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PHARMACODYNAMICS
F A C U L T Y O F P H A RM A C Y
UNIVERSITY OF SANTO TOMAS
DRUG RECEPTORS AND
PHARMACODYNAMICS
PHARMACODYNAMICS
Actions/effects of the drug on the body
Determines the group in which the drug
is classified and plays a major role in
deciding whether a group is appropriate
therapy for particular symptom or disease
DRUG RECEPTORS AND
PHARMACODYNAMICS
RECEPTORS
Specific molecules in a biologic system with
which drugs interact to produce changes in
the function of the system
Determine the quantitative relations
between dose or concentration of drug and
pharmacologic effects
Selective in choosing a drug molecule to
bind to avoid constant activation by
promiscuous binding of many different
molecules
DRUG RECEPTORS AND
PHARMACODYNAMICS
RECEPTORS
Changes its function upon binding in such a
way that the function of the biologic system
is altered in order to have pharmacologic
effect
Selective in ligand-binding characteristics
(respond to proper chemical signals and not to
meaningless ones)
Mediate the actions of both pharmacologic
agonists and antagonists
DRUG RECEPTORS AND
PHARMACODYNAMICS
RECEPTORS
Majority are proteins which provide the
necessary diversity and specificity of shape and
electrical charge
DRUG RECEPTORS AND
PHARMACODYNAMICS
RECEPTORS
RECEPTOR SITE/RECOGNITION SITE
Specific binding region of the
macromolecule
High and selective affinity to the drug
molecule
Interaction between the drug and the
receptor is the fundamental event that
initiates the action of the drug
DRUG RECEPTORS AND
PHARMACODYNAMICS
CLASSIFICATION OF RECEPTORS
1. REGULATORY PROTEINS
2. ENZYMES
3. TRANSPORT PROTEINS
4. STRUCTURAL PROTEINS
DRUG RECEPTORS AND
PHARMACODYNAMICS
CLASSIFICATION OF RECEPTORS
REGULATORY PROTEIN
Best characterized drug receptors
Mediates the action of endogenous
chemical signals like neurotransmitters,
autacoids and hormones
Mediates the effects of the most useful
therapeutic agents
DRUG RECEPTORS AND
PHARMACODYNAMICS
CLASSIFICATION OF RECEPTORS
ENZYMES
Inhibited (or less commonly, activated)
bybinding a drug
E.g. dihydrofolate reductase, the
receptor for methotrexate
TRANSPORT PROTEINS
Eg, Na + /K + ATPase, the membrane
receptor for digitalis
DRUG RECEPTORS AND
PHARMACODYNAMICS
CLASSIFICATION OF RECEPTORS
STRUCTURAL PROTEINS
E.g. tubulin, the receptor for colchicine,
an anti-inflammatory drug
DRUG RECEPTORS AND
PHARMACODYNAMICS
EFFECTORS
Molecules that translate the drug-receptor
interaction into a change in cellular
activity
Eg, adenyl cyclase
Some receptors are also effectors
A single molecule may incorporate both
the drug binding site and the effector
mechanism
DRUG RECEPTORS AND
PHARMACODYNAMICS
DRUG CONCENTRATION
AND RESPONSE
DRUG RECEPTORS AND
PHARMACODYNAMICS
GRADED DOSE-RESPONSE CURVE
Response of a particular receptor-effector
system is measured against increasing
concentration of a drug
Graph of the response versus the drug dose
DRUG RECEPTORS AND
PHARMACODYNAMICS
B max
Total number of
receptor sites
All receptors
have been
occupied
DRUG RECEPTORS AND
PHARMACODYNAMICS
KD
Equilibrium
dissociation constant
Concentration of drug
required to bind 50% of
the receptors
Measure of the affinity
of a drug for its binding
site on the receptor
Smaller K D –greater
affinity of drug to
receptor
DRUG RECEPTORS AND
PHARMACODYNAMICS
A B C
Agonist dose
DRUG RECEPTORS AND
PHARMACODYNAMICS
A B C
Agonist dose
CURVE A
Agonist response in the absence of
antagonist
DRUG RECEPTORS AND
PHARMACODYNAMICS
A B C
Agonist dose
CURVE B
After treatment with low concentration of antagonist,the
curve is shifted to the right
Maximal response is preserved because the
remainingavailable receptors are still in excess
DRUG RECEPTORS AND
PHARMACODYNAMICS
A B C
Agonist dose
CURVE C
Produced after larger concentration of antagonist,
the available receptors are no longer “spare”,
sufficient enough to mediate an undiminished
maximal response
DRUG RECEPTORS AND
PHARMACODYNAMICS
A B C
Agonist dose
CURVE D and E
With higher concentrations of antagonist, reduce the
number of available receptors to the point that maximal
response is diminished
EC 50 may approximate the K D that characterizesthe
binding affinity of the agonist for the receptor
DRUG RECEPTORS AND
PHARMACODYNAMICS
COUPLING
Transduction process between the
occupancy of receptors and production
of specific effect
Highly efficient coupling can be elicited
by a full agonist and spare receptors
DRUG RECEPTORS AND
PHARMACODYNAMICS
SPARE RECEPTORS
Maximal drug response is obtained at less
than maximal occupation of the receptors
Not qualitatively different from nonspare
