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by Lee Eun Jin
ANALYSIS OF DOSE RESPONSE RELATIONSHIP
• DOSE = amount of drug administered to the patient
• RESPONSE = effect in the body produced by the drug
• Drug + Receptor Drug-Receptor Complex Response
Dose-response relationshipDose-response relationship
Depends on multiple factors
A drug usually has one desired effect that causes a change in a target organ or structure
It will also have secondary effects because it will be absorbed by other areas of the body
Main effects and side effectsMain effects and side effects
Main effect – the effect you want the drug to have
Side effects – secondary effects that may or may not be desirable or helpful
Goal is to use a dose of a drug that is effective, but has minimal side effects
Dosage-response curveDosage-response curve Making dosage decision
Compare dosage to the percentage of people showing different effects
ED10- effective dose where 10% of people show response of interest
Example – dosages of a drug used to increase attention (main effect) but also has 2 side effects◦ Heart palpitations ◦ death
• The dose-response relationships for drugs may be Graded or quantal.Graded dose-response curve • can be constructed for responses that are measured on a continuous scale • Eg, heart rate. • Graded dose-response curves relate the intensity of response to the size of
the dose, and hence are useful for characterizing the actions of drugs. Quantal dose-response curve • can be constructed for drugs that elicit an all-or-none response• Eg, presence or absence of epileptic seizures. • For most drugs, the doses that are required to produce a specified quantal
effect in a population are log normally distributed, so that the frequency distribution of responses plotted against log dose is a gaussian normal distribution curve.
• The percentage of the population requiring a particular dose to exhibit the effect can be determined from this curve.
• When these data are plotted as a cumulative frequency distribution, a sigmoidal dose-response curve is generated.
Graded dose response
• means that a slight increase of drug should bring about a small increase in the response
• For example, increase doses of histamine cause gradual contraction of the guinea-pig ileum.
• Very low doses of histamine have virtually no effect and responses can be observed, only beyond a threshold does of about 20ng.
• Again, very high doses of more than 50g have no additional effects, and the response remains constant at this maximal level.
• Graded dose response means the pharmacological effects of the drugs expressed in quality or number, such as the heart rate by beat, blood pressure by mmHg, also the contract of ileum in height effected by the drugs.
GRADED DOSE-RESPONSE CURVE
ED50
ED50
• An all-or-none response to a drug and relates to the frequency with which a specific dose of a drug produces a specific response in a population. • Indicates that a given dose of a drug has or has not evoked a certain effect in the various subject under investigation, that is the pharmacological effects are expressed in passive or negative. •For example, to test either presence or absence of hypnosis for a sedative. (e.g., death among the mice in a pre-clinical study or effective among the patients in a clinical trial.)
QUANTAL DOSE-RESPONSE CURVE
Frequency Distribution
CumulativeFrequency Distribution
GradedGraded
QuantalQuantal
•• Measured in a single biologic unitMeasured in a single biologic unit•• Relates dose to intensity of effectRelates dose to intensity of effect
•• All-or-none All-or-none
pharmacologic effectpharmacologic effect
•• Population studiesPopulation studies
•• Relates dose to Relates dose to
frequency of effectfrequency of effect
• • Continuous scaleContinuous scale
Dose
Dose
rate(%)
rate(%)
Dose-Response Curve InformationDose-Response Curve Information
4 Important Values: Potency Efficacy Slope Variability
oAbsolute amount of drug required to produce an effect
oMore potent drug is the one that requires lower do to cause same effect
o Measure of amount of drug required for effect (ED50)
Potency • refers to the concentration (EC50) or dose (ED50) of a drug required to produce
50% of the drug's maximal effect as depicted by a graded dose-response curve. • EC50 equals KD when there is a linear relationship between occupancy and
response. • Often, signal amplification occurs between receptor occupancy and response,
which results in the EC50 for response being much less (ie, positioned to the left on the abscissa of the log dose-response curve) than KD for receptor occupancy.
• Potency depends on both the affinity of a drug for its receptor, and the efficiency with which drug-receptor interaction is coupled to response.
• The dose of drug required to produce an effect is inversely related to potency. • In general, low potency is important only if it results in a need to administer
the drug in large doses that are impractical. • Quantal dose-response curves provide information on the potency of drugs
that is different from the information derived from graded dose-response curves.
• In a quantal dose-response relationship, the ED50 is the dose at which 50% of individuals exhibit the specified quantal effect
PotencyPotency
Effect
Dose
A B
TherapeuticEffect
Efficacy (Intrinsic activity)• THE Ability of the drug to elicit a response when it binds to
the receptor. • Conformational changes in receptors as a result of drug
occupancy initiate biochemical and physiologic events that characterize the drug's response.
