Learning Objectives Module 2A, B, C Flashcards
ED50
- The median effective dose
- The dose needed to produce a specific therapeutic response in 50% of patients
- Also referred to as standard or average dose
- ## This dose does not apply to everyone as some patients will respond to lower or higher doses then average
TD50
- Median toxicity dose
- The dose needed to produce a given toxicity in 50% of a group of patients
- Lethal doses observed in preclinical studies (cells and animals as we don’t test the lethal dose in humans)
- We determine this from adverse effects which are reported in clinical trials as toxicities are monitored closely and will happen before death
The dose response relationship:
- Looks at an individuals response to a drug
a) Phase 1: very few target cells have been affected by the drug
b) Phase 2: Shows the linear relationship between amount of drug given and degree of response obtained - Not all drugs have a linear relationship but most do
c) Phase 3: plateau - No further response occurs with a higher dose
- This is as all receptors are occupied so you have already obtained 100% of the indication
- Even though there is no further response there still will be adverse effects and more signs of toxicity
Onset
- the time it takes to reach the effective dose
- How fast the drug gets absorbed and enters the blood
Intensity
- how strong the drug is
- The stronger the intensity the more plasma concentration you will receive with less drug
Duration
- time drug lasts in therapeutic window
- How strong the bond between drug and receptor is (affinity)
Therapeutic Window (TW)
- the range of drug plasma concentration when the drug gives the desired effect with no fear of toxicity
- Based on population as we don’t know the therapeutic window for a specific patient
- There are empirical dosing regimens designed to put the drug Css (steady state) in the therapeutic range
Therapeutic range (TR)
*the range of dose where most of the population will get the desired effect with no fear of toxicity
- Based on population as we don’t know the therapeutic window for a specific patient
- There are empirical dosing regimens designed to put the drug Css (steady state) in the therapeutic range
Therapeutic index (TI)
*The ratio of toxic plasma concentration (Cp) to effective Cp values
tells us how large or small the room we have to “play” with drug dosing
- Compares the amount of drug which causes the indication to the amount which causes toxicity
- A ratio and has no units
Wide vs narrow TI
- The ratio of toxic plasma concentration (Cp) to effective Cp values
- Compares the amount of drug which causes the indication to the amount which causes toxicity
- A ratio and has no units
a) Wide TI; safe, regular monitoring unnecessary - The ratio of toxic Cp to effective Cp is large
b) Narrow TI: not very safe and drug monitoring is necessary for safety - The ratio of toxic Cp to effective Cp is small and toxicity could come when indication occurs
elements of the dosage regimen
- Amount of drug
- Route of administration
- Dosing interval
- Formulation
Determinants of the dosage regimen
- Activity toxicity
- Therapeutic window
- Side effects
- Toxicity
- Cp vs response - Pharmacokinetics:
- Absorption, distribution, metabolism, excretion - Clinical factors
- State of patient: age, weight, condition, other disease states
- Management of therapy: multiple drug therapy
- Convenience of regimen
- Compliance - Other factors
- Route of administration
- Dosage form
- Tolerance- dependence
- Pharmacogenetics
- Drug interactions
- Cost
Pharmacokinetics:
What the body does to the drug
Pharmacodynamics
What the drug does to the body
relationship between PK and PD
PD couldn’t happen without PK and it can happen anywhere in the table but usually during the distribution phase
- PK is everything before the drug receptor interactions an PD is anything during and after
Linear PK (pharmacokinetics
proportional increase in Cp (drug plasma concentration) with increased dose
Non linear PK
disproportional increase of Cp with increased dose (this leads to unpredictable response of a drug
What are the primary PK parameters
determined by physiology/ dont change with the dose of the drug
1. Absorption rate constant (Ka)
2. Oral bioavailability
3. Hepatic clearance
4. Renal clearance
5. Volume of distribution
Absorption rate constant (Ka)
- Determined by blood flow at absorption site, gastric emptying, GIT motility
Oral bioavailability
Determined by gastric emptying, acid secretion, enzymatic activity, GIT motility
Hepatic clearance (ClH)
- Determined by hepatic blood flow (Qh), binding in blood (Fu(b)), intrinsic clearance (Clint)
- Liver clearance