receptors, not hidden or unavailable
Temporal in character, when occupied, they
can be coupled to respond, there is still
effect
Drugs with low binding affinity for
receptors will be able to produce full
response even at low concentration
DRUG RECEPTORS AND
PHARMACODYNAMICS
SPARE RECEPTORS
Compare concentration for 50% of maximal
effect (EC 50) with concentration for 50%
maximal binding (K D )
K D > EC 50 with spare receptors
Effect of the drug-receptor interaction may
persist for a longer time than the
interaction itself
Actual number of receptors may exceed the
number of effectors available
DRUG RECEPTORS AND
PHARMACODYNAMICS
INERT BINDING SITES
Non-regulatory molecules of the body
Binding with these molecules will result to
no detectable change in the functionof the
biologic system
Buffers the concentration of the drug
Bound drugs do not contribute directly to
the concentration gradient that drives
diffusion
Eg, albumin
DRUG RECEPTORS AND
PHARMACODYNAMICS
AGONIST
Binds to the receptor and directly or
indirectly bring about an effect
Full activation of the effector system
PARTIAL AGONIST
Produces less than the full effect, even
when it has saturated the receptors
Acts as an inhibitor in the presence of a
full agonist
DRUG RECEPTORS AND
PHARMACODYNAMICS
ANTAGONIST
Binds but do not activate the receptors
Blocks or competes with agonist
CLASSIFICATION OF ANTAGONIST
1. Competitive Antagonist
2. Irreversible Antagonist
3. Chemical Antagonist
4. Physiologic Antanogist
DRUG RECEPTORS AND
PHARMACODYNAMICS
COMPETITIVE ANTAGONIST
Competes with agonist receptor
Binds to the receptor reversibly without
activating the effector system
Antagonist increases the agonist
concentration needed for a given degree of
response
Concentration-effect curve is shifted to
higher doses (ie, horizontally to the right
of the dose axis)
Same maximal effect is reached
DRUG RECEPTORS AND
PHARMACODYNAMICS
COMPETITIVE ANTAGONIST
COMPETITIVE ANTAGONIST
2 THERAPEUTIC IMPLICATIONS
(1) Degree of inhibition produced by the
competitive antagonist depends on the
concentration of antagonist (eg, propranolol)
(2) Clinical response to a competitive antagonist
depends on the concentration of agonist that
is competing for binding to the receptor
DRUG RECEPTORS AND
PHARMACODYNAMICS
IRREVERSIBLE ANTAGONIST
Binds with the receptor via covalent bonds
Antagonist’s affinity to the receptor maybe so
high
Receptor is not available to bind the agonist
Duration of action is relatively independent
More dependent on the rate of turnover of
receptors
Eg, phenoxybenzamine binding with alpha
receptors
DRUG RECEPTORS AND
PHARMACODYNAMICS
IRREVERSIBLE ANTAGONIST
Concentration-effect curve moves
downward
No shift of the curve in the dose axis
E max is not reached
No increase in median effective dose
(ED 50 ) unless there are spare receptors
DRUG RECEPTORS AND
PHARMACODYNAMICS
DRUG RECEPTORS AND
PHARMACODYNAMICS
CHEMICAL ANTAGONISM
Does not depend on interaction with the
agonist’s receptor
Drug that interacts directly with the drug
being antagonized to remove it or to
prevent it from reaching its target
Eg, protamine used to counteract the
effect of heparin making it unavailable
for interaction with proteins involved in
the formation of blood
DRUG RECEPTORS AND
PHARMACODYNAMICS
PHYSIOLOGIC ANTAGONISM
Makes use of the regulatory pathway
Effects that are less specific and less easy
to control
Binds to a different receptor producing an
effect opposite to that produced by the drug
it is antagonizing
Examples
Glucocorticoids catabolic effects of increase in sugar
is physiologically opposed by insulin
Histamine causes bronchoconstriction in asthmatic
patients, opposed by bronchodilators like salbutamol
and epinephrine
DRUG RECEPTORS AND
PHARMACODYNAMICS
SIGNALING MECHANISMS
5 BASIC TRANSMEMBRANE SIGNALING
MECHANISMS
(1) Lipid soluble drug crossing the plasma
membrane and acts on intracellular
receptor (eg, steroids)
From: Drug Receptors & Pharmacodynamics
Basic & Clinical Pharmacology, 13e, 2015
Date of download: 2/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved.
DRUG RECEPTORS AND
PHARMACODYNAMICS
SIGNALING MECHANISMS
5 BASIC TRANSMEMBRANE SIGNALING
MECHANISMS
(2) Transmembrane receptor protein-
intracellular enzymatic activity is
regulated by a ligand that binds to
the protein’s extracellular domain
DRUG RECEPTORS AND
PHARMACODYNAMICS
SIGNALING MECHANISMS
5 BASIC TRANSMEMBRANE SIGNALING
MECHANISMS
(3) Transmembrane receptor that binds
and stimulates a protein tyrosine
kinase (eg, insulin)
From: Drug Receptors & Pharmacodynamics
Basic & Clinical Pharmacology, 13e, 2015
Date of download: 2/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved.
