The document discusses various Phase II biotransformation reactions. It describes conjugation reactions like conjugation with glucuronic acid, sulphate moieties, alpha amino acids, and glutathione. Conjugation with glucuronic acid is the most common reaction where glucuronic acid is attached to form glucuronides. Conjugation with sulphate occurs less frequently. Amino acid conjugation forms amide bonds between carboxylic acids and amino acids like glycine. These conjugation reactions make compounds more polar and water soluble for excretion.
Metabolic Changes of Drugs and Related Organic Compounds describes the human metabolic processes of various functional groups found in therapeutic agents.
The importance of a chapter on metabolism lies in the fact that drug interactions are based on these processes.
For pharmacists, it is necessary for them to understand why certain drugs are contraindicated with other drugs.
This chapter attempts to describe the various phases of drug metabolism, the sites where these biotransformation will occur, the role of specific enzymes, metabolism of specific functional groups, and several examples of the metabolism of currently used therapeutic agents.
Metabolic Changes of Drugs and Related Organic Compounds describes the human metabolic processes of various functional groups found in therapeutic agents.
The importance of a chapter on metabolism lies in the fact that drug interactions are based on these processes.
For pharmacists, it is necessary for them to understand why certain drugs are contraindicated with other drugs.
This chapter attempts to describe the various phases of drug metabolism, the sites where these biotransformation will occur, the role of specific enzymes, metabolism of specific functional groups, and several examples of the metabolism of currently used therapeutic agents.
The phenomenon of complex formation of drug with protein is called as Protein drug binding. The proteins are particularly responsible for such an interaction. A drug can interact with several tissue components.
Biopharmaceutics: Mechanisms of Drug AbsorptionSURYAKANTVERMA2
Biopharmaceutics is defined as the study of factors influencing the rate and amount of drug that reaches the systemic circulation and the use of this information to optimise the therapeutic efficacy of the drug products.
The phenomenon of complex formation of drug with protein is called as Protein drug binding. The proteins are particularly responsible for such an interaction. A drug can interact with several tissue components.
Biopharmaceutics: Mechanisms of Drug AbsorptionSURYAKANTVERMA2
Biopharmaceutics is defined as the study of factors influencing the rate and amount of drug that reaches the systemic circulation and the use of this information to optimise the therapeutic efficacy of the drug products.
Dr. Dhiraj J. Trivedi presenting Lecture on Carbohydrate metabolism for medical students.
Professor, SDM College of Medical Sciences, Dharwad, Karnataka, India
Conjugation reaction phase ii-metabolism,,according to pci syllbusPriyanka Mittal
phase II biotransformation
When phase I reactions are not producing sufficiently hydrophilic (water soluble) or inactive metabolites, the drugs or metabolites formed from phase I reaction undergoes phase II reactions
Mayur metabolism/certified fixed orthodontic courses by Indian dental academyIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Carbohydrates are the sugars, starches and fibers found in fruits, grains, vegetables and milk products. Though often maligned in trendy diets, carbohydrates — one of the basic food groups — are important to a healthy diet.
Vías de utilización de la glucosa como la glucólisis, vías de degradación de pentosas por organismos eucariotas y procariotas, bacterias, hongos y virus para alumnos de las carreras de medicina, biotecnología , biología, enfermería, veterinaria y cualquier estudiante relacionado con el área de la salud que le interese la rama de la bioquímica y las vías alternativas a la glucólisis
