Why Drug[1]

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Why Drug[1]

  1. 1. HOW DO DRUGS WORK?
  2. 2. WHY BE CONCERNED ABOUT HOW DRUGS WORK? <ul><li>FDA Approved and Unapproved Uses </li></ul><ul><li>Interactions with Other Drugs </li></ul><ul><li>Adverse Effects and Contraindications </li></ul>AIDS MEMORIZATION OF:
  3. 3. WHY BE CONCERNED ABOUT HOW DRUGS WORK? <ul><li>Better assessment of new modalities for using drugs </li></ul><ul><li>Better assessment of new indications for drugs </li></ul><ul><li>Better assessment of new concerns regarding risk-benefit </li></ul>AIDS EVALUATION OF MEDICAL LITERATURE:
  4. 4. WHY BE CONCERNED ABOUT HOW DRUGS WORK? The patient has more respect for and trust in a therapist who can convey to the patient how the drug is affecting the patient’s body. AIDS PATIENT-DOCTOR RELATIONSHIP: A patient who understands his/her therapy is more inclined to become an active participant in the management of the patient’s disease.
  5. 5. WHY BE CONCERNED ABOUT HOW DRUGS WORK? Knowledge of how a drug works increases the therapist’s confidence that the drug is being used appropriately. PEACE OF MIND!
  6. 6. HOW DO DRUGS WORK? <ul><li>Some drugs antagonize, block or inhibit endogenous proteins </li></ul><ul><li>Some drugs activate endogenous proteins </li></ul><ul><li>A few drugs have unconventional mechanisms of action </li></ul>Most drugs work by interacting with endogenous proteins:
  7. 7. HOW DO DRUGS ANTAGONIZE, BLOCK OR INHIBIT ENDOGENOUS PROTEINS? <ul><li>Antagonists of Cell Surface Receptors </li></ul><ul><li>Antagonists of Nuclear Receptors </li></ul><ul><li>Enzyme Inhibitors </li></ul><ul><li>Ion Channel Blockers </li></ul><ul><li>Transport Inhibitors </li></ul><ul><li>Inhibitors of Signal Transduction Proteins </li></ul>
  8. 8. HOW DO DRUGS WORK BY ANTAGONIZING CELL SURFACE RECEPTORS? A macromolecular component of the organism that binds the drug and initiates the drug’s effect. Definition of RECEPTOR : Most receptors are proteins that have undergone various post-translational modifications such as covalent attachments of carbohydrate, lipid and phosphate.
  9. 9. HOW DO DRUGS WORK BY ANTAGONIZING CELL SURFACE RECEPTORS? A receptor that is embedded in the cell membrane and functions to receive chemical information from the extracellular compartment and to transmit that information to the intracellular compartment. Definition of CELL SURFACE RECEPTOR :
  10. 10. HOW DO DRUGS WORK BY ANTAGONIZING CELL SURFACE RECEPTORS? Cell Membrane Unbound Endogenous Activator (Agonist) of Receptor Inactive Cell Surface Receptor Extracellular Compartment Intracellular Compartment
  11. 11. HOW DO DRUGS WORK BY ANTAGONIZING CELL SURFACE RECEPTORS? Cell Membrane Bound Endogenous Activator (Agonist) of Receptor Active Cell Surface Receptor Extracellular Compartment Intracellular Compartment Cellular Response
  12. 12. HOW DO DRUGS WORK BY ANTAGONIZING CELL SURFACE RECEPTORS? Cell Membrane Displaced Endogenous Activator (Agonist) of Receptor Inactive Cell Surface Receptor Extracellular Compartment Intracellular Compartment Bound Antagonist of Receptor (Drug)
  13. 13. Footnote: Most antagonists attach to binding site on receptor for endogenous agonist and sterically prevent endogenous agonist from binding. However, antagonists may bind to remote site on receptor and cause allosteric effects that displace endogenous agonist or prevent endogenous agonist from activating receptor. HOW DO DRUGS WORK BY ANTAGONIZING CELL SURFACE RECEPTORS?
