Introduction

Pharmacodynamics ▷ 2 Pharmacodynamics
Pharmacokinetics
Drug 2.1 General principles of drug action
metabolism
Theory of drug-receptor interaction
G protein-
coupled The two-state model of receptor activation
receptors Dose-effect relationships and their modulation
Pharmacology by signaling cascades
of cell Potency, efficacy, and therapeutic index
excitation
Hormones Drugs act on many different targets and in diverse
ways. Nevertheless, there are some general principles
Pharmacology
of nitric oxide of drug action that are applicable to many drugs;
these are the subject of pharmacodynamics. In this
Eicosanoids
chapter, we are going to cover the following concepts:
and related
drugs
2.1.1 The invention of the receptor concept
Intermediate
metabolism,
diabetes, and
atherosclerosis
Chemotherapy
of infectious
diseases
Cancer
chemotherapy
Ribonucleic
acids as drugs
and drug
targets In this excerpt from his Nobel lecture [4], Paul Ehrlich
develops the idea of receptor blockade. Although this
Drug delivery
concept is viable and important, it does not account
Drug discovery
for the effect of tetanus toxin. Instead, tetanus toxin
Credits and is a protease that cleaves synaptobrevin, an
copyright intracellular protein that is important for
Notes neurotransmitter exocytosis (see slide 6.9.1).
References
The receptor concept is fundamental to pharmacology.
Glossary As stated above, most receptors are protein
Index molecules; in this chapter, we will confine the
Site search discussion to this case.
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2.1.2 How do drugs affect their receptors?
 Mode of binding: reversible vs. irreversible
Introduction
Binding site: orthosteric vs. allosteric
Pharmacodynamics ▷ Functional effect: activation vs. inhibition
Pharmacokinetics Most drugs bind their targets reversibly and non-
Drug covalently, but some important exceptions exist.
metabolism Furthermore, binding is orthosteric in most cases,
G protein- which means that the drug binds to the receptor
coupled within the same site as the receptor’s physiological
receptors ligand. For example, all of the antagonists of
Pharmacology histamine and angiotensin that were discussed in
of cell slides 1.2.3–1.2.8 bind orthosterically. This mode of
excitation binding implies that the receptor can not bind its
Hormones physiological ligand and the drug at the same time; if
Pharmacology both are present, they will compete for the same
of nitric oxide binding sites. Allosteric binding occurs with
Eicosanoids benzodiazepines, barbituric acid derivatives and
and related several other ligands of the GABAA receptor in the
drugs brain (see slide 6.10.8).
Intermediate A drug that activates its receptor is referred to as an
metabolism,
agonist, whereas an inhibitory drug is also called an
diabetes, and
atherosclerosis antagonist. Drugs that target enzymes are virtually
always antagonists, while with hormone and
Chemotherapy
neurotransmitter receptors there usually are both
of infectious
diseases agonistic and antagonistic drugs. Where this is the
case, only one or the other may have therapeutic
Cancer
chemotherapy value; for example, with histamine receptors, only
antagonists are clinically useful.
Ribonucleic
acids as drugs
and drug 2.1.3 Labetalol as an example of
targets stereoselective drug action
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
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As with
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selectivity of receptors and drugs is based to a great
 extent on the “lock and key” principle, that is, on
Introduction
steric complementarity. Like enzyme substrates, many
Pharmacodynamics ▷ drug molecules are chiral, which means that they
occur as R and S (or and ) enantiomers. Since
Pharmacokinetics proteins consist of -amino acids only, they are also
Drug chiral molecules. Therefore, we should expect protein
metabolism receptors to interact with drugs in an enantioselective
G protein- manner. This is indeed the case; a good example of
coupled this is the drug labetalol.
receptors
Labetalol, an α- and β-adrenergic receptor antagonist,
Pharmacology
of cell is a racemic mixture of four stereoisomers. The R,R
excitation isomer carries most of the β-adrenergic blocking
Hormones activity, whereas the S,R isomer carries most of the α-
blocking activity. The R,S and S,S isomers are dead
Pharmacology
freight.
of nitric oxide
Eicosanoids Many drugs occur as racemic mixtures, and as with
and related labetalol the isomers will often differ in specificity and
drugs activity. Ideally, one would purify the isomer that has
Intermediate useful pharmacological activity, and remove others
metabolism, that are inactive and might only contribute to toxicity.
diabetes, and However, in practice, this purification may be difficult
atherosclerosis and costly, and it is usually done only where necessary
Chemotherapy to avoid significant drug toxicity.
of infectious
diseases
2.1.4 Two natural stereoisomers with separate
Cancer therapeutic uses
chemotherapy
Ribonucleic
acids as drugs
and drug
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References Both quinine and quinidine are obtained from the bark
Glossary of the Cinchona tree. Quinine is used against malaria;
Index its mechanism of action is believed to resemble that of
chloroquine (slide 11.9.1).
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 Quinidine also has some antimalarial activity, but is
Introduction
used in clinical medicine for its inhibitory effect on
Pharmacodynamics ▷ sodium channels in the heart, which is useful in
certain types of cardiac arrhythmias.
Pharmacokinetics
Drug
metabolism 2.2 Mass-action kinetics in drug-
receptor interaction
G protein-
coupled
receptors Both in its assumptions and its conclusions, the theory
of drug-receptor interaction is quite similar to enzyme
Pharmacology
kinetics, and it might be a good idea to dust off your
of cell
excitation biochemistry textbook to refresh your memory on that
subject.
Hormones
Pharmacology
2.2.1 Mass action kinetics and receptor
of nitric oxide
occupancy
Eicosanoids
and related [L][Rfree ]

