7. Dr.RameshBhandari
NO
Because of SINK
Condition Diluted in blood
Distributed in tissues
Protein bound
Metabolized &
Excreted
So, the concentration of the GIT is always greater
than the concentration of the drug in blood.
12. Dr.RameshBhandari
Excretion
Excretory
Route
Mechanism Drug Excreted
Urine Free, Hydrophilic, Unchanged Drugs or
metabolites of MW < 300
Bile Active Secretion Hydrophilic, Unchanged Drugs or
metabolites of MW > 500
Lung Passive
Diffusion
Gaseous and volatile, Blood and tissue
insoluble drugs
Saliva Passive
Diffusion
Active Transport
Free, unionized, lipophilic drugs, some
polar drugs
Milk Passive
Diffusion
Free, unionized, lipophilic drugs (basic)
13. Dr.RameshBhandari
A drug’s effect its concentration
at the SITE OF ACTION
Is it PRACTICABLE to measure the
drug concentration in the
RECEPTOR SITES / TISSUES??
Depends on
15. Dr.RameshBhandari
Then, How to Measure
Drug Concentration??
Answer is:
Kinetic Homogeneity
It describes the predictable relationship
between plasma drug concentration and
concentration at the receptor site.
16. Dr.RameshBhandari
Changes in the plasma drug
concentration reflect
Proportional changes in the
drug concentration in other
tissues.
20. Dr.RameshBhandari
Pharmacokinetic homogeneity is the foundation
on which all therapeutic and toxic plasma drug
concentrations are established.
When studying concentration of drug in plasma,
we assume that these plasma concentrations
directly relate to concentrations in tissues where
the disease is to be modified by the drug. (e.g.
CNS in parkinson’s disease and bone in
osteomyelitis)
However this may not be true for all drugs.
21. Dr.RameshBhandari
Clinical Correlation
Drugs concentrate in some tissues because
of physical or chemical properties.
Examples: digoxin, which concentrates in
the myocardium,
and
lipid-soluble drugs such as benzodiazepines,
which concentrate in fat.
22. Dr.RameshBhandari
Pharmacodynamics
It refers to the relationship
between drug concentration at the
site of action and the resulting
effect, including the time course
and intensity of therapeutic and
adverse effects.
23. Dr.RameshBhandari Pharmacodynamics in relation with
Pharmacokinetics
50%
100%
1
0
100
Fig: Plasma Drug Concentration at the receptor site to effect
Plasma Drug Concentration
(mg/ml)
Effect(%)
24. Dr.RameshBhandari
Clinical Pharmacokinetics
Clinical Pharmacokinetics is the application of the
pharmacokinetic principles, using drug
concentration and pharmacodynamic criteria to
optimize drug therapy in individual patient.
Application of pharmacokinetic principles to the safe
and effective therapeutic management of the drugs in
patient.
Applied pharmacokinetics is a broader term.
25. Dr.RameshBhandari Applications of Clinical
Pharmacokinetics
TDM
Dosage Adjustment in an individual patient
Formulation development: BA/BE, ADME
studies
Drug development process: Deciding Dosage
regimen
Rational Drug design
26. Dr.RameshBhandari Linear versus Nonlinear
Pharmacokinetics
When drugs are given in a constant
basis, such as continuous intravenous
infusion or an oral medication given
every 12 hours, serum drug
concentrations increases until the rate
of drug administration equals the rate
of drug elimination.
27. Dr.RameshBhandari
When the rate of drug administration
equals the rate of drug elimination, the
amount of drug contained in the body
reaches a constant value. This
equilibrium condition is known as
steady state.
28. Dr.RameshBhandari
If a steady state concentration versus
dose yields a straight line, the drug is
said to follow Linear pharmcokinetics.
In this situation steady state serum
concentration increases or decreases
proportionally with dose.
29. Dr.RameshBhandari
When steady state concentration
change in a disproportionate fashion
after the dose is altered, a plot of steady
state concentration versus dose is not a
straight line and the drug is said to
follow non-linear pharmacokinetics.
34. Dr.RameshBhandari If patient has no drug in the body then can
administer an amount called loading dose to
achieve a given Atarget and Dp(target).
Since loading dose must provide Atarget
amount of drug in body, since not all
administered dose is absorbed.
LD*B = Atarget then LD = Atarget / B
LD = Vd * Dp / B
35. Dr.RameshBhandari
LD = Vd * Dp
B
The amount of drug that must be
given to achieve rapidly a target
concentration of the drug in the
plasma is solely depends on Vd, B
and Dp.
36. Dr.RameshBhandari Vd is easily obtained
Give bolus of
drug.
Measure plasma
levels overtime.
Extrapolate to
find plasma level
at time 0.
Vd = DoseIV / Dp
0
Dp
0
1
2
3
4
5
6
4 8 12 16 20 24
Time (in hours)LogDp(mcg/ml)
37. Dr.RameshBhandari Examples of using Vd to calculate
LD
Pharmacokinetic Parameter
for digoxin
Dp(target) = 1.5 mcg
Vd = 580 L
Oral Bioavailability = 0.7
Calculate LD?
39. Dr.RameshBhandari
Concept of Clearance
Clearance determines the maintenance
dose (MD) that is required to obtain a
given steady-state serum concentration
(Css).
MD = Css.Cl
40. Dr.RameshBhandari How does Clearance influence
Dp
ss
According to definition,
Steady state is said to exist when:
Rate of Drug Administration = Rate of drug elimination
41. Dr.RameshBhandari
Rearranging equation of Cl,
Dp = Rate of drug Elimination
Cl
Applying steady state in above Cl equation,
Dp
ss = Rate of drug Elimination at steady state
Cl
42. Dr.RameshBhandari Applying steady state in above Cl equation,
Dp
ss = R0 (Rate of drug administration = rate of drug elimination)
Cl
Maintenance dose = amount of drug taken at regular
intervals
Dosing interval = Time between MDs
Bioavailability = fraction of dose absorbed in systemic
circulation
43. Dr.RameshBhandari
Rate of drug administration = Amount of drug delivered to the systemic circulation
Time
R0 = B x MD
DI
Then substituting value of R0 in steady state equation of Cl,
Dp
ss = B x MD
DI x Cl
Hence, Dp
ss wont depend on absolute value of MD and DI
but it will depend on ratio of MD and DI