  14. 14. HOW DO DRUGS WORK BY ANTAGONIZING CELL SURFACE RECEPTORS? KEY CONCEPTS: <ul><li>Cell surface receptors exist to transmit chemical signals from </li></ul><ul><li>the outside to the inside of the cell. </li></ul><ul><li>Some drugs bind to cell surface receptors, yet do not activate </li></ul><ul><li>the receptors to trigger a response. </li></ul><ul><li>When cell surface receptors bind the drug molecule, </li></ul><ul><li>the endogenous chemical cannot bind to the </li></ul><ul><li>receptor and cannot trigger a response. </li></ul><ul><li>The drug is said to “antagonize” or “block” the receptor and </li></ul><ul><li>is referred to as a receptor antagonist. </li></ul>
  15. 15. ARE DRUGS THAT ANTAGONIZE CELL SURFACE RECEPTORS CLINICALLY USEFUL? <ul><li>Angiotensin Receptor Blockers (ARBs) for high blood pressure, </li></ul><ul><li>heart failure, chronic renal insufficiency </li></ul><ul><li>(losartan [Cozaar ® ]; valsartan [Diovan ® ]) </li></ul>Some important examples: <ul><li>Beta-Adrenoceptor Blockers for angina, myocardial infarction, </li></ul><ul><li>heart failure, high blood pressure, performance anxiety </li></ul><ul><li>(propranolol [Inderal ® ]; atenolol [Tenormin ® ]) </li></ul>
  16. 16. HOW DO DRUGS WORK BY ANTAGONIZING NUCLEAR RECEPTORS? A receptor that exists in the intracellular compartment and upon activation binds to regulator regions in the DNA and modulates gene expression. Definition of NUCLEAR RECEPTOR :
  17. 17. HOW DO DRUGS WORK BY ANTAGONIZING NUCLEAR RECEPTORS? Unbound Endogenous Activator (Agonist) of Nuclear Receptor Inactive Nuclear Receptor In Cytosolic Compartment Intracellular Compartment Nucleus DNA Inactive Nuclear Receptor In Nuclear Compartment
  18. 18. HOW DO DRUGS WORK BY ANTAGONIZING NUCLEAR RECEPTORS? Intracellular Compartment Nucleus DNA Modulation of Transcription Active Nuclear Receptor Bound Endogenous Activator (Agonist) of Nuclear Receptor
  19. 19. HOW DO DRUGS WORK BY ANTAGONIZING NUCLEAR RECEPTORS? Displaced Endogenous Activator (Agonist) of Nuclear Receptor Intracellular Compartment Nucleus DNA Bound Antagonist of Receptor (Drug) Inactive Nuclear Receptor In Cytosolic Compartment Inactive Nuclear Receptor In Nuclear Compartment
  20. 20. HOW DO DRUGS WORK BY ANTAGONIZING NUCLEAR RECEPTORS? Footnote: Most antagonists attach to binding site on receptor for endogenous agonist and sterically prevent endogenous agonist from binding. However, antagonists may bind to remote site on receptor and cause allosteric effects that displace endogenous agonist or prevent endogenous agonist from activating receptor.
  21. 21. HOW DO DRUGS WORK BY ANTAGONIZING NUCLEAR RECEPTORS? KEY CONCEPTS: <ul><li>Nuclear receptors exist to mediate the effects of intracellular, </li></ul><ul><li>endogenous chemicals on gene expression. </li></ul><ul><li>Some drugs bind to nuclear receptors, yet do not activate </li></ul><ul><li>the receptors to translocate to the nucleus, bind DNA </li></ul><ul><li>and alter gene expression. </li></ul><ul><li>When nuclear receptors bind the drug molecule, </li></ul><ul><li>the endogenous chemical cannot bind to the </li></ul><ul><li>receptor and cannot alter gene expression. </li></ul><ul><li>The drug is said to “antagonize” or “block” the receptor and </li></ul><ul><li>is referred to as a receptor antagonist. </li></ul>
  22. 22. ARE DRUGS THAT ANTAGONIZE NUCLEAR RECEPTORS CLINICAL USEFUL? <ul><li>Mineralocorticoid Receptor Antagonists for edema due to </li></ul><ul><li>liver cirrhosis and for heart failure </li></ul><ul><li>(spironolactone [Aldactone ® ]) </li></ul>Some important examples: <ul><li>Estrogen Receptor Antagonists for the prevention and treatment </li></ul><ul><li>of breast cancer (tamoxifen [Nolvadex ® ]) </li></ul>
