Learning Objectives Module 2A, B, C Flashcards

1
Q

ED50

A
  • 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
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2
Q

TD50

A
  • 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
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3
Q

The dose response relationship:

A
  • 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
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4
Q

Onset

A
  • the time it takes to reach the effective dose
  • How fast the drug gets absorbed and enters the blood
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5
Q

Intensity

A
  • how strong the drug is
  • The stronger the intensity the more plasma concentration you will receive with less drug
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6
Q

Duration

A
  • time drug lasts in therapeutic window
  • How strong the bond between drug and receptor is (affinity)
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7
Q

Therapeutic Window (TW)

A
  • 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
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8
Q

Therapeutic range (TR)

A

*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
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9
Q

Therapeutic index (TI)

A

*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

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10
Q

Wide vs narrow TI

A
  • 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
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11
Q

elements of the dosage regimen

A
  • Amount of drug
  • Route of administration
  • Dosing interval
  • Formulation
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12
Q

Determinants of the dosage regimen

A
  1. Activity toxicity
    - Therapeutic window
    - Side effects
    - Toxicity
    - Cp vs response
  2. Pharmacokinetics:
    - Absorption, distribution, metabolism, excretion
  3. Clinical factors
    - State of patient: age, weight, condition, other disease states
    - Management of therapy: multiple drug therapy
    - Convenience of regimen
    - Compliance
  4. Other factors
    - Route of administration
    - Dosage form
    - Tolerance- dependence
    - Pharmacogenetics
    - Drug interactions
    - Cost
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13
Q

Pharmacokinetics:

A

What the body does to the drug

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14
Q

Pharmacodynamics

A

What the drug does to the body

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15
Q

relationship between PK and PD

A

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
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16
Q

Linear PK (pharmacokinetics

A

proportional increase in Cp (drug plasma concentration) with increased dose

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17
Q

Non linear PK

A

disproportional increase of Cp with increased dose (this leads to unpredictable response of a drug

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18
Q

What are the primary PK parameters

A

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

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19
Q

Absorption rate constant (Ka)

A
  • Determined by blood flow at absorption site, gastric emptying, GIT motility
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20
Q

Oral bioavailability

A

Determined by gastric emptying, acid secretion, enzymatic activity, GIT motility

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21
Q

Hepatic clearance (ClH)

A
  • Determined by hepatic blood flow (Qh), binding in blood (Fu(b)), intrinsic clearance (Clint)
  • Liver clearance
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22
Q

Renal Clearance (ClR)

A
  • Determined by renal blood flow (fu(b)), active secretion/ reabsorption, urine pH and flow, glomerular filtration
  • Kidney clearance
23
Q

Volume of distribution (Vd)

A
  • Determined by fu(b), tissue binding, partitioning tissue perfusion, body composition and size,
  • Vd is a characteristic of a drug
  • Affected by physiology
24
Q

What are the secondary PK parameters

A
  1. Elimination half life
  2. Elimination rate constant
  3. fraction excreted unchanged
25
Q

Elimination half life equation

A

T 1/2 = 0.5 0.693 x volume of distribution/ systemic clearance

26
Q

Elimination rate constant

A

K = systemic clearance/ volume of distribution

27
Q

Fraction excreted unchanged

A

Fe= renal clearance/ systemic clearance

28
Q

What are the derived PK parameters

A
  • Area under the curve (IV)
  • Steady state concentration
  • Area under the curve (oral)
  • Average plateau concentration(IV)
  • Tmax,/ Cmax
29
Q

the different transport mechanisms across polarized epithelia

A
  1. Transcellular: through the cell
    i) Paracellular: through tight junctions
    ii) Passive diffusion
  2. Endo/ exocytosis
  3. Carrier mediated
    - Active
    - Facilitated diffusion
30
Q

drug characteristics that determine transport across plasma membranes

A
  • We know what qualities a drug need to undergo passive diffusion (small, non ionized, lipid soluble), passive diffusion is the easiest as it will do it itself
  • Transport it dependent on size, ionization, and solubility of the drug
  • This is why protein binding effects distribution of drugs
31
Q

Explain the fundamental principles of drug action

A

i) Pharmacokinetics
ii) Pharmacodynamics
iii) Pharmacology

32
Q

Pharmacokinetics

A

describes the ADME which bring a drug to the site of action

33
Q

Pharmacodynamics

A

explains the relationship between the drug concentration at the site of action and the response