Upon completion of module on Google classroom you will able to
1. Understand concept of Google Classroom.
2. Create your own class using Google Classroom.
3. Invite students and teachers to join Google Class.
4. Add topics and course content in Classroom.
5. Create and conduct assignments for students.
6. Post announcements and notices.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Phase II Reactions in
Biotransformation
Mr. K. K. Mali
Assistant Professor,
YSPM’s Yashoda Technical Campus,
Faculty of Pharmacy, Satara
2. Content
• Introduction of biotransformation
• Phase II Reactions
• Conjugation with glucuronic acid
• Conjugation with sulphate moieties
• Conjugation with alpha amino acids
• Conjugation with glutathione and mercapturic acid
formation
• Acetylation reaction
• Methylation reaction
• Miscellaneous conjugation reactions
April 13, 2018 2Phase II Reactions In Biotransformation
3. Content
• Factors affecting biotransformation of drugs
• Physicochemical properties of drug
• Chemical factors
• Induction of drug metabolising enzymes
• Inhibition of drug metabolising enzymes
• Environmental factors chemicals
• Biological factors
• Species differences
• Strain differences
• Sex differences
• Age
• Diet
April 13, 2018 3Phase II Reactions In Biotransformation
4. Content
• Factors affecting biotransformation of drugs
• Altered physiological factors
• Pregnancy
• Hormonal imbalance
• Diseased states
• Temporal factors
• Circadian rhythm
April 13, 2018 4Phase II Reactions In Biotransformation
6. Introduction of biotransformation
April 13, 2018 6Phase II Reactions In Biotransformation
• True detoxification reaction
• Phase II metabolites are
• Highly polar
• Free from pharmacological activity
• Non-carcinogenic due to conjugation
7. Phase II reactions
• Phase II metabolites are
• Attachment of small polar endogenous molecules such as glucuronic acid,
sulfate and amino acids to Phase I metabolites or parent drugs
• Products are more water-soluble and easily excretable
• Trapping highly electrophilic molecules with endogenous nucleophiles
such as glutathione prevent damage to important macromolecules (DNA,
RNA, proteins)
• Regarded as true detoxifying pathway (with few exceptions)
• In general, appropriate transferase enzymes activate the transferring group
(glucuronate, sulphate, methyl, acetyl) in a coenzyme form
April 13, 2018 7Phase II Reactions In Biotransformation
8. Phase II reactions
Characteristics of conjugation reactions
• Initial activation step
Drug is activated
or
Conjugating reagent activated
• Capacity limited reaction
a. Limited amount of conjugating reagent
b. Limited amount of enzyme
Order of capacity limited reaction
Glucuronidation > Amino acid conjugation > Sulphation and Glutathione conjugation
April 13, 2018 8Phase II Reactions In Biotransformation
9. Phase II reactions
Phase II reactions and their characteristics
April 13, 2018 9Phase II Reactions In Biotransformation
Conjugation
reaction
Conjugating
Agent
Enzyme
involved
Activated
intermediate
Functional
groups
Glucuronidation Glucuronic Acid UDP-glucuronyl
transferase
UDPGA -OH, -COOH,
-NH2, -SH
Sulphation Sulphate Sulpho
transferase
PAPS -OH, -NH2
Amino Acid Glycine Acyl
transferase
Acyl CoA -COOH, NH2
Glutathione Glutathione Glutathione-S
transferase
- Alkyl halide, alkyl
nitrate, alkyl
epoxide, etc
Acetylation Acetyl CoA N-Acetyl
Transferase
Acetyl CoA Hydrazines, -
NH2, -SO2NH2
Methylation L-Methionine Methyl
Transferase
S-adenosyl
Methionine
-OH,
-NH2, -SH
10. • Glucuronidation is the most common conjugation pathway
• The coenzyme, UDP glucuronic acid is synthesized from the corresponding
phosphate
• UDP-glucuronic acid contains D-glucuronic acid in the a-configuration at the
anomeric center, but glucuronate conjugates are b-glycoside, meaning inversion
of stereochemistry is involved in the glucuronidation
• Glucuronides are highly hydrophilic and water soluble
• UDP glucuronosyl transferase is closely associated with Cyp450 so that Phase I
products of drugs are efficiently conjugated
• Four general classes of glucuronides: O-, N-, S-, and C-
• Neonates have undeveloped liver UDP-glucuronosyl transferase activity, and
may exhibit metabolic problem. For example, chloramphenicol (Chloroptic)
leads neonates to “gray baby syndrome”
• Neonatal jaundice may be attributable to their inability to conjugate bilirubin