  23. 23. HOW DO DRUGS WORK BY INHIBITING ENZYMES? Active Enzyme Substrate Product Cellular Function
  24. 24. HOW DO DRUGS WORK BY INHIBITING ENZYMES? Inactive Enzyme Substrate Bound Enzyme Inhibitor (Drug)
  25. 25. HOW DO DRUGS WORK BY INHIBITING ENZYMES? KEY CONCEPTS: <ul><li>Enzymes catalyze the biosynthesis of products from substrates. </li></ul><ul><li>Some drugs bind to enzymes and inhibit enzymatic activity. </li></ul><ul><li>Loss of product due to enzyme inhibition mediates the </li></ul><ul><li>effects of enzyme inhibitors. </li></ul>
  26. 26. ARE DRUGS THAT INHIBIT ENZYMES CLINICALLY USEFUL? <ul><li>Cyclooxygenase Inhibitors for pain relief, </li></ul><ul><li>particularly due to arthritis (aspirin; ibuprofen [Motrin ® ]) </li></ul>Some important examples: <ul><li>Angiotensin Converting Enzyme (ACE) Inhibitors for </li></ul><ul><li>high blood pressure, heart failure, and </li></ul><ul><li>chronic renal insufficiency </li></ul><ul><li>(captopril [Capoten ® ]; ramipril [Altace ® ]) </li></ul><ul><li>HMG-CoA Reductase Inhibitors for hypercholesterolemia </li></ul><ul><li>(atorvastatin [Lipitor ® ]; pravastatin [Pravachol ® ]) </li></ul>
  27. 27. HOW DO DRUGS WORK BY BLOCKING ION CHANNELS? Open Ion Channel Intracellular Compartment Ions (e.g., Ca ++ , Na + , K + ) [Ions] Cellular Response
  28. 28. HOW DO DRUGS WORK BY BLOCKING ION CHANNELS? Blocked Ion Channel Intracellular Compartment Ions (e.g., Ca ++ , Na + ) Drug that Blocks Ion Channels Ions (e.g., K + )
  29. 29. HOW DO DRUGS WORK BY BLOCKING ION CHANNELS? KEY CONCEPTS: <ul><li>Ion channels allow ions to transverse the cell membrane </li></ul><ul><li>through a pore and down an electrochemical gradient. </li></ul><ul><li>Some drugs bind to ion channels and physically </li></ul><ul><li>block the pore or cause an allosteric change </li></ul><ul><li>that closes the pore. </li></ul><ul><li>Changes in the intracellular concentration of ions mediates </li></ul><ul><li>the effects of inhibitors of ion channels. </li></ul>
  30. 30. ARE DRUGS THAT BLOCK ION CHANNELS CLINICALLY USEFUL? <ul><li>Calcium Channel Blockers (CCBs) for angina and high blood pressure </li></ul><ul><li>(amlodipine [Norvasc ® ]; diltiazem [Cardizem ® ]) </li></ul>Some important examples: <ul><li>Sodium Channel Blockers to suppress cardiac arrhythmias </li></ul><ul><li>(lidocaine [Xylocaine ® ]; amiodarone [Cordarone ® ]) </li></ul>
  31. 31. HOW DO DRUGS WORK BY INHIBITING TRANSPORTERS? Active Transporter Intracellular Compartment Membrane Impermeable Solute Cellular Response Membrane Impermeable Solute
  32. 32. HOW DO DRUGS WORK BY INHIBITING TRANSPORTERS? Inactive Transporter Intracellular Compartment Membrane Impermeable Solute Membrane Impermeable Solute Drug that Inhibits Transporters
  33. 33. HOW DO DRUGS WORK BY INHIBITING TRANSPROTERS? KEY CONCEPTS: <ul><li>Transporters bind to and shuttle membrane impermeable </li></ul><ul><li>solutes across the cell membrane. </li></ul><ul><li>Some drugs bind to transporters and cause allosteric changes </li></ul><ul><li>that prevent proper functioning of the transporters. </li></ul><ul><li>Changes in the intracellular concentration of specific solutes mediates </li></ul><ul><li>the effects of inhibitors of transporters. </li></ul>
  34. 34. ARE DRUGS THAT INHIBIT TRANSPORTERS CLINICALLY USEFUL? <ul><li>Selective Serotonin Reuptake Inhibitors (SSRIs) for the </li></ul><ul><li>treatment of depression </li></ul><ul><li>(fluoxetine [Prozac ® ]; fluvoxamine [Luvox ® ]) </li></ul>Some important examples: <ul><li>Inhibitors of Na-2Cl-K Symporter (Loop Diuretics) in </li></ul><ul><li>renal epithelial cells to increase urine and sodium </li></ul><ul><li>output for the treatment of edema </li></ul><ul><li>(furosemide [Lasix ® ]; bumetanide [Bumex ® ]) </li></ul>
