response to the drug
  • at initial exposure, drug or metabolite acts as a hapten and combines with a protein to generate an Ag
  • Ag induces latent synthesis of Ab’s
  • subsequent exposure to the drug results in an Ag-Ab response
19
Q

drug allergy

A
  • seen in a small fraction of the population
  • no apparent dose-response - a minute amount of drug results in response
  • effects not related to pharmacologic activity
  • sensitizing period required b/w 1st and 2nd exposure
  • circulating Abs can be found after 1st exposure
20
Q

two ways to develop drug tolerance

A
  1. decrease in effective concentration of the agonist at the site of action
    • drug disposition tolerance
    • end result is decreased effect of drug
  2. decrease in the normal reactivity of the receptor
    • cellular or pharmacologic tolerance
    • downregulation of receptors
    • change in receptor affinity
    • most often seen with CNS drugs, such as narcotics, depressants, and stimulants
21
Q

cross tolerance

A
  • tolerance develops to one drug that is also seen with drugs belonging to the same class
  • ex: an individual tolerant to morphine develops tolerance to all narcotics
22
Q

tachyphylaxis

A
  • acute development of tolerance following rapid, repeated administration of a drug
  • the first administration produces a much larger response than subsequent doses, when given after a breif interval
  • CANNOT overcome this type of tolerance with increasing dose
  • ex: ephedrine (NE release - indirect mechanism)
23
Q

drug allergy

A

an adverse response to a foreign chemical resulting from previous exposure to the substance

  • involves an immune response to the drug
  • at initial exposure, drug or metabolite acts as a hapten and combines with a protein to generate an Ag
  • Ag induces latent synthesis of Ab’s
  • subsequent exposure to the drug results in an Ag-Ab response
24
Q

drug allergy

A
  • seen in a small fraction of the population
  • no apparent dose-response - a minute amount of drug results in response
  • effects not related to pharmacologic activity
  • sensitizing period required b/w 1st and 2nd exposure
  • circulating Abs can be found after 1st exposure
25
Q

pharmacogenetics

A

genetic variation within humans that affects responsiveness to drugs

  • can affect drug target or metabolism of drug
  • can alter both therapeutic and adverse effects
  • can result from polymorphisms in coding and non-coding regions of genes
  • may be the result of SNPs
26
Q

T2HS

A

Ab-dependent cytolytic rxn

  • drug binds to surface component of cell causing the cell to appear foreign (tissue antigens)
  • IgG and IgM Ab’s produced
  • Ab’s activate the complement system
  • cell lysis results
  • blood cells are primary target tissues
  • subsides within months after removal of drug
27
Q

T3HS

A

immune complex formation

  • drug reacts in blood with soluble Ab (IgG)
  • resulting immune complex deposited in vascular endothelium
  • cell mediated immune response (T-cells) causing local inflammation and complement activation
  • serum sickness, hemolysis and allergic nephritis
  • subsides 1-2 weeks after drug is removed
28
Q

T4HS

A

delayed hypersensitivity (cell mediated)

  • hours or days after exposure before rxn occurs
  • mediated by antigen contact with sensitized T cells and macrophages
  • interaction causes release of lymphokines/cytokines
  • subsequent influx of neutrophils and macrophages
  • ex: contact dermatitis with topical drugs
29
Q

idiosyncratic reaction

A
  • a genetically-determined abnormal reactivity to a drug
  • may be extreme sensitivity to low doses or insensitivity to high doses
  • often a difference in drug metabolizing enzymes

now referred to as pharmacogenetics

30
Q

pharmacogenetics

A

genetic variation within humans that affects responsiveness to drugs

  • can affect drug target or metabolism of drug
  • can alter both therapeutic and adverse effects
  • can result from polymorphisms in coding and non-coding regions of genes
  • may be the result of SNPs
31
Q

companion diagnostics

A

a way to ID which patients will benefit from very specific cancer therapies (drugs only work for certain mutations)