drugs K = [LR]

Intermediate
metabolism,
[LR] [L]
Receptor occupancy = Y = =
diabetes, and [Rtotal ] [L]+K

atherosclerosis
The law of mass action represents the simplest
Chemotherapy
possible case, but nevertheless an experimentally
of infectious
diseases important one. The key parameter here is the receptor
occupancy, that is, the fraction of receptor that is
Cancer
chemotherapy bound to the ligand and therefore subject to the
ligand’s functional effect. The second equation
Ribonucleic
assumes that the ligand is present in excess over the
acids as drugs
and drug receptor, which is almost always the case.
targets
Drug delivery 2.2.2 Linear and semi-logarithmic plots of
receptor occupancy
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
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 Receptor saturation, as a function of ligand
Introduction
concentration, can be plotted in various formats. The
Pharmacodynamics ▷ linear plot shows that, at ligand concentrations well
below the dissociation constant, receptor saturation
Pharmacokinetics increases in an approximately linear fashion. At
Drug concentrations significantly greater than the
metabolism dissociation constant, it approaches saturation and
G protein- changes very little.
coupled
receptors An advantage of the linear plot is freedom from
distortion. However, it is not good at covering a wide
Pharmacology
of cell range of ligand concentrations or affinities, which is
excitation often required for comparing different ligands in the
same plot. For this purpose, a semi-logarithmic plot—
Hormones
with a logarithmic scale for the ligand concentration—
Pharmacology is more convenient. In such a plot, all curves that
of nitric oxide
obey mass-action kinetics are transformed into the
Eicosanoids same sigmoidal shape. The inflection point of each
and related
curve is at Y=0.5 and gives the dissociation constant;
drugs
the horizontal offset between two curves represents
Intermediate the difference in affinity. We will mostly use this plot
metabolism,
format in the following.
diabetes, and
atherosclerosis
2.2.3 The Scatchard plot
Chemotherapy
of infectious
diseases
Cancer
chemotherapy
Ribonucleic
acids as drugs
and drug
targets
Drug delivery
Drug discovery
Credits and The Scatchard plot is another way to depict the
copyright binding of ligands to receptors. In order to construct
Notes this plot, the concentrations of both receptor-bound
References ligand and free ligand are measured, and the ratio of
bound to free ligand is plotted against the
Glossary
concentration of bound ligand.
Index
It is easy to show that, if all drug molecules bind to a
Site search
single class of receptors with uniform affinity, all data
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points will fall on a straight line. Therefore, if the
 plotted line is not straight, this suggests that the
Introduction
binding sites are inhomogeneous and vary in affinity.
Pharmacodynamics ▷ Note, however, that this requires ligand binding to
follow simple mass action kinetics, which is not always
Pharmacokinetics the case (see slide 2.5.1).
Drug
metabolism Also note that the Scatchard analysis does not assume
that the concentration of the ligand always exceeds
G protein-
that of the receptor—in fact, some of the data points
coupled
receptors in the curve must be obtained at limiting ligand
concentrations; otherwise, the y coordinate would be
Pharmacology
of cell very low for all data points. This is usually
excitation accomplished by the use of radioactively labeled drug
molecules, which can be measured accurately at such
Hormones
low concentrations.
Pharmacology
of nitric oxide
Eicosanoids 2.3 Reversible and covalent receptor
and related inhibition
drugs
Intermediate
metabolism,
diabetes, and
atherosclerosis
Chemotherapy
of infectious
diseases
Cancer
chemotherapy
Ribonucleic
acids as drugs
and drug
targets As pointed out above, most drugs bind their targets
orthosterically, that is, they dislodge some
Drug delivery
physiological agonist—such as histamine or
Drug discovery angiotensin—from its receptor. If such a drug does not
Credits and itself activate the receptor, this will cause inhibition.
copyright
A drug may bind either noncovalently and reversibly,
Notes
or covalently and irreversibly.7 It turns out that the
References two cases affect the receptor quite differently: With a
Glossary reversible inhibitor, the receptor saturation curve for
Index the physiological agonist is shifted to the right, while
Site search with a covalent inhibitor it is vertically compressed.
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2.3.1 Theory of competitive inhibition
 Introduction

Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors
Pharmacology Competitive inhibition occurs when a physiological
of cell
agonist and an inhibitory drug bind reversibly to the
excitation
same binding site on their receptor. The two binding
Hormones equilibria are linked by the free receptor, which can
Pharmacology only engage in one reaction at any time.
of nitric oxide
Let KL and KI be the dissociation constants that govern
Eicosanoids
and related binding of the physiological agonist and the inhibitor,
drugs respectively. Then, if the concentration of the inhibitor
[I] is fixed, we can comprise the entire term KL(1 +
Intermediate
metabolism, [I]/KI) into a single number, K′. Since K′ is necessarily
diabetes, and greater than KL, the resulting curve in the
atherosclerosis semilogarithmic plot is shifted to the right relative to
Chemotherapy the situation without inhibitor, as illustrated in slide
of infectious 2.3.
diseases
Try to derive this equation on a rainy day—it’s all basic
Cancer
chemotherapy high school math. You’ll be glad you did!8

Ribonucleic
acids as drugs 2.3.2 Theory of irreversible or covalent
and drug inhibition
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
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 Introduction

Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors
Pharmacology
of cell
excitation
Hormones
Pharmacology With a drug that inhibits its receptor through covalent
of nitric oxide reaction, it is not as easy to predict the exact extent
Eicosanoids to which the receptor will be altered by the drug.
and related However, after sufficient time, most of the drug will
drugs have been inactivated or eliminated in some way, and
Intermediate the fraction of inhibitor-bound receptor [RI] will no
metabolism, longer change.9 The complementary fraction of
diabetes, and unmodified receptor will continue to bind the agonist
atherosclerosis
at equilibrium, governed by KL.
Chemotherapy
of infectious If you compare the second equation to the one given
diseases in slide 2.2.1, you will see that irreversible inhibition
Cancer causes a vertical compression of the simple mass
chemotherapy action receptor saturation curve, again as illustrated in
Ribonucleic slide 2.3.
acids as drugs
and drug 2.3.3 Two inhibitors of α-adrenergic receptors
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
Site search As an experimental example of competitive and
covalent inhibition, we will compare two inhibitors of
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α-adrenergic receptors. These receptors, which are
 activated by the catecholamine hormones epinephrine
Introduction
and norepinephrine, are found on different cell types.
Pharmacodynamics ▷ On smooth muscle cells, α receptor activation raises
the cytoplasmic calcium concentration, which results
Pharmacokinetics in muscle cell contraction.
Drug
metabolism This slide shows the structures of the physiological
agonist norepinephrine, and of the two antagonists
G protein-
tolazoline and phenoxybenzamine.
coupled
receptors
Pharmacology 2.3.4 Inhibition of spleen strip contraction by
of cell tolazoline and phenoxybenzamine
excitation
Hormones
Pharmacology
of nitric oxide
Eicosanoids
and related
drugs
Intermediate
metabolism,
diabetes, and The effect of tolazoline and phenoxybenzamine on α-
atherosclerosis adrenergic receptors can be observed in spleen strips.
Chemotherapy The spleen is like a large sponge that is soaked with
of infectious blood. Contraction of smooth muscle cells embedded
diseases in the spleen tissue will squeeze out the blood and
Cancer inject it into the circulation. This contraction is
chemotherapy triggered by epinephrine or norepinephrine.
Ribonucleic
The graphs shown here are replotted from original
acids as drugs
and drug data in [5]. In the experiment, spleen strips were
targets placed between two elastic hooks, bathed in
norepinephrine with or without added inhibitor, and
Drug delivery
the resulting contractile force was measured. If one
Drug discovery compares these experimental curves to the theoretical
Credits and ones shown in slide 2.3, it is pretty clear which
copyright inhibitor binds to the receptor reversibly, and which
Notes one acts irreversibly.
References
Glossary 2.3.5 Mechanism of covalent receptor blockade
by phenoxybenzamine
Index
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 Introduction

Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors Phenoxybenzamine has a benzylamine moiety that
Pharmacology structurally resembles the catecholamines and
of cell facilitates its initial, noncovalent binding to the
excitation
receptor. This sets the stage for the subsequent
Hormones covalent reaction, which is brought about by the
Pharmacology chloroethyl group. This group undergoes spontaneous
of nitric oxide cyclization to the aziridine derivative, which then
Eicosanoids reacts covalently with a cysteine residue in the
and related receptor.
drugs
Antagonists of α-adrenergic receptors cause smooth
Intermediate
muscle relaxation not only in the spleen but in the
metabolism,
diabetes, and vascular system in general, and they are useful in the
atherosclerosis treatment of arterial hypertension. Competitive
antagonists such as tolazoline are more widely used
Chemotherapy
of infectious for this purpose than covalent ones like
diseases phenoxybenzamine. However, phenoxybenzamine is
Cancer useful in pheochromocytoma, which is a tumor of the
chemotherapy adrenal gland that produces excessive amounts of
epinephrine and norepinephrine. These high amounts
Ribonucleic
acids as drugs of hormones could overrule competitive inhibitors, but
and drug they will not overcome the irreversible inhibition
targets exercised by phenoxybenzamine.
Drug delivery
Drug discovery 2.4 The two-state model of receptor
Credits and activation
copyright
Notes
References
Glossary
Index
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 Mass-action theory is good enough for competitive
Introduction
inhibition; however, it cannot explain how agonistic
Pharmacodynamics ▷ drugs (or physiological ligands) might activate their
receptors. The simplest theory to account for receptor
Pharmacokinetics activation assumes that a receptor occurs in exactly
Drug two conformational states. In one state, the receptor
metabolism is active, for example because this conformation can
G protein- bind some adapter protein that triggers the
coupled downstream effect; in the other conformation, it is
receptors inactive.
Pharmacology
of cell The two conformations are at equilibrium. With most
excitation receptors, this intrinsic equilibrium favors the inactive
conformation; therefore, in the absence of ligands,
Hormones
receptors tend to be inactive. However, the equilibrium
Pharmacology will be shifted by ligands that preferentially bind to
of nitric oxide
one or the other conformation.
Eicosanoids
and related
drugs 2.4.1 Agonist behavior in the two-state model

Intermediate
metabolism,
diabetes, and
atherosclerosis
Chemotherapy
of infectious
diseases
Cancer In the two-state model, an agonist is a ligand that
chemotherapy
binds selectively to the active receptor conformation.
Ribonucleic The free energy released by binding will trap a fraction
acids as drugs of the receptor molecules in the active state; only the
and drug
residual fraction of unbound receptor will continue to
targets
equilibrate between the active and the inactive
Drug delivery conformation.
Drug discovery
Note that, if the affinity of the drug for the inactive
Credits and
conformation is indeed zero, the active fraction of the
copyright
receptor will slightly exceed the ligand-bound fraction.
Notes Such a drug is referred to as a full agonist.
References
Glossary 2.4.2 Antagonists and partial agonists
Index
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 Introduction

Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors
Pharmacology
of cell
excitation
Hormones After the foregoing, it will not surprise you to hear
Pharmacology that the two-state model explains the effect of
of nitric oxide antagonists by assuming that they bind selectively to
Eicosanoids the inactive receptor conformation. In principle, the
and related receptor equilibrium will then be shifted toward this
drugs conformation; however, a decreased receptor activity
Intermediate can only be observed if the receptor in question had
metabolism, measurable activity in the unbound state. Antagonists
diabetes, and that measurably decrease spontaneous receptor
atherosclerosis activity are also referred to as inverse agonists.
Chemotherapy
of infectious An interesting case are the partial agonists, which bind
diseases to both the inactive and the active states. In order to
achieve partial activation, that is, to shift the receptor
Cancer
chemotherapy equilibrium toward the active state, the drug’s affinity
for the active state has to be greater than that for the
Ribonucleic
acids as drugs inactive state.
and drug A drug with exactly equal affinities for the active and
targets
the inactive state would not shift the conformational
Drug delivery equilibrium at all, and therefore on its own would not
Drug discovery change receptor activity. Nevertheless, such drugs are
Credits and referred to as neutral antagonists; presumably, this is
copyright because an antagonistic effect will result when such a
Notes drug is applied together with an agonist. Neutral
antagonism would seem to be mostly a theoretical
References
case; it is very unlikely that a compound would bind
Glossary the two different conformations with exactly the same
Index affinity.
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2.4.3
Loading [MathJax]/extensions/MathMenu.js Dose-effect curves in the two-state model
 Introduction

Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors
This slide shows numerical examples for receptor
Pharmacology active fraction as a function of ligand concentration,
of cell
for various types of ligands. Each curve represents a
excitation
different set of values for KA and KI. However, all
Hormones
combinations have been adjusted so as to correspond
Pharmacology to the same receptor saturation curve (Y; dashed red
of nitric oxide line).
Eicosanoids
and related At the left end of the x axis, the receptor saturation is
drugs negligible, and the y axis intercepts of the other
Intermediate curves reflect the fraction of the receptor that is in the
metabolism, active conformation due to its intrinsic conformational
diabetes, and equilibrium. This fraction was arbitrarily set to 0.2,10
atherosclerosis which is higher than observed with most real-life
Chemotherapy receptors. This choice was made to more clearly
of infectious distinguish all the curves for the different ligands from
diseases one another and from the receptor occupancy.
Cancer
chemotherapy 2.4.4 Application of the two-state model:
Ribonucleic Effects of aripiprazole on serotonin and
acids as drugs dopamine receptors
and drug
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index Earlier, we noted that receptors for a given hormone
Site search or neurotransmitter may occur in multiple variants
(see slide 1.2.3). A drug may bind to more than one
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receptor variant. Where this is the case, the two-state
 model allows that a drug may be an agonist on one
Introduction
receptor variant, yet an antagonist at another. Such
Pharmacodynamics ▷ behavior is indeed observed with the antipsychotic
drug aripiprazole, which binds to various serotonin (5-
Pharmacokinetics hydroxytryptamine, 5-HT) receptors and also to
Drug several dopamine (D) receptors.
metabolism
In this slide, which shows data replotted from [6], it
G protein-
can be seen that aripiprazole increases the activity of
coupled
receptors the 5-HT1A receptor subtype, but to a lesser extent
than serotonin does; it therefore is a partial agonist at
Pharmacology
of cell this receptor. In contrast, at the 5-HT2B receptor,
excitation aripiprazole is an inverse agonist. It also inhibits the
Hormones dopamine D2L receptor. Since this receptor has no
detectable basal activity, it cannot be discerned
Pharmacology
whether aripiprazole is a neutral antagonist or an
of nitric oxide
inverse agonist at this receptor.
Eicosanoids
and related
drugs 2.5 Beyond the two-state model
Intermediate
metabolism, As we have just seen, the two-state model can
diabetes, and account for a fair variety of experimental observations,
atherosclerosis and accordingly it is widely used in the scientific
Chemotherapy literature. However, some observations cannot be
of infectious explained within this model’s rules.
diseases
Cancer 2.5.1 Cooperative behavior of oligomeric
chemotherapy receptors
Ribonucleic
acids as drugs
and drug
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
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 Introduction

Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors
Pharmacology
of cell
excitation
Hormones
Pharmacology
of nitric oxide
Eicosanoids The two-state model assumes mass-action equilibrium
and related for ligand binding to both the active and the inactive
drugs
state. However, oligomeric receptors often bind their
Intermediate ligands cooperatively. In such receptors, individual
metabolism, subunits may still bind the ligand according to mass-
diabetes, and
action kinetics. However, the subunits are not free to
atherosclerosis
change their conformation individually; instead, the
Chemotherapy
transitions of all subunits are tied together and occur
of infectious
diseases in concert. This changes the shape of both receptor
activity and ligand saturation curves, such that they
Cancer
become steeper and sharper than those of comparable
chemotherapy
single-subunit receptors.11
Ribonucleic
acids as drugs This slide illustrates a hypothetical receptor that
and drug contains three subunits and one that has only a single
targets subunit. The equilibrium constants—Kintr, Ka and Ki—
Drug delivery are assumed to be the same for each receptor
Drug discovery subunit, regardless of subunit stoichiometry. In the
Credits and trimeric receptor, partial conformational changes are
copyright forbidden; all subunits change conformation
simultaneously, regardless of saturation with ligand.
Notes
References
2.5.2 Effect of cooperativity on receptor activity
Glossary
Index
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 Introduction

Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein- This slide illustrates hypothetical dose-response curves
coupled for the two receptors shown in the previous slide. The
receptors
value of Kintr (1/3) was chosen to favor the inactive
Pharmacology conformation only slightly. In addition, the values of
of cell
Ka and Ki were chosen so as to make the ligand a
excitation
partial agonist. With these parameters, the active
Hormones
fraction of the monomeric receptor (left, n=1) shows a
Pharmacology rather shallow response to the ligand.
of nitric oxide
In the trimeric receptor, all the equilibrium constants
Eicosanoids
and related have been retained; the only change is that the
drugs conformational transitions of all three subunits must
Intermediate now occur in unison. This single change suffices to
metabolism, make the transition from the inactive to the active
diabetes, and state much steeper and more decisive. A steeper
atherosclerosis transition is also evident in the receptor saturation
Chemotherapy curve (right).
of infectious
diseases What this amounts to is that cooperative receptors
have a better signal-to-noise ratio than monomeric
Cancer
receptors. This is an important advantage in cellular
chemotherapy
signal processing.
Ribonucleic
acids as drugs
and drug 2.5.3 Agonist-specific coupling
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
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 Some receptors couple to more than one adapter
Introduction
protein; the latter can initiate separate signaling
Pharmacodynamics ▷ cascades inside the cell. With such receptors, it is
sometimes observed that a drug activates one of
Pharmacokinetics these downstream cascades more strongly than the
Drug other. This effect is referred to as agonist-specific
metabolism coupling or stimulus trafficking.
G protein-
To understand agonist-specific coupling, one has to
coupled
receptors assume the existence of more than one active
receptor conformation. Agonist-specific coupling
Pharmacology
of cell therefore cannot be accounted for within the confines
excitation of the two-state model.
Hormones
2.5.4 Experimental example: Agonist-specific
Pharmacology coupling of 5-HT2 receptors
of nitric oxide
Eicosanoids
and related
drugs
Intermediate
metabolism,
diabetes, and
atherosclerosis
Chemotherapy
of infectious
diseases
Cancer
chemotherapy
Ribonucleic
acids as drugs
and drug
targets
Drug delivery The 5-HT2 serotonin receptor subtype binds two
Drug discovery different G proteins. The first one, Gαq, activates
Credits and phospholipase C (PLC), which releases inositol-
copyright triphosphate; the second one, Gα12, activates
Notes phospholipase A2 (PLA2), which releases arachidonic
acid.
References
Glossary Two agonists were compared to serotonin with respect
to the activation of PLC and of PLA2. TFMPP (3-
Index
Trifluoromethylphenylpiperazine) resembles serotonin
Site search
with respect to PLC activation, but it activates PLA2 to
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a lower degree. Conversely, DOI (1-[2,5-dimethoxy-4-
 iodophenyl]-2-aminopropane) shows the opposite
Introduction
behavior. Figure prepared from original data in [7].
Pharmacodynamics ▷
2.5.5 Some receptors have refractory states
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors
Pharmacology
of cell
excitation
Hormones
Pharmacology
of nitric oxide
Eicosanoids
and related
drugs
Intermediate
metabolism,
diabetes, and
atherosclerosis So far, all receptors—whether or not they comply with
the two-state model—were assumed to freely go back
Chemotherapy
of infectious and forth between active and inactive conformations.
diseases However, in some receptors, another functional state
exists in which the receptor is functionally inactive and
Cancer
chemotherapy at the same time not amenable to activation.

Ribonucleic One receptor that can assume such a refractory state

acids as drugs is the nicotinic acetylcholine receptor. This receptor, a
and drug ligand-gated ion channel, is activated (opened) by
targets
binding of acetylcholine. While still bound to the
Drug delivery ligand, the receptor transitions from the active (open)
Drug discovery state to its refractory state. As in the inactive state,
Credits and the channel is now closed; however, since
copyright acetylcholine remains bound, it cannot be activated
Notes again directly. Only once acetylcholine dissociates is
the receptor free to revert to the proper inactive state,
References
in which it is once more susceptible to activation (see
Glossary slide 6.10.6).
Index
Obviously, the existence of such a third functional
Site search receptor state is incompatible with the two-state
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model.
 Introduction
2.6 Dose-effect relationships in
biochemical cascades
Pharmacodynamics ▷
Pharmacokinetics
Drug
metabolism
G protein-
coupled
receptors
Pharmacology
of cell
excitation
Hormones
Pharmacology
of nitric oxide In the nicotinic acetylcholine receptor, it is possible to
observe both the binding of a ligand and its functional
Eicosanoids
and related effect—namely, the conductivity of the closed or open
drugs channel—in the same molecule. However, very often,
Intermediate the functional response is observed not in the receptor
metabolism, itself but a good way downstream of it. An example is
diabetes, and the contraction of smooth muscle cells induced by
atherosclerosis norepinephrine (see slide 2.3.4). Here, receptor
Chemotherapy activation triggers a lengthy biochemical cascade that
of infectious involves phospholipase C activation, calcium release,
diseases calmodulin activation, and protein phosphorylation.
Cancer
If we observe the effect of a drug on its receptor
chemotherapy
downstream of such a biochemical cascade, the latter
Ribonucleic can significantly affect the shape of the measured
acids as drugs
dose-response curves. To better understand this
and drug
targets effect, we will consider a simple model cascade, which
is shown on the right hand side of this slide. It
Drug delivery
consists of a receptor R, a second messenger M2, and
Drug discovery an effector E. The following quantitative assumptions
Credits and were made:12
copyright
Notes 1. Binding of receptor ligand (L) to the receptor, as
well as of M2 to the effector, conforms to mass
References
action kinetics. Additionally, the receptor is
Glossary assumed to conform to the two-state model.
Index 2. The strength of the functional effect—that is, the
Site search response parameter that is plotted along the y
axis in a dose-response curve—is proportional to
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the saturation of E with M2.
 3. The rate of inactivation of M2 by M2-ase is
Introduction
assumed to be of first order with respect to the
Pharmacodynamics ▷ concentration of M2.