  35. 35. HOW DO DRUGS WORK BY INHIBITING SIGNAL TRANSDUCTION PROTEINS? (Some overlap with enzyme inhibitors) Cell Membrane Bound Endogenous Activator (Agonist) of Receptor Active Cell Surface Receptor Extracellular Compartment Intracellular Compartment Cellular Response Multiple Signal Transduction Proteins (each is a potential drug target)
  36. 36. HOW DO DRUGS WORK BY INHIBITING SIGNAL TRANSDUCTION PROTEINS? (Some overlap with enzyme inhibitors) Cell Membrane Bound Endogenous Activator (Agonist) of Receptor Active Cell Surface Receptor Extracellular Compartment Intracellular Compartment Blockade or Augmentation of Signal Transduction Pathway by Drug
  37. 37. HOW DO DRUGS WORK BY INHIBITING SIGNAL TRANSDUCTION PROTEINS? KEY CONCEPTS: <ul><li>Signal transduction proteins transmit a chemical signal </li></ul><ul><li>from a receptor to the final biological target. </li></ul><ul><li>Some drugs bind to and inhibit key signal transduction proteins. </li></ul><ul><li>Inhibition of key signal transduction proteins may block or </li></ul><ul><li>augment the signal transduction pathway and this </li></ul><ul><li>mediates the effects of the drug. </li></ul>
  38. 38. <ul><li>Tyrosine Kinase Inhibitors for chronic myelocytic leukemia </li></ul><ul><li>(imatinib [Gleevec ® ]) </li></ul>Some important examples: <ul><li>Type 5 Phosphodiesterase Inhibitors for erectile dysfunction </li></ul><ul><li>(sildenafil [Viagra ® ]) </li></ul><ul><li>This is a major focus of drug development </li></ul>ARE DRUGS THAT INHIBIT SIGNAL TRANSDUCTION PROTEINS CLINICALLY USEFUL?
  39. 39. HOW DO DRUGS WORK BY ACTIVATING ENDOGENOUS PROTEINS? <ul><li>Agonists of Cell Surface Receptors </li></ul><ul><li>Agonists of Nuclear Receptors </li></ul><ul><li>Enzyme Activators </li></ul><ul><li>Ion Channel Openers </li></ul>
  40. 40. HOW DO DRUGS WORK BY ACTIVATING CELL SURFACE RECEPTORS? Cell Membrane Inactive Cell Surface Receptor Extracellular Compartment Intracellular Compartment
  41. 41. HOW DO DRUGS WORK BY ACTIVATING CELL SURFACE RECEPTORS? Cell Membrane Active Cell Surface Receptor Extracellular Compartment Intracellular Compartment Bound Exogenous Agonist of Receptor (Drug) Cellular Response
  42. 42. Footnote: Most agonists attach to binding site on receptor for endogenous agonist and trigger a response. However, agonists may bind to remote site on receptor and cause allosteric effects that increase the ability of an endogenous agonist to bind to or activate the receptor. HOW DO DRUGS WORK BY ACTIVATING CELL SURFACE RECEPTORS?
  43. 43. HOW DO DRUGS WORK BY ACTIVATING CELL SURFACE RECEPTORS? KEY CONCEPTS: <ul><li>Cell surface receptors exist to transmit chemical signals from </li></ul><ul><li>the outside to the inside of the cell. </li></ul><ul><li>Some drugs bind to cell surface receptors and trigger a response. </li></ul><ul><li>Drugs in this group are called receptor agonists. </li></ul><ul><li>Some drug agonists are actually the endogenous chemical signal, </li></ul><ul><li>whereas other drug agonists mimic endogenous chemical signals. </li></ul>
  44. 44. <ul><li>Alpha 1 -Adrenoceptor Agonists for nasal congestion </li></ul><ul><li>(oxymetazoline [Afrin ® ]; phenylephrine [Neosynephrine ® ]) </li></ul>Some important examples: <ul><li>Opioid Receptor Agonists for analgesia </li></ul><ul><li>(morphine; meperidine [Demerol ® ]) </li></ul>ARE DRUGS THAT ACTIVATE CELL SURFACE RECEPTORS CLINICALLY USEFUL?
  45. 45. HOW DO DRUGS WORK BY ACTIVATING NUCLEAR RECEPTORS? Inactive Nuclear Receptor In Cytosolic Compartment Intracellular Compartment Nucleus DNA Inactive Nuclear Receptor In Nuclear Compartment
  46. 46. HOW DO DRUGS WORK BY ACTIVATING NUCLEAR RECEPTORS? Intracellular Compartment Nucleus DNA Modulation of Transcription Active Nuclear Receptor Bound Exogenous Agonist of Receptor (Drug)
  47. 47. HOW DO DRUGS WORK BY ACTIVATING NUCLEAR RECEPTORS? Footnote: Most agonists attach to binding site on receptor for endogenous agonist and trigger a response. However, agonists may bind to remote site on receptor and cause allosteric effects that increase the ability of an endogenous agonist to bind to or activate the receptor.
  48. 48. HOW DO DRUGS WORK BY ACTIVATING NUCLEAR RECEPTORS? KEY CONCEPTS: <ul><li>Nuclear receptors exist to mediate the effects of intracellular, </li></ul><ul><li>endogenous chemicals on gene expression. </li></ul><ul><li>Some drugs bind to nuclear receptors and trigger a response. </li></ul><ul><li>Drugs in this group are called receptor agonists. </li></ul><ul><li>Some drug agonists are actually an endogenous chemical, </li></ul><ul><li>whereas other drug agonists mimic an endogenous chemical. </li></ul>
  49. 49. ARE DRUGS THAT ACTIVATE NUCLEAR RECEPTORS CLINICALLY USEFUL? <ul><li>Estrogen Receptor Agonists for hormone </li></ul><ul><li>replacement therapy in postmenopausal </li></ul><ul><li>women (conjugated equine estrogens [Premarin ® ]) </li></ul>Some important examples: <ul><li>Glucocorticoid Receptor Agonist for inflammation </li></ul><ul><li>(hydrocortisone[Cortef ® ]; dexamethasone [Decadron ® ]) </li></ul>
  50. 50. HOW DO DRUGS WORK BY ACTIVATING ENZYMES? Inactive Enzyme Substrate
  51. 51. HOW DO DRUGS WORK BY ACTIVATING ENZYMES? Active Enzyme Substrate Product Cellular Function Enzyme Activator (Drug)
  52. 52. HOW DO DRUGS WORK BY ACTIVATING ENZYMES? KEY CONCEPTS: <ul><li>Enzymes catalyze the biosynthesis of products from substrates. </li></ul><ul><li>Some drugs bind to enzymes and increase their enzymatic activity. </li></ul><ul><li>Increased biosynthesis of product mediates the </li></ul><ul><li>effects of enzyme activators. </li></ul>
  53. 53. ARE DRUGS THAT ACTIVATE ENZYMES CLINICALLY USEFUL? <ul><li>Activators of Guanylyl Cyclase for angina </li></ul><ul><li>(nitroglycerin; isosorbide dinitrate [Isordil ® ]) </li></ul>Some important examples: <ul><li>Reactivators of Cholinesterase after poisoning with nerve gas </li></ul><ul><li>or organophosphate pesticide </li></ul><ul><li>(pralidoxime [Protopam ® ]) </li></ul>
  54. 54. HOW DO DRUGS WORK BY OPENING ION CHANNELS? Closed Ion Channel Intracellular Compartment Ions (e.g., Ca ++ , Na + ) Ions (e.g., K + ) Binding Site on Ion Channel
  55. 55. HOW DO DRUGS WORK BY OPENING ION CHANNELS? Open Ion Channel Intracellular Compartment Ions (e.g., Ca ++ , Na + , K + ) [Ions] Cellular Response Drug That Opens Ion Channel
  56. 56. HOW DO DRUGS WORK BY OPENING ION CHANNELS? KEY CONCEPTS: <ul><li>Ion channels allow ions to transverse the cell membrane </li></ul><ul><li>through a pore and down an electrochemical gradient. </li></ul><ul><li>Some drugs bind to ion channels and allosterically open </li></ul><ul><li>the ion channel or allosterically render the </li></ul><ul><li>channel more readily opened by </li></ul><ul><li>other endogenous chemicals. </li></ul><ul><li>Changes in the intracellular concentration of ions mediates </li></ul><ul><li>the effects of drugs that open ion channels. </li></ul>
  57. 57. ARE DRUGS THAT OPEN ION CHANNELS CLINICALLY USEFUL? <ul><li>Potassium Channel Openers for hair regrowth </li></ul><ul><li>(minoxidil [Rogaine ® ]) </li></ul>Some important examples: <ul><li>GABA A Chloride Channel Openers for anxiety </li></ul><ul><li>(alprazolam[Xanax ® ]; midazolam [Versed ® ]) </li></ul>
  58. 58. HOW DO DRUGS WORK BY UNCONVENTIONAL MECHANISMS OF ACTION? <ul><li>Disrupters of Structural Proteins </li></ul><ul><li>Drugs that Are Enzymes </li></ul><ul><li>Drugs that Covalently Link to Macromolecules </li></ul><ul><li>Drugs that React Chemically with Small Molecules </li></ul><ul><li>Drugs that Bind Free Molecules or Atoms </li></ul>
  59. 59. HOW DO DRUGS WORK BY UNCONVENTIONAL MECHANISMS OF ACTION (Continued)? <ul><li>Drugs that Are Nutrients </li></ul><ul><li>Drugs that Exert Actions Due to Physical Properties </li></ul><ul><li>Drugs that Work Via an Antisense Action </li></ul><ul><li>Drugs that Are Antigens </li></ul><ul><li>Drugs with Unknown Mechanisms of Action </li></ul>
  60. 60. <ul><li>Vinca Alkaloids for cancer </li></ul><ul><li>(vincristine [Oncovin ® ]; vinblastine [Velban ® ]) </li></ul>Some important examples: <ul><li>Colchicine for gout </li></ul>DO SOME DRUGS DISRUPT STRUCTURAL PROTEINS?
  61. 61. ARE SOME DRUGS ENZYMES? <ul><li>Thrombolytic therapy for acute myocardial infarction </li></ul><ul><li>(alteplase [Activase ® ]) </li></ul>Some important examples:
  62. 62. DO SOME DRUGS COVALENTLY LINK TO MACROMOLECULES? <ul><li>DNA alkylating agents for the treatment of cancer </li></ul><ul><li>(cyclophosphamide [Cytoxan ® ]; chlorambucil [Leukeran ® ]) </li></ul>Some important examples:
  63. 63. DO SOME DRUGS REACT CHEMICALLY WITH SMALL MOLECULES? <ul><li>Antacids that neutralize gastric acid </li></ul><ul><li>(various preparations containing Al(OH) 3 , Mg(OH) 2 or CaCO 3 ) </li></ul>Some important examples:
  64. 64. DO SOME DRUGS BIND FREE MOLECULES OR ATOMS? <ul><li>Bile-Acid Sequestrants for hypercholesterolemia </li></ul><ul><li>(cholestyramine [Questran ® ]) </li></ul>Some important examples: <ul><li>Chelating Agents for heavy metal poisoning </li></ul><ul><li>(dimercaprol; penicillamine) </li></ul><ul><li>Proteins that bind TNF- α for rheumatoid arthritis </li></ul><ul><li>(infliximab [Remicade®]; etanercept [Enbrel®]) </li></ul>
  65. 65. ARE SOME DRUGS NUTRIENTS? <ul><li>Vitamins, minerals, lipids, carbohydrates, aminoacids </li></ul>Some important examples:
  66. 66. DO SOME DRUGS EXERT ACTIONS DUE TO PHYSICAL PROPERTIES? <ul><li>Bulk Laxatives for constipation </li></ul><ul><li>(psyllium [Metamucil ® ]; polycarbophil [Fibercon ® ] </li></ul>Some important examples: <ul><li>Osmotic Diuretics for edema </li></ul><ul><li>(mannitol) </li></ul>
  67. 67. DO SOME DRUGS WORK VIA AN ANTISENSE ACTION? <ul><li>Antisense Deoxyoligonucleotides for cytomegalovirus retinitis </li></ul><ul><li>in patients with AIDS </li></ul><ul><li>(fomivirsen [Vitravene ® ] </li></ul>An important example: <ul><li>This is a major focus of drug development </li></ul>
  68. 68. ARE SOME DRUGS ANTIGENS? Some important examples: <ul><li>Vaccines </li></ul>
  69. 69. IS THE MECHANISM OF ACTION OF SOME DRUGS UNKNOWN? <ul><li>Inhalation Anesthetics for general anesthesia </li></ul><ul><li>(Isoflurane [Forane ® ]; Sevoflurane [Ultane ® ] </li></ul>Some important examples:
  70. 70. HOW DO DRUGS WORK? Now you know!!

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