DRUG RECEPTORS AND
PHARMACODYNAMICS
SIGNALING MECHANISMS
5 BASIC TRANSMEMBRANE SIGNALING
MECHANISMS
(4) Ligand-gated transmembrane ion
channel which regulates the opening
of the ion channel (eg, GABA, excitatory
acetylcholine)
From: Drug Receptors & Pharmacodynamics
Basic & Clinical Pharmacology, 13e, 2015
Date of download: 2/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved.
DRUG RECEPTORS AND
PHARMACODYNAMICS
SIGNALING MECHANISMS
5 BASIC TRANSMEMBRANE SIGNALING
MECHANISMS
(5) Transmembrane receptor is coupled
with an effector enzyme by G protein
which modulates production of an
intracellular second messenger
[eg, cathecolamine (epinephrine)]
From: Drug Receptors & Pharmacodynamics
Basic & Clinical Pharmacology, 13e, 2015
Date of download: 2/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved.
From: Drug Receptors & Pharmacodynamics
Basic & Clinical Pharmacology, 13e, 2015
Date of download: 2/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved.
DRUG RECEPTORS AND
PHARMACODYNAMICS
INTRACELLULAR 2 ND MESSENGERS
Date of download: 2/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved.
DRUG RECEPTORS AND
PHARMACODYNAMICS
INTRACELLULAR 2 ND MESSENGERS
B. CALCIUM AND PHOSPHOINOSITIDES
Bind to receptors linked to G proteins
while others bind to receptor tyrosine
kinases
Crucial step is the stimulation of
membrane enzyme phospholipase C
From: Drug Receptors & Pharmacodynamics
Basic & Clinical Pharmacology, 13e, 2015
Date of download: 2/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved.
DRUG RECEPTORS AND
PHARMACODYNAMICS
INTRACELLULAR 2 ND MESSENGERS
C. cGMP (Cyclic guanosine monophosphate
Few signaling roles in a few cell types like
the intestinal mucosa and vascular smooth
muscle cells
Causes relaxation of vascular smooth
muscles by a kinase-mediated mechanism
DRUG RECEPTORS AND
PHARMACODYNAMICS
RECEPTOR DESENSITIZATION
Response gradually diminishes even if
thedrug is still there (after reaching an
initial high level of response)
Reason is UNKNOWN
DRUG RECEPTORS AND
PHARMACODYNAMICS
STRUCTURE ACTIVITY
RELATIONSHIP
Cells use more than one signaling
mechanism to respond to the drug
DRUG RECEPTORS AND
PHARMACODYNAMICS
QUANTAL DOSE-RESPONSE CURVE
Graph of the fraction of a population that
shows a specified response to increasing
doses of a drug
DRUG RECEPTORS AND
PHARMACODYNAMICS
POTENCY
Amount of drug needed to produce a
given effect
In the graded dose-response curve, the
effect chosen is the 50% of the maximal
effect and the dose is (EC 50 )
In the quantal dose-response curve,
ED 50 , TD 50 , and LD 50 are variables in
50% of the population
DRUG RECEPTORS AND
PHARMACODYNAMICS
A C D
Log concentration
DRUG RECEPTORS AND
PHARMACODYNAMICS
VARIATION OF RESPONSES IN INDIVIDUALS
IDIOSYNCRATIC RESPONSE
Caused by differences in metabolism (genetic)or
immunologic mechanisms
Response to the drug is unknown or unusual
HYPOREACTIVE RESPONSE
Intensity of the drug is decreased
Large dose of the drug is needed to havean effect
DRUG RECEPTORS AND
PHARMACODYNAMICS
VARIATION OF RESPONSES IN INDIVIDUALS
HYPEREACTIVE RESPONSE
Intensity of the drug is increased or
exaggerated
TOLERANCE
Decreased sensitivity acquired as a
result of exposure to the drug
DRUG RECEPTORS AND
PHARMACODYNAMICS
VARIATION OF RESPONSES IN INDIVIDUALS
TACHYPHYLAXIS
Tolerance develops after a few doses
DRUG RECEPTORS AND
PHARMACODYNAMICS
WHAT TO DO TO AVOID/CIRCUMVENT
TOXIC EFFECTS
Give low doses
Carefully monitor the patient
Employ ancillary procedures
Use a safer drug
DRUG RECEPTORS AND
PHARMACODYNAMICS
HEPARIN
Low doses for prevention of blood clots
Very high doses causes internal bleeding
Monitor PT, PTT and bleeding parameters
STEROIDS
Give lowest dose possible
Give adjunctive drugs
Anatomic selectivity (lungs-by inhalation)
DRUG RECEPTORS AND
PHARMACODYNAMICS
R1 DR 1 X (beneficial)
D +
R2 DR 2 Y (toxic)