with glucuronic acid
Conjugation with glucuronic acid
11. Conjugation with glucuronic acid
1. Catalysed by microsomal enzymes.
2. Dominates at high substrate concentration
3. Most common phase II reaction. Why?
April 13, 2018 11Phase II Reactions In Biotransformation
12. Conjugation with glucuronic acid
Steps in glucuronidation formation
1. Synthesis of activated coenzyme UDPGA
2. Transfer of glucuronyl moiety from UDPGA to substrate RXH
April 13, 2018 12Phase II Reactions In Biotransformation
pyrophosphorylase
-D-Glucose-1-phosphate + UTP UDPG + PPi
UDPG-dehydrogenase
UDPG + 2NAD+ + H2O UDPGA + 2NADH +2H+
UDP-glucuronyl transferase
UDPGA + RXH RX-glucuronic acid + UDP
Where, X = O, COO, NH or S
14. Conjugation with glucuronic acid
1. O-glucuronide conjugation
a. OH compounds
Ex. Alcohol:- Chloramphenicol
Phenol:- Morphine, paracetamol
b. COOH compounds
Ex. Salicylic acid
2. N-glucuronide conjugation
Ex. Desimipramine, Meprobamate
3. S-glucuronide conjugation
Ex. Thiophenol
4. C-glucuronide conjugation
Ex. Phenylbutazone
April 13, 2018 14Phase II Reactions In Biotransformation
15. Conjugation with glucuronic acid
• O-Glucuronide: Phenols
Acetaminophen Morphine
April 13, 2018 Phase II Reactions In Biotransformation 15
OH
CH3
O
H
N
HO OH
N
O
CH3
16. Conjugation with glucuronic acid
• O-Glucuronide: Alcoholes
Chloramphenicol Propranolol
April 13, 2018 Phase II Reactions In Biotransformation 16
O2N
Cl
Cl
O
H
N
OH
OH
H
CH3
CH3
OH
NO
17. Conjugation with glucuronic acid
• O-Glucuronide: Enols
Hydroxycoumarine
April 13, 2018 Phase II Reactions In Biotransformation 17
O O
OH
18. Conjugation with glucuronic acid
• O-Glucuronide: N-hydroxyamines/amides
N-hydroxydapsone N-Hydroxy-2-
acetylaminoflourene
April 13, 2018 Phase II Reactions In Biotransformation 18
S
O2
H2N NHOH
N
CH3
OH
19. Conjugation with glucuronic acid
• O-Glucuronide:
April 13, 2018 Phase II Reactions In Biotransformation 19
Aryl acids
Salicylic Acid
Arylalkyl Acids
Fenoprofen
O
OH
O
CH3
OH
COOH
20. Conjugation with glucuronic acid
• N-Glucuronide:
April 13, 2018 Phase II Reactions In Biotransformation 20
Arylamine
7-Amino-5-nitroindazole
N
H
N
NH2
O2N
Alkylamines
Desipramine
N
H
CH3
N
21. Conjugation with glucuronic acid
• N-Glucuronide:
April 13, 2018 Phase II Reactions In Biotransformation 21
Sulphonamides
Sulfisoxazole
OO
H2N
N
H
S
CH3
CH3
N
O
H3C
O
NH2
NH2
H3C O
O
O
Amides
Meprobamate
22. Conjugation with glucuronic acid
• N-Glucuronide:
April 13, 2018 Phase II Reactions In Biotransformation 22
Amitryptiline
3o Amines
Cyproheptadine
CH3N
3o Amines
23. Conjugation with glucuronic acid
• N-Glucuronide:
April 13, 2018 Phase II Reactions In Biotransformation 23
Cotinine
Aromatic Amine
24. Conjugation with glucuronic acid
• S-Glucuronide:
April 13, 2018 Phase II Reactions In Biotransformation 24
Sulfhydryl
Methimazole
Carbodithioic acid
Disulfirum
(reduced form)
CH3
HS
N
N
H3C
H3C
S
SH
N
25. Conjugation with glucuronic acid
• C-Glucuronide:
April 13, 2018 Phase II Reactions In Biotransformation 25
Phenylbutazone
CH3
O
O
N
N
26. Conjugation with glucuronic acid
Example: Benzoic acid
April 13, 2018 26Phase II Reactions In Biotransformation
Water Soluble, Excreted
27. Conjugation with sulphate moiety
• Occurs less frequently than does glucuronidation presumably due to
fewer number of inorganic sulfates in mammals and fewer number
of functional groups (phenols, alcohols, arylamines and N-hydroxy
compounds)
1. Catalysed by nonmicrosomal enzymes
2. Less common
3. Dominates at low substrate concentration
April 13, 2018 27Phase II Reactions In Biotransformation
