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Lecture № 3
Module «Pharmacology»
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Pharmacodynamics
investigation of processes in the body due to the influence of
pharmaceutical substances
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Influence of PS is
found on:
Molecular;
Cellular;
Organ;
Systemic;
Whole body
levels.
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Targets for PS
Biological structure on cellular and molecular levels PS interacts
with is termed «target» (emetic center, heart)
«TARGETS»
FOR PHARMACEUTCIAL SUBSTANCES
1. Biomembrances and ionic channels
2. Receptors (outside and inside cells)
3. Enzyme systems
4. Intracellular metabolites
5. Intercellular substances
6. Infectious and parasitic agents
7. Toxins and venoms
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Targets for PS
Biological structure on molecular level PS interacts with is
termed «receptor» (pharmacological receptor)
Receptors – functionally active macromolecules (proteins,
lipoproteins, nucleoproteins, glycoproteins) or their fragments :
regulating proteins; enzymes; carrier proteins; structural
proteins
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Quantitative characteristics of drug-receptor interaction
The higher Kd , the lower affinity; the lower Kd, the higher affinity.
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Quantitative characteristics of drug-receptor interaction
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Characteristics of pharmaceutical molecules
Origin:
1. Analogues of endogenous compounds (hormones, enzymes);
2. Xenobiotics (Greek «xenos» – alien).
Sizes:
From very tiny (Li, MW=7) up to enormous (Alteplase, MW=59 050)
The major part: from 100 to 1000 Da
100 – lowest MW that can provide selectivity of binding processes;
1000 – largest size (upper limit) that can provide movement of PS throughout the
body
Shape:
Provide physical interaction with receptor
The best option – shape of PS is complementary to receptor’s shape
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Chirality phenomenon. Enantioselectivity of PS
About 50-50% of PS are chiral molecules i.e. they are enantiomer pair.
Racemic mixture (racemate) – mixture of two compounds,
which structural formulas correlate as a subject
and its mirror reflection
Enantioselectivity is different;
Potency and efficacy are different;
Metabolism rate is different;
Duration of action is different.
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Chirality phenomenon. Enantioselectivity of PS
About 50-50% of PS are chiral molecules i.e. they are enantiomer pair.
Racemic mixture (racemate) – mixture of two compounds,
which structural formulas correlate as a subject
and its mirror reflection
Enantioselectivity is different;
Potency and efficacy are different;
Metabolism rate is different;
Duration of action is different.
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Types of interactions between PS and receptor
Type I: Type II:
PS binds to receptor and activates it → PS binds to receptor and prevents other
molecules (PS-agonist or endogenous
pharmacological effect.
substrates) to bind with receptor →
induction of pharmacological effects
opposite to the agonist effect.
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Interaction of PS-agonist with receptor
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Interaction of PS-antagonist with receptors
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Mathematical evaluation of PS-receptor interaction
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Types of antagonism:
If antagonist occupies the same binding sites on receptors as agonist
does then they both are able to displace each other from the binding
sites. This is competitive antagonism.
PS – competitive antagonist (reversible).
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Type of antagonism:
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Type of antagonism:
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Drug – receptor interaction
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Drug – receptor interaction
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Drug – receptor interaction
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Physiological antagonism of PS effects
For example,
Glucocorticoid hormones increase blood glucose level,
whereas insulin exert physiological opposite influence,
because they affect different receptor-effector systems.
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Types of receptors
and signal transfer via plasmatic membrane
I. Intracellular proteins –
cytosol and nuclear proteins.
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Types of receptors
Examples:
Acetyl choline, GABA, glycine, aspartate, glutamate
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Types of receptors
3) G-protein coupled receptors:
System with three components: Receptor –
G-protein (GTP-binding protein) –
enzyme(s) or ion channel(s).
Gs-proteins→adenylate cyclase stimulation→
↑cAMP →(+) chronotropic effects;
Gi-proteins→ adenylate cyclase inhibition →
(-) chronotropic effects.
Gq-proteins →phospholipase С activation→
Hydrolysis of phosphatidylinositol 4,5-bisphosphate
→formation of inositol 1,4,5-trisphosphate→
Interaction with Ca-channels
sarcoplasmic reticulum→
release of Ca2+ into cytoplasma→
accelerated formation of Ca2+-calmodulin complex
→activation of kinase of myosin light chains→
phosphorylation of myosin light chains →
amplification of actin to myosin interaction
→smooth muscle contraction (vessels).
G-protein coupled receptors, structurally similar;
they make a group of serpentine receptors».
Examples: ACTH, norepinephrine, adrenaline, dophamine, 31
LH, TSH, PSH, glucagon.
Types of receptors
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Intracellular messengers (mediators): cAMP
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Intracellular messengers (mediators)
cAMP→stimulation of protein kinase (phosphate transfer from ATP to
substrate enzyme-proteins):
glycogen degradation in hepatocytes (glycogen phosphorylase);
triglyceride degradation in fat cells (lipase);
smooth muscle relaxation (phosphorylation of myosin light chain kinase).
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Intracellular messengers (mediators)
Ca2+ and phosphoinositides:
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Intracellular messengers (mediators)
Ca2+ and phosphoinositides: PS+R →phospholipase С activation →
hydrolysis of phosphatidylinositol 4,5-bisphosphate (phospholipids of
plasmatic membrane) into diacylglycerol and inositol 1,4,5-
trisphosphate.
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Intracellular messengers (mediators)
cGMP →stimulation of cGMP-dependent protein kinase →relaxation of smooth
muscles in vessels
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Non-receptor interactions
(non-receptor targets for PS)
Ion channels – voltage-gated channels (regulated by action potential), i.e. open due to
depolarization of cell membrane - Na+,
K+, Ca2+ and other. PSs block (more often) or activate channels.
• Slow Ca2+ channel blockers (verapamil)→inhibition of Ca2+ ion flow inside cells.
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Non-receptor interactions
(non-receptor targets for PS)
• Enzymes:
PS inhibit enzymes (cyclooxygenase→ inhibition of prostaglandin synthesis)
• Carrier systems (carrier proteins): Na+, K+- ATPase of cardiomyocyte membranes.
• Infectious and viral pathogens;
• Toxins and venoms (reaction antidote + toxin (unithiol binds heavy metal ions;
• HCl neutralization in stomach;
• Effects of general anesthetics (PS dissolves in membrane lipids);
• Laxative effect of saline drugs (effect of hypertensive solution);
• Diuretic action of osmotic diuretics;
• Dissociation of oxidative phosphorylation (Т3, Т4);
• Inhibition of protein biosynthesis.
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Role of PS chemical structure for its action
Relationships between structure and pharmacological effects:
•-COOH, NH2-groups→molecule ionization→absorption
•Homologues orders of PS
Ammonium tetramethyl =1 un. acetyl choline, 1,4 un., 60 un., 86 un., 430 un., 58 un., 1
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Role of PS chemical structure for its action
• Prostanoic acid derivatives – PGF - ↑BP, PGЕ - ↓AD
Tubocurarine
Reason of no relationship:
•Structural formula does not reflect real conformation and properties of PS.
•Physico-chemical properties of PS when interacting with receptors is not known.
•Comparison of PS with different mode of actions: for example, Mg2+→blocks AC release from
synaptic vesicles; curare poison→blocks AC receptors: both PSs→muscle relaxation.
•Comparison of inactive PS (pro-drugs) with active metabolites.
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Influence of ambient factors on PS effects
Food – food quality, lack of food, lack of nutritional components:
Diet regime for various diseases; protein deficit→hypovitaminosis ;
Carbohydrate excess→increased rick of peptic ulcer due to aspirin intake;
Cheese, sour cream taken with antidepressant → BP↑
Isolation – excitability, aggression – psychostimulants become toxic, sedative drugs become less
effective.
Biological rhythms (daily, seasonal) – chronopharmacology (part of chronobiology) –
Investigating dependence of drug effects on time of administration. Biorhythms: circadian
(daily), hourly, weekly, monthly.
Biological rhythms characteristics: acrophase – period in a cycle during which the cycle crests or peaks,
batiphase – the moment in cycle in which the minimum value is produced; amplitude – deviation of
function from mean; mesor – mean (e.g. mean daily) value of the function studied.
Main terms of chronopharmacology: chronopharmacokinetics – alteration of absorption,
distribution, biotransformation and excretion of PS; chronesthesia – rhythmic alteration of the body
sensitivity to PS; chronergia – rhythmic alteration of pharmacological effects of PS.
Examples: hypnotics are more effective at night, penicillins are metabolized slower during night,
ginseng is not effective in summer.
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Influence of intrinsic factors on PS effects
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Influence of intrinsic factors on PS effects
There are special tables for poisons and high potent drugs.
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Influence of intrinsic factors on PS effects
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Influence of intrinsic factors on PS effects
Body weight – dose increase or decrease required (mg/kg).
Pathologic processes – alter body reaction on PS (taken to account that PS works in the
presence of pathologic process and pathologic process itself affects reaction on PS).
Exhaustion, dehydration – increased reaction on PS (1.5-2.0-fold dose decrease).
Anacid gastritis → K+ resorption decreases in 5 times compared to normal values.
↓рН → PS weak acids (phenobarbital) are deionized (become less polar) → easier transport
through biomembranes → better absorption from blood into tissues → effect strengthening.
Hence, barbiturate poisoning requires blood alkalization.
Kidney disorders → slowed excretion (in 5-10 times) → toxic effect.
Liver disorders → biotransformation defects → toxic effects.
Tuberculosis, alcoholism → гlow blood albumin level → toxic effect.
Endocrine diseases → thyroxin inhibits microsomal oxidation, myxedema (thyroid hypofunction)
→ dramatic reduction of PS effects.
Gene mutation → alteration of biotransformation enzyme activity. Fermentopathies → increased / reduced activity
→ strengthened /weaken PS metabolism→ strengthened /weaken PS effects (PS toxicity). Atypical reactions on
PS – idiosyncrasy. For example, congenital deficiency glucose-6-phosphate dehydrogenase of erythrocytes makes
quinine (antimalarial PS) transforms into quinone → hemolysis of erythrocytes (hemolytic anemia).
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Combination drug therapy
Pharmacotherapy – treatment of disease with drugs:
1. Monotherapy – treatment with one medication.
2. Polytherapy – treatment with several medication (for 1 patient):
Polypharmacy
Polytherapy – unreasonable
1-5 medication polytherapy.
results in side effects in 4%
16-20 medication - in 54%.
Doctor is to prescribe no more than 3-5 PS.
For treatment of major part of diseases 200 drugs is enough
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Four classes of interactions
Class Description Example Measures
А Not significant Ranitidine+ Therapy
interaction Phenobarbital correction is
В Interaction is not - nor required
described
PHARMACEUTICAL PHARMACOLOGICAL
(outside human body) (inside human body)
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Pharmacological drug incompatibility
with other medications
PHARMACOKINETIC PHARMACODYNAMIC
Synergism Antagonism
Absorption
Distribution
New effects
Biotransformation
Excretion
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Pharmacokinetic drug
incompatibility
at absorption from GI
1. Effect of PS on Ph value in GI
(increased рН rises degree of ionization of weak acids
and slows down their absorption)
Example of incompatibility:
Antacids and direct anticoagulant, NSAID, cardiac
glycosides, sulfanilamides, nitrofurans
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2. PS effects of GI motility
(major part of PS is absorbed in proximal part of small
intestine, thus rate of stomach content evacuation
determines time of effect commencing and its intensity)
Examples of incompatibility:
М-choline blockers and narcotic drugs decelerate evacuation and
increase toxicity of iron medications, cardiac glycosides and
NSAID
Metoclopramide accelerates GI peristalsis, and this leads to faster
effects of ethanol, acetaminophen, tetracyclines and
bensodiazepines.
But slow absorbing PS (cardiac glycosides, cimetidine, etc.) do not
have enough time for absorption and this will reduce therapeutic
efficiency.
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3. Influence of PS on membrane transport systems in
GI (enzyme activity and membrane state of intestinal
epithelium) Some PS damage cells of mucous lining
Examples on incompatibility:
Aminoglycosides, polymyxins, tetracyclines – reduce absorption of
iron, cyanocobalamin and folic acid
So, aminoglycoside intake 3-times reduces digoxin blood level.
Diphenin – slows down absorption of folic acid with consecutive
megaloblastic anemia.
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Pharmacokinetic drug
incompatibility
with other medications
at stage of distribution
_ + _ + + Drug (cation)
2 _ _
3
1 + + 4 Albumin (polyanion)
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Displacement effects is short :
Increase of drug concentration in free form affects
active sites as well as alters drug distribution and
elimination.
С’
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Long increase of concentration (and clinical
signs) are possible:
• If key sites of distribution and elimination
are saturated.
• if therapeutic index of the drug being
displaced is low
С’
t
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Drug incompatibility
with other medications
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Drug incompatibility
with other medications
biotransformation
I phase II phase
Metabolism Conjugation
(lowered pharmacological (increased hydrophilicity
activity – water solubility
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Drug incompatibility
with other medications
conjugation
Elimination
Major part of NSAID (in particular indomethacin)
reduce (via COX-1 suppression):
• rate of glomerular filtration,
• velocity of urine formation,
• free water clearance,
• electrolyte excretion.
and disturb elimination pharmaceutical substances, that
are excreted through kidneys
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Combination PS effects
1. Synergism (Greek. syn – together, erg – work) –
joint action of PSs, when effects of two PSs
is stronger, then this of one PS alone:
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Combination PS effects
2. Antagonism – interaction between PS resulting in reduced
or disappeared effects of one or both PSs.
Types:
а) pharmaceutical – occurs at different stages of production, storage or administration of
PS (in one syringe) with formation of inactive or toxic compounds, impaired solubility
(sedimentation), stratification of emulsions, melting of powders (eutectic mixtures).
б) physical – physical interaction of PSs (adsorption on activated carbons);
в) chemical – chemical interaction with formation of inactive complexes (cuprenil and
copper medications);
г) functional (pharmacological):
direct – PSs affect the same receptors (acetyl choline and blocker of acetyl
choline receptors);
indirect – PSs affect different receptors (or functional elements) (acetyl choline
→ binding to acetyl choline receptors → bronchospasm; adrenaline → binding to
noradrenaline receptors → bronchial dilatation);
can be unilateral (strychnine and ether – antagonists; ether reduce strychnine effects
(convulsions), but strychnine does not reduce ether effects).
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Pharmacodynamic drug
interaction
5
3
Synergism:
2 1- sub-additive effect
2- summation
q 3-potentiation
4 4- ANTAGONISM
5- Synergy-antagosnism
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Drug interaction
Practical meaning:
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Body reactions on repeated drug intake
1. Effect weakening (habituation, tolerance – latin. tolerantia – capacity to stand to, patience)
– increase of body sustainability to drug associated with reduced therapeutic activity
(toxic effects). This may be due to:
• Limited absorption (inflammation, mucous lining GI, scars);
• Induction of microsomal oxidizing;
• Receptor desensitization. Developing in several days to several months.
Tachyphylaxis – rapidly diminishing response to successive doses of a drug, rendering it less
effective in several minutes and up to days.
Mithridatism – gradually developing habituation to medications and poisons occurring due to
long intake of increasing doses from very small to the large ones.
2. Effect enhancing – accumulation – increase of drug amount in the body and its effects:
• Material cumulation amounts of PS getting into body is higher than eliminated; may be
necessary for therapeutic effect (cardiac glycosides), may be caused by liver or kidney
disorders → toxic effects.
• Functional cumulation – enhanced effects of PS administered repeatedly without increase
of its blood or tissue concentration.
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Drug addiction
predilection– aim of taking medication is not corresponding with its indication
base – need in mood alteration, pleasant relaxation,, facilitation, increase of working capacity,, an
effort to relieve pain, the desire for intoxication and easy ecstasy.
Predilection leads to addiction – condition associated with forced desire to take a medication
(or chemical compound) for a long period or periodically for experience of psychic effect again
or to avoid worsening of general state due to the lack of medication (cancellation).
Primary reason is a property of such medication and other compounds to induce pleasant and/or
unusual feeling leading to psychological dependence.
May medications and chemical compounds induce formation of physical dependence, i.e.
condition which is characterized by severe disturbance of somatic status when intake of he drug
or compound is discontinued. This condition is termed withdrawal syndrome.
Intake of medication or chemical compounds makes relief of the general conditions and continuing
intake reduce withdrawal syndrome.
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Drug addition
Narcotic compound (narcotic) – first of all, this is first of all, a legal term
indicating that some authority organization (in Russia – Russian ministry of
health) refers this compound and narcotic and included it into the official list of
narcotic compounds.
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Drug side effects
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Drug side effects
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Drug influence of fetus and newborn
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EL
EL FINAL
FINAL
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