34
Q

Pharmacology

A
  • explains the general properties of drug receptors and drug-receptor interactions at the basis of drug action
  • The study of what drugs are, what drugs do and how drugs work
  • This is done through chemical processed, mainly through binding to regulatory molecules
  • When they bind to the regulatory molecules they will either activate or inhibit normal body processes
35
Q

Drug (2 types also)

A
  • A chemical that interacts with molecules in the body to affect a physiological function
  • Are promiscuous as they bind to many receptor
    a) Endogenous sources
  • From the body (hormones, neurotransmitters)
  • Anything with activity must bind to a receptor to fulfill its action
    b) Exogenous
  • Not from the body
  • Plants (phytochemicals), marine life, micro-organisms, fungi, synthetic
  • Most of the drugs that are prescribed are synthetic meaning man made
36
Q

Receptor:

A
  • The macromolecule which a drug must bind to have an effect
  • When the drug binds it changes the receptor to cause a biological function
37
Q

inert binding site:

A
  • Molecules to which drug bind but the binding doesn’t cause any change which we can detect in the biologic system
  • Eg. Albumin
38
Q

Affinity:

A

how avidly the drug binds to the receptor (the want for the DR complex)

  • on a graph is also the same as Kd and EC50
39
Q

Capacity:

A

the maximum response that is possible in the body

40
Q

Specificity:

A
  • The ability of drug to produce an action at a specific site
  • Refers to the relative potency (measure of drug activity) of a drug between the receptors of two or more different endogenous binding sites
41
Q

Selectivity:

A
  • Refers to the relative potency of a drug for the receptor subtypes of the same endogenous binding site
  • Eg. Cox-1, cox2
42
Q

Efficacy (intrinsic activity)

A
  • the ability of drug once bound to receptor
43
Q

What is efficacy dependent upon

A

a) Drug receptor coupling
- What type of receptor, what signal transduction goes on, what kind of bonds
- Full agonists usually have stronger bonds
b) Drug concentration
- Concentration range may dictate binding

44
Q

Pharmacophore:

A
  • The critical portion of the drug molecule that participates in the D-R binding
  • Associated with the pharmacological effect
  • The rest of the molecule will then be tweaked to have favourable PK
45
Q

List the broad categories of receptor types

A
  1. Ligand gated ion channel
  2. GPCRs
  3. Kinase
  4. nuclear
46
Q

Ligand gated ion channel

A

responds in milliseconds
- Found on cell membranes
- The channel opens only when a ligand is bound to it which lets ions pass through
- Fastest channels
- Drugs still compete with endogenous ligands

47
Q

G-protein coupled receptor

A

seconds
- A single ligand can produce a large response as these receptors amplify signal transduction
- The duration depends on longevity of GTP binding to the g-protein not the receptors affinity for the ligand
- Found on plasma membranes and over 1000 types so they are grouped

48
Q

Kinase- liked and related receptors

A

hours
- When activated they cause changes in gene expression
- The endogenous ligands include hormones, neurotransmitters, cytokines…
- The ligand binds and this causes a cascade of phosphorylation that leads to changes in gene transcription rates

49
Q

different types of Kinase-linked receptors

A

i. Receptor tyrosine kinases: most common
ii. Receptor serine-threonine kinases
iii. Cytokine receptors

50
Q

Nuclear receptor

A

hours
- Ligand gated transcription factors
- They are intracellular meaning the drug must cross the plasma membrane to interact with either the nucleus or cytoplasm
- When bound it causes changes in gene transcription rates
- Examples that use nuclear receptors are vitamin D, hormones, corticosteroids
- There are 4 subfamilies which are grouped by molecular action

51
Q

Explain the law of mass action

A
  • It describes the drug receptor interaction
  • Describes the equilibrium between the concentration of the reactants (D and R) and the concentration of the drug-receptor complex (D-R)
  • The rate of change of the reactant concentration is directly proportional to the concentration of the reactants in both directions
52
Q

What is K12 vs K21

A

a) The rate where the components associate (K12) depends on the drug and receptor concentrations individually
b) The rate where the D-R complex dissociates (K21) depends on the concentration of the D-R complex

53
Q

If there is a small vs large Kd in relation to affinity

A
  • If have a small Kd then high affinity
  • If high Kd then have a low affinity