28. Conjugation with sulphate moiety
Steps in Sulphate Conjugation
1. Synthesis of activated coenzyme PAPS
2. Transfer of sulphate moiety from PAPS to substrate RXH
April 13, 2018 28Phase II Reactions In Biotransformation
ATP-sulfurylase/Mg++
ATP + SO4
2- APS + PPi
APS-phosphokinase/Mg++
APS + ATP PAPS + ADP
Sulfotransferase
PAPS + RXH RX-SO3 + PAP
Where, X = O, NH
29. Conjugation with sulphate moiety
Three enzyme-catalyzed reactions are involved in sulfate
conjugation
April 13, 2018 29Phase II Reactions In Biotransformation
S
O
O
-
O O-
ATP PPi
Mg+2
ATP sulfurylase
Sulfate
O
OP
O
O-
OS
O
O
-
O
Ad
HO OH
Adenosine-5'-
phosphosulfate (APS)
Mg
+2
APS phosphokinase
O
OP
O
O-
OS
O
O
-
O
Ad
-2
O3PO OH
ATP ADP
3'-phosphoadenosine-5'-
phosphosulfate (PAPS)
PAP
Sulfotransferase
RXH
S
O
O
-
O XR
Sulfate
conjugate
(soluble)
30. Conjugation with sulphate moiety
• Phenolic sulfation predominates
• Phenolic O-glucuonidation competes favorably with sulfation due to
limited sulfate availability
• Sulfate conjugates can be hydrolyzed back to the parent compound by
various sulfatases
• Sulfoconjugation plays an important role in the hepatotoxicity and
carcinogenecity of N-hydroxyarylamides
• In infants and young children where glucuronyltransferase activity is
not well developed, have predominating O-sulfate conjugation
• Examples include: a-methyldopa, albuterol, terbutaline,
acetaminophen, phenacetin, phenol (salbutamol, paracetamol),
amines (aniline)
April 13, 2018 30Phase II Reactions In Biotransformation
31. Conjugation with sulphate moiety
• Examples
April 13, 2018 31Phase II Reactions In Biotransformation
COOHH3C
H
H
N
HO
HO HO CH3
HO
CH3
CH3
HOH
N
-Methyldopa
CH3
CH3
CH3
OH
HOH
NHO
Albuterol Terbutaline
32. Conjugation with sulphate moiety
Conversion of Minoxidil to Minoxidil Sulphate
April 13, 2018 32Phase II Reactions In Biotransformation
Minoxidil Monoxidil Sulphate
33. Conjugation with alpha amino acids
• The first mammalian drug metabolite isolated, hippuric acid, was the
product of glycine conjugation of benzoic acid
• Amino acid conjugation of a variety of caroxylic acids, such as
aromatic, arylacetic, and heterocyclic carboxylic acids leads to amide
bond formation
• Glycine conjugates are the most common
• Taurine, arginine, asparagine, histidine, lysine, glutamate, aspartate,
alanine, and serine conjugates have also been found
April 13, 2018 33Phase II Reactions In Biotransformation
COH
R O
Benzoic Acid, R = H
Salicylic Acid, R = OH
CONHCH2COH
R O O
Hippuric Acid, R = H
Salicyluric Acid, R = OH
34. Conjugation with alpha amino acids
Less common due to limited number of amino acids
Steps:
1. Activation of carboxylic acid drug substrate
2. Acetylation of amino acid
April 13, 2018 34Phase II Reactions In Biotransformation
Acyl synthetase
RCOOH + ATP RCOAMP + H2O + PPi
Acyl CoA transferase
RCOAMP + CoASH RCOSCoA + AMP
N-acyl transferase
RCOSCoA + H2N-R’ -COOH RXH RCONH-R’-COOH + CoASH
Where, R’ = -CH2 If glycine, CH-CH2-CH2-NH2 if glutamine
35. Conjugation with alpha amino acids
Mechanism of Amino Acid conjugation
Examples:
1. Aryl acid: Salicylic acid
2. Heterocyclic aryl acid: Nicotinic acid
April 13, 2018 35Phase II Reactions In Biotransformation
An Acyl-CoA Intermediate
Glycine Conjugate R = H
Glutamine Conjugate R = CH2CH2CONH2
Drug-COOHDrug-COOH
36. Conjugation with alpha amino acids
Brompheniramine Metabolism
April 13, 2018 36Phase II Reactions In Biotransformation
Br
N
N
CH3
CH3
P450
Br
N
NH
CH3
P450
Br
N
NH2
P450
Br
N CHO
Br
N
N
CH3
CH3
Br
N
O
H
N COOH
Br
N COOH
Brompheniramine
Aldehyde
dehydrogenase
Glycine
N-acyