longitudnal section of kidney 09-12-20101klecop, nipani

LONGITUDNAL SECTION OF KIDNEY

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• DEFINITION OF PHARMACOKINETICS AND PHARMACODYNAMICS

Renal Excretion

• Glomerular filtration depends on: Renal blood flow & GFR; direct relationship Plasma protein binding; only free unbound drugs are filtered

• Tubular Secretion in the proximal renal tubule mediates raising drug concentration in PCT lumen

Organic anionic & cationic transporters (OAT & OCT) mediate active secretion of anionic & cationic drugs

Passive diffusion of uncharged drugs Facilitated diffusion of charged & uncharged drugs Penicillin is an example of actively secreted drugs

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Renal Excretion

• Tubular re-absorption in DCT:• Because of water re-absorption, urinary D concentration increases

towards DCT favoring passive diffusion of un-ionized lipophillic drugs• It leads to lowering urinary drug concentrationo Urinary pH trapping:• Chemical adjustment of urinary pH can inhibit or enhance tubular

drug reabsorption• For example, aspirin overdose can be treated by urine alkalinization

with Na Bicarbonate (ion trapping) and increasing urine flow rate (dilution of tubular drug concentration)

• Ammonium chloride can be used as urine acidifier for basic drug overdose treatment

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Drug Elimination Pulmonary excretion of drugs into expired air: Gases & volatile substances are excreted by this route No specialized transporters are involved Simple diffusion across cell membrane predominates. It depends on: Drug solubility in blood: more soluble gases are slowly excreted Cardiac output rise enhance removal of gaseous drugs Respiratory rate is of importance for gases of high blood solubility Biliary excretion of few drugs into feceso Such drugs are secreted from the liver into the bile by active transporters,

and then into duodenumo Examples: digoxin, steroid hormones, some anticancer agentso Some drugs undergo enterohepatic circulation back into systemic circulation

CLEARANCE:-

Is defined as the hypothetical volume of body fluids containing drug from which the drug is removed/ cleared completely in a specific period of time. Expressed in ml/min. CL = kVD, k: elimination rate constant

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Clearance• It is ability of kidney, liver and other organs to eliminate drug from the

bloodstream• Units are in L/hr or L/hr/kg• Used in determination of maintenance doses• Drug metabolism and excretion are often referred to collectively as

clearance• The endpoint is reduction of drug plasma level• Hepatic, renal and cardiac failure can each reduce drug clearance and hence

increase elimination T1/2 of the drug

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TOTAL BODY CLEARANCE:-

Is defined as the sum of individual clearances by all eliminating organs is called total body clearance/ total systemic clearance.

Total Body Clearance = CLliver + CLkidney + CLlungs +CLx

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Metabolism & Excretion Kinetics

• Elimination (metabolism + excretion) of most drugs follow first-order kinetics at therapeutic dose level

Amount of drug cleared in a given unit of time is directly proportional to the concentration of the drug according to Michaelis-Menten (linear) kinetics:

• Only few drugs (e.g., phenytoin, alcohol) show saturation clearance (Zero-order, non-linear) kinetics Clearance mechanisms become saturated at therapeutic level, and clearance

remain constant even with increased drug plasma level SLOW ELIMINATION at therapeutic levels leadsto toxic reactions

E = Vmax x C km + C

Minimum effective conc.

Therapeutic success of a rapidly & completely absorbed drug.

Therapeutic failure of a slowly absorbed drug.

Subtherapeutic level

Time

Plasma

Drug

Conc.

Not only the magnitude of drug that comes into the systemic circulation but also the rate at which it is absorbed is important this is clear from the figure.

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Loading Dose

• Loading Dose = Target Plasma C x VD

• What Is the is the loading dose required fro drug A if:

target concentration is 30 mg/L

VD is 0.75 L/kg, patients weight is 75 kg

Answer• VD = 0.75 L/kg x 75 kg

= 56.25 L• Target Conc. = 10

mg/L• Dose = 30 mg/L x

56.25 L = 1659 mg

Half-life (t1/2)

• Half-life: is a derived parameter, completely determined by volume of distribution and clearance.

• (Units = time)• As Vd increases t1/2 increases

Maintenance Dose

• Maintenance Dose = CL x target steady state drug concentration

• The units of CL are in L/hr or L/hr/kg• Maintenance dose will be in mg/hr

Steady-State• Steady-state occurs after a

drug has been given for approximately 4-5 t1/2

• At steady-state the rate of drug administration equals the rate of elimination

• Plasma concentration after each dose is approximately the same

C

t

Cpav

Four half lives to reach steady state

Importance of Steady State (SS)

• At SS Rate in = Rate Out• Steady state is reached usually within 4 – 5

half-lives at linear kinetics• It is important for drug concentrations

interpretation in:Therapeutic Drug Monitoring (TDM)Evaluation of clinical response

Dosing and Steady State

• Dosing: Administration of medication over time, so that therapeutic levels can be achieved.

• Steady-state: o drug accumulates and plateaus

at a particular level o rate of accumulation determined

by half lifeo reach steady state in about five

times the elimination half-life

How Drugs Act: Pharmacodynamics

2004-2005

Pharmacodynamics (how drugs work on the body)

It is the study of biochemical and physiological effects of drugs and their mechanism of action at organ level as well as cellular level.

2004-2005

Pharmacodynamics (how drugs work on the body)

It is the study of biochemical and physiological effects of drugs and their mechanism of action at organ level as well as cellular level.

Do NOT impart new functions on any system, organ or cell Only alter the PACE of ongoing activity

• STIMULATION • DEPRESSION• REPLACEMENT • CYTOTOXIC ACTION

Principles of drug action

Majority of drugs interact with target biomolecules: Usually a Protein

• ENZYMES

• ION CHANNELS

• TRANSPORTERS • RECEPTORS

Targets of drug action

I- Ion Channels

DirectPhysical blocking

of channel local anesthetic & amiloride

ModulatorBind to the channel

protein itselfCa channel blockers

II- Enzymes

ChE inhibitors

α-Methyl dopa

II- Enzymes (cont.)

• Drug acts as

Substrate leading to reversible OR irreversible inhibition of enzymereversible inhibition of cholinesterase by neostigmine Irreversible inhibition of cyclo-oxygenase by aspirin

True/False substrateL-DOPA converted into dopamine α-methyldopa converted into α-methylnorepinephrine (false

transmitter)

III- Carrier Molecules• What is carrier molecule? Carrier protein molecules function to transport

ions & small organic molecules (too polar to penetrate) across cell membranes.