Pharmacokinetics The next slide illustrates the consequences of these

Drug assumptions, using some arbitrarily chosen numerical
metabolism values for the various parameters of the model.
G protein-
coupled 2.6.1 The response of a biochemical cascade
receptors depends on receptor density
Pharmacology
of cell
excitation
Hormones
Pharmacology
of nitric oxide
Eicosanoids
and related
drugs
Intermediate
metabolism, The curves in this graph characterize the behavior of
diabetes, and the hypothetical cascade described in the preceding
atherosclerosis
slide. The dashed curve shows the active fraction (fA)
Chemotherapy of the receptor (R), and the solid curves measure the
of infectious
activity of the effector (E), for different densities of
diseases
receptor (Rtotal) as indicated. We can make several
Cancer
observations:
chemotherapy
Ribonucleic 1. The ligand is a partial agonist, since fA maxes out
acids as drugs significantly below 1. Note also that fA itself does
and drug not change with receptor abundance; therefore,
targets
the same fA curve applies to each of the dose-
Drug delivery effect curves.
Drug discovery 2. The maximal receptor response increases with
Credits and increasing receptor abundance, ultimately
copyright approaching 1. Therefore, the ligand, which
Notes remains a partial agonist with respect to the
receptor, behaves as a full agonist with respect to
References
the downstream response when the receptor
Glossary
density is sufficiently high.
Index 3. At higher receptor densities, the dose-response
Site search curve also shifts significantly to the left—the
effector is already going strong before the
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receptor even gets out of bed!
 4. At the highest receptor abundance, the functional
Introduction
response observed without any ligand also
Pharmacodynamics ▷ becomes noticeable. This is due to our
assumption of receptor two-state behavior; with a
Pharmacokinetics large enough number of receptor molecules, the
Drug small fraction of spontaneously active ones begins
metabolism to make an impact.
G protein-
coupled Cascade effects such as the one modeled here are
receptors readily observed in vivo. For example, the contractile
force of the heart can be stimulated through β-
Pharmacology
of cell adrenergic receptors. A half-maximal response can be
excitation obtained with just 2% of receptor saturation, and the
response will be maximal long before the receptor
Hormones
becomes saturated [9].
Pharmacology
of nitric oxide Greater than physiological receptor density is often
Eicosanoids attained when receptors are expressed in cell culture
and related for in vitro studies. We can expect the dose-response
drugs curves in such systems to be higher and left-shifted
Intermediate from those that would be observed in vivo.
metabolism,
diabetes, and The opposite effect—namely, right-shifted and
atherosclerosis vertically depressed curves—can be expected when
the receptor density is artificially reduced. This is
Chemotherapy
of infectious exactly what we noted earlier with the gradual
diseases depletion of α-adrenergic receptors with
Cancer phenoxybenzamine (see slide 2.3.4).
chemotherapy
Ribonucleic 2.7 Potency and efficacy
acids as drugs
and drug
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
Site search This slide introduces two basic concepts that are
frequently used in the characterization of drug activity.
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The efficacy of a drug is the maximal strength of its
 effect; therefore, the efficacy of Red forte™ exceeds
Introduction
that of Blue mite©.
Pharmacodynamics ▷ The potency is defined as the inverse of a drug’s EC50,
Pharmacokinetics which in turn is the concentration at which the drug
Drug exhibits 50% of its maximal effect. In our example,
metabolism the potency of Blue mite© exceeds that of Red forte™.
G protein-
coupled 2.8 Therapeutic and toxic drug effects
receptors
Pharmacology
of cell
excitation
Hormones
Pharmacology
of nitric oxide
Eicosanoids
and related
drugs
Intermediate
metabolism,
diabetes, and
atherosclerosis Most drugs exercise not only beneficial but also toxic
Chemotherapy effects. The two effects may be related in different
of infectious ways. Toxicity may arise as an extension of the
diseases beneficial effect and be unseparable from it (top). For
Cancer example, barbituric acid derivatives exercise a useful
chemotherapy hypnotic effect but become narcotic and finally lethal
with increasing dosage; all of these effects arise from
Ribonucleic
acids as drugs activation of the GABAA receptor in the brain. Such
and drug drugs tend to have a low therapeutic index or
targets therapeutic range, which means a low ratio of toxic
Drug delivery over therapeutic concentration.
Drug discovery At the other end of the scale (bottom), toxicity and
Credits and benefit arise downstream of entirely separate
copyright receptors, both of which are activated by the same
Notes drug. In this case, it is desirable to develop a drug
with specificity for the receptor that mediates the
References
beneficial effect; we have already discussed the
Glossary
histamine H2 receptor antagonists as an example.
Index
Finally, it is also possible that benefit and toxicity arise
Site search
downstream of the same receptor, but that their
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respective signaling chains diverge at some point
 upstream of the ultimate effector molecules (middle).
Introduction
In such cases, it may be possible to avoid toxicity by
Pharmacodynamics ▷ developing drugs that act downstream of the
branching point.
Pharmacokinetics
An example of this latter case is provided by
Drug
metabolism antagonists of the nicotinic acetylcholine receptor.
These drugs reduce blood pressure and have been
G protein-
used in the past to treat hypertension. However, since
coupled
receptors they inhibit both the sympathetic and the
parasympathetic nervous system (see slide 6.13.2),
Pharmacology
of cell they are prone to side effects. Drugs that act
excitation specifically on downstream receptors, such as the
adrenergic receptors of the sympathetic nervous
Hormones
system, have better selectivity and fewer side effects.
Pharmacology
of nitric oxide This figure was adapted from one found in [10].
Eicosanoids
and related
drugs
Intermediate
metabolism,
diabetes, and
atherosclerosis
Chemotherapy
of infectious
diseases
Cancer
chemotherapy
Ribonucleic
acids as drugs
and drug
targets
Drug delivery
Drug discovery
Credits and
copyright
Notes
References
Glossary
Index
Site search
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