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General pharmacology (Pharmacokinetics; drug administration and absorption) Prof. Hanan Hagar Dr.Ishfaq Bukhari Pharmacology Department What is Pharmacology? From the Greek pharmakon (drug), and legein (to speak or discuss) Broadly defined as the study of how chemical agents affect living processes. e.g Hormones, Neurotransmitters and drugs What is Pharmacology Pharmacology studies the effects of drugs and how they exert their effects. Acetylsalicylic acid (ASA) or Aspirin can reduce inflammation, , pain and fever It inhibit the action of a human cell membrane enzyme known as cyclooxygenase, which is responsible for the synthesis of a number of inflammatory mediators. Penicillin cures certain bacterial infections disrupt the synthesis of cell walls in susceptible bacterial strains by inhibiting a key enzyme. Some Pharmacology Definitions and Areas of Study Pharmacokinetics Study the fate of drugs once ingested. It covers , How the body absorbs, distributes, metabolizes, and excretes drugs (what the body does to a drug?) Pharmacodynamics Study the mechanisms by which drugs work ,Also study endogenous agents (what the drug does to the body?) Pharmacokinetics (Drug absorption) The student should be able to Discuss the different routes of drug administration Identify the advantages and disadvantages of various routes of drug administration Know the various mechanisms of drug absorption List different factors affecting drug absorption Define bioavailability Recommended books Lippincott’s illustrated reviews (Pharmacology) by Howland and Mycek Basic and Clinical Pharmacology by by Katzung PHARMACOKINETICS: Pharmacokinetics:It is the study of what the body does to the drug i.e ADME ABSORPTION DISTRIBUTION METABOLISM EXCRETION of the drug Note: Pharmacodynamic is what the drug does to our body Routes of drug administration Routes of drug administration Enteral via gastrointestinal tract (GIT)( Oral and Rectal ) Sublingual Parenteral administration = injections. Topical application Inhalation Advantages - Easy Self use -Safe - convenient - cheap - No need for sterilization - Disadvantages - Slow effect No complete absorption - Destruction by pH and enzymes - GIT irritation - Food - Drug interactions -Drug-Drug interactions - First pass effect - (low bioavailability). - Not suitable for vomiting & unconscious patient emergency & bad taste drugs Factors affecting absorption from GIT GIT motility changed by drug / diseases Presence of food Blood flow/surface area GIT juices pH of GIT fluids Chemical/drug interactions dosage form of a drug Most of the drug is absorbed with in 1-3 hours,mostly it occurs in small intestine ,rate of absorption depends on lipid solubility ,ionization and pH. Factors affecting absorption from GIT Drugs administered in aqueous solution are absorbed faster & completely than tablet or suspension forms. Drugs such as the tetracyclines, which are highly ionized, can complex with Ca++ ions in membranes, food, or milk, leading to a reduction in their rate of absorption. Factors that accelerate gastric emptying time, permitting drugs to reach the large absorptive surface of the small intestine sooner, will increase drug absorption unless the drug is slow to dissolve. First pass Metabolism Metabolism of drug in the gut wall or portal circulation before reaching systemic circulation So the amount reaching system circulation is less than the amount absorbed Where ? Liver Gut wall Gut Lumen Results ? Low bioavailability. Short duration of action of drugs (t ½). First pass effect Stomach pH The low pH of the gastric contents (pH 1–2) may influence absorption of drugs because it can affect the degree of drug ionization. e.g, the weak base diazepam will be highly Ioninized in the gastric juice, and absorption will be slow. weak acid drug, acetaminophen will exist mainly in its unionized form and can more readily diffuse from the stomach into the systemic circulation. Small intestine The small intestine, with its large surface area and high blood perfusion rate, has a greater capacity for absorption than does the stomach. Conditions that shorten intestinal transit time (e.g., diarrhea) decrease intestinal drug absorption, while increases in transit time will enhance absorption by permitting drugs to remain in contact with the intestinal mucosa longer. Oral Dosage Forms (oral formulations) Tablets (enteric coated tablets) Capsules (hard and soft gelatin capsules) Syrup Suspension Emulsion Tablets Hard- gelatin capsule Spansule Soft- gelatin capsule Advantages Rapid effect (Emergency) No first pass metabolism. High bioavailability No GIT destruction No food drug interaction Dosage form: friable tablet Disadvantages Not for - irritant drugs - Frequent use Advantages Suitable for children Vomiting or unconscious patients Irritant & Bad taste drugs. less first pass metabolism (50%) Dosage form: suppository or enema Disadvantages Irregular absorption & bioavailability. Irritation of rectal mucosa. Intradermal (I.D.) (into skin) Subcutaneous (S.C.) (under skin) Intramuscular (I.M.) (into muscles) Intravenous (I.V.) (into veins) Intra-arterial (I.A.) (into arteries) Intrathecal (I.T.) (cerebrospinal fluids ) Intraperitoneal (I.P.) (peritoneal cavity) Intra - articular (Synovial fluids) Advantages Rapid action (emergency) High bioavailability No food-drug interaction No first pass metabolism No gastric irritation Suitable for Vomiting &unconsciousness Irritant & Bad taste drugs. Dosage form: Vial or ampoule Disadvantages Infection Sterilization. Pain Needs skill Anaphylaxis Expensive. Not suitable for oily solutions or poorly soluble substance Ampoule Single use Vial Repeated use Injection Special Utility Limitations I.D. Minute volume (0.1 ml) Suitable for vaccinations & sensitivity test Not suitable for large volumes S.C. 0.1 ml – 1 ml Suitable for some poorly soluble suspensions and for instillation of slow-release implants e.g. insulin zinc preparation Not suitable for large volumes I.M. larger volume 3-5 ml Suitable Not suitable for irritant drugs for moderate volumes, oily vehicles, and some irritating substances I.V. Suitable for large volumes and for irritating substances Not suitable for oily solutions or poorly soluble substances Must inject solutions slowly as a rule Drugs are mainly applied topically to produce local effects. They are applied to Skin (percutaneous) e.g. allergy test, topical antibacterial and steroids prep and local anesthesia Mucous membrane of respiratory tract (Inhalation) e.g. asthma Eye drops e.g. conjunctivitis Ear drops e.g. otitis externa Intranasal, e.g. decongestant nasal spray Advantages Mucous membrane of respiratory system Rapid absorption (large surface area) Provide local action Minor systemic effect Less side effects. No first pass effect Disadvantages Dosage form: volatile gases (anesthetics), aerosol, nebulizer for asthma Only few drugs can be used Nebulizer Atomizer a medicated adhesive patch applied to skin to provide systemic effect (prolonged drug action) e.g. the nicotine patches (quit smoking) Scopolamine (vestibular depressant) Is the passage of drug from its site of administration to its site of action through various cell membranes. Except for intravenous administration, all routes of drug administration require that the drug be transported from the site of administration into the systemic circulation. Is the passage of drug from its site of administration to its site of action through cell membranes. Cell membrane Sites of Administration Sites of action Sites of Administration Absorption & distribution Elimination The transport of drugs across membranes occurs through one or more of the following processes: 1. 2. 3. 4. Simple diffusion = passive diffusion. Active transport. Facilitated diffusion. Pinocytosis (Endocytosis). water soluble drug (ionized or polar) is readily absorbed via diffusion through aqueous channels or pores in cell membrane. Lipid soluble drug (nonionized or non polar) is readily absorbed via diffusion through lipid cell membrane itself. Characters common. Occurs along concentration gradient. Non selective Not saturable Requires no energy No carrier is needed Depends on lipid solubility. Depends on pka of drug - pH of medium. Drugs exist in two forms ionized (water soluble) nonionized forms (lipid soluble) in equilibrium. Drug ionized form + nonionized form Only nonionized form is absorbable. Nonionized / ionized fraction is determined by pH and pKa As general basic drugs are more ionized and less diffusible in a relatively acidic medium, on the contrary basic are more lipid soluble and more diffusible in a relatively alkaline medium PKa of the drug (Dissociation or ionization constant): pH at which half of the substance is ionized & half is unionized. The lower the pKa value (pKa < 6) of the acidic drug the stronger the acid e.g aspirin (Pka= 3.0 ), The higher the pKa value (pKa >8) of a basic drug, the stronger the base e.g propranolol ( pKa= 9.4) PKa of the drug (Dissociation or ionization constant): pH at which half of the substance is ionized & half is unionized. pH of the medium Affects ionization of drugs. Weak acids best absorbed in stomach. Weak bases best absorbed in intestine. Which one of the following drugs will be best absorbed in stomach (pH=3)? Aspirin pka=3.0 warfarin pka=5.0 Arrange the following drugs in ascending order from least to greatest in rate of absorption in small intestine (pH=7.8)? Propranolol pka= 9.4 Aspirin pka=3.0 Relatively unusual. Occurs against concentration gradient. Requires carrier and energy. Specific Saturable. eg. Sugar, amino acids and Iron absorption. Uptake of levodopa by brain. Occurs along concentration gradient. Requires carriers Selective. Saturable. No energy is required. Passive transport along concentration gradient (From high to low) Active transport against concentration gradient (From low to high) No carriers Needs carriers Not saturable saturable Not selective Selective No energy energy is required Active transport Against concentration gradient (From low to high) Needs carriers Carrier-mediated facilitated diffusion along concentration gradient (From high to low) Needs carriers saturable saturable Selective Selective Energy is required No energy is required Endocytosis: uptake of membrane-bound particles. Exocytosis: expulsion of membrane-bound particles. Phagocytosis occurs for high molecular weight Drugs or highly lipid insoluble drugs. OUT IN IN OUT Factors modifying drug absorption GENERAL FACTORS lipid solubility Degree of ionization Drug solubility (aqueous sol better than oily,susp,sol) Dosage forms (depending on particle size and disintegration) Concentration of drugs Circulation at site of absorption Area of absorbing surface (small intestine has large surface area) Route of administration. Is the fraction of unchanged drug that enters systemic circulation after administration and becomes available to produce an action I.V. provides 100% bioavailability. Oral usually has less than I.V.