• In some tissues, agonists demonstrating high efficacy can result in a maximal effect, even when only a small fraction of the receptors is occupied
EfficacyEfficacy• Efficacy – how large an effect the drug produces• Maximum effect obtained with drug (not potency)
Response
Log Drug Concentration [Molar]
0
100
50
ED501
2
Slope: Effect of incremental increase in dose
change in effect from change in dose
Variability: Reproducibility of data
different for different people
Threshold (minimal) dose◦ Least amount needed to produce desired effects
Maximum effect◦ Greatest response produced regardless of dose used
Effect
Dose
A
B
TherapeuticEffect
Dosage (mg/kg)
Th
era
peu
tic
re
sp
on
se
%
100
50
ED50
Death
100
50
LD50
MED M
TD
ED50- dose which will be therapeutically effective in 50% of animals (median effective dose)LD50- dose which will, on average, kill 50% of animals in a populationMED- minimum effective dose (the least dose that is likely to be effective).Also called toxic dose-low(TDL)MTD- maximum tolerated dose (or minimum toxic dose) (more than this will produce signs of toxicity).Also called highest nontoxic dose (HNTD)
Therapeutic Range
Toxic
Co
nce
ntr
atio
nC
on
cen
trat
ion
Subtherapeutic
ED50
TI = LD50 / ED50
LD50
Therapeutic index (TI): The index used forjudging drug's safety.
Factors Altering Drug ResponsesFactors Altering Drug Responses
Age◦ Pediatric or geriatric◦ Immature or decreased hepatic, renal function
Weight◦ Big patients “spread” drug over larger volume
Gender◦ Difference in sizes◦ Difference in fat/water distribution
Factors Altering Drug ResponsesFactors Altering Drug Responses
Environment◦ Heat or cold◦ Presence or real or perceived threats
Fever Shock
• Toxicology is the science that deals with the amount of an agent that causes an adverse action in some living system
•‘All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy.’- Paracelus (16th century physician-alchemist)
•‘A poison is any substance or matter which, when applied to the body outwardly, or in any way introduced into it, can destroy life by its own inherent qualities, without acting mechanically, and irrespective of temperature.’
• Toxicity is the degree to which a substance can damage an organism
Principle causes of drug toxicity/side effects
a. the predictable
b. the less predictable
c. the unpredictable
a. the predictable• excessive action at a primary site (over dosage)
e.g. anaesthetics, warfarin
non-selectivity: acting at unrelated sites (more likely with • over dosage) e.g. chlorpromazine
• incomplete selective toxicity: acts against the host as well as the target organism or cell
e.g. protein synthesis inhibitors, antimicrobials, antifungal
• tolerance (dependence & abuse potential)e.g. benzodiazepines, opioids unavoidable side-effectse.g. immunosuppression by corticosteroids – opportunistic infections
a. the predictable
Pharmacokinetic Drug interactions:
• absorption e.g. gastric emptying, gut motility
Atropine and metoclopramide
•distribution e.g. displacement from plasma proteins
aspirin and warfarin
•metabolism e.g. increased by enzyme induction
barbiturates and steroids
• excretion e.g. active transport competition
NSAIDS and methotrexate
a. the predictable
• Age- most drugs tested on young to middle-aged volunteers-causing problems such as: -drug clearance mechanisms (renal and hepatic) are limited in newborns-clearance is reduced in elderly (increasing half life) reduction in lean body mass, serum albumin, total body water.
increased body fatdeclined renal functionreduced hepatic blood flowreduced activities of cytochrome P450 enzymes•Gender
- a relative increase of body fat in females
b. the less predictable
• Genetic factors
e.g. polymorphism in NAT2 in the liver (N-acetyltransferase2).-metabolises about 16 common drugs (phenytoin, hydralazine)
Plasma esterase – suxamethonium (about 1 in 3000 individuals)
c. the unpredictable
• untoward adverse reactions
• drug allergies and anaphylactic reactions e.g. penicillin (1 in 50,000 patients exposed)
Multiple dosingMultiple dosing On continuous steady administration of a drug,
plasma concentration will rise fast at first then more slowly and reach a plateau, where:
rate of administration = rate of elimination i.e.steady state is reached.
Therefore, at steady state:Dose (Rate of Administration) = clearance x plasma conc.
steady state conc. = Dose/clearance
0
1
2
3
4
5
6
7
0 5 10 15 20 25 30
Time
Pla
sm
a C
on
cen
trati
on
Repeated doses –Maintenance dose
Therapeutic level
Single dose – Loading dose
• Drug development
- Site of action- Selection of dose and schedule
- Potency, efficacy and safety
- Drug interactions
• Patient management
-Therapeutic drug monitoring-Risk benefit (therapeutic indices)
Morphine
Aspirin
THERAPEUTIC INDEX – AN INDEX OF SAFETY
Hypnosis
Death
Margin of Safety = LD1
ED99
ED50AED99A
LD1
A
Desired vs undesired effects: Indices of drug safety.
• Safety Index• Therapeutic Index
Safety index: LD1/ED99
-20
0
20
40
60
80
100
0.00
010.
001
0.01 0.
1 1 10 100 1K 10
K10
0K
Sleep Death
LDLD11
EDED9999
Therapeutic index: LD50/ED50
-20
0
20
40
60
80
100
0.00
010.
001
0.01 0.
1 1 10 100 1K 10
K10
0K
Sleep Death
Causes of Variability in Drug Response
Those related to the biological system1. Body weight and size2. Age and Sex3. Genetics - pharmacogenetics4. Condition of health5. Placebo effect
Causes of Variability in Drug Response
• Those related to the conditions of administration1. Dose, formulation, route of administration.2. Resulting from repeated administration of drug:
drug resistance; drug tolerance-tachyphylaxis; drug allergy
3. Drug interactions:chemical or physical; GI absorption; protein binding/distribution; metabolism (stimulation/inhibition); excretion (pH/transport processes); receptor (potentiation/antagonism); changes in pH or electrolytes.
DoseDose EffectEffectEffect site Effect site ConcentrationConcentration
Pharmacokinetics Pharmacodynamics
AbsorptionAbsorption
DistributionDistribution
MetabolismMetabolism
Elimination Elimination
Drug interactionsDrug interactions
Tissue/organ sensitivity Tissue/organ sensitivity (target status)(target status)
Monitoring drug responsesMonitoring drug responses
LevelLevel Molecular (e.g., enzyme inhibition, receptor Molecular (e.g., enzyme inhibition, receptor
binding assay)binding assay) Cellular (Cellular (in vitroin vitro tissue culture, blood cells) tissue culture, blood cells) Tissue or organ (Tissue or organ (in vitroin vitro or or in vivoin vivo)) Animal disease modelAnimal disease model
Endpoint used to measure the effect may be different Endpoint used to measure the effect may be different at each levelat each level
Overall effect = Sum of multiple drug effects and Overall effect = Sum of multiple drug effects and physiological responses to drug effectsphysiological responses to drug effects
Endpoints to monitor drug effectsEndpoints to monitor drug effects
LEVEL ENDPOINT
Molecular Enzyme e inhibition
Cellular Proliferation rate, Apoptosis
Tumor Response (Change in tumor size)
Organism Survival, Quality of life
DOSE-RESPONSE RELATIONSHIPS
The effect of dose on the magnitude of pharmacologic response.
Panel A is a linear graph.
*Effect =*Effect =EffectEffectMaxMax • [Drug] • [Drug]
KKDD + [Drug] + [Drug]
*EC50=drug dose that shows fifty percent of maximal response.
DOSE-RESPONSE RELATIONSHIPS
The effect of dose on the magnitude of pharmacologic response.
Panel B is a semi-logarithmic plot
of the same data.
Determinants of Drug Activity
1. Potency: the amount of drug to produce an effect of a given magnitude
2. Efficacy: the maximal response (effect) produced by drug
Bio
logi
c ef
fect
Log dose
potency
efficacy
0
50
100
Bio
logi
c ef
fect
(%)
Log dose (mg)
1 10 100
MorphineCodeine
Aspirin
DOSE-RESPONSE RELATIONSHIPS
Typical dose-response curve
for drugs showing differences in potency and efficacy.
DOSE-RESPONSE RELATIONSHIPS
Effects of drug antagonists.
DOSE-RESPONSE RELATIONSHIPS
Effects of partial agonists.
-1 0 1 2
RE
SPO
NS
E
Full Agonist
Partial Agonist
Antagonist
Log([A]/KA)
QUANTAL DOSE-RESPONSE RELATIONSHIPS
Therapeutic Index
Therapeutic index =
toxic dose(LD50)/effective dose(EC50)
This is a measure of a drug’s safety• A large number = a wide margin of safety• A small number = a small margin of safety
QUANTAL DOSE-RESPONSE RELATIONSHIPS
Effects of partial agonists.
QUANTAL DOSE-RESPONSE RELATIONSHIPS
Effects of partial agonists.
Drugs- receptor- response Some drugs can act without binding to a receptor spare receptors allow maximum response without full receptor
occupancy Efficacy is the amount of drug needed to produce an effect. Affinity is the attractiveness between 2 drug molecules. Agonist are the drugs that block the response. Partial agonist has affinity and maximum efficacy. Antagonist has efficacy but no affinity. Competitive antagonist decreases potency Non competitive antagonist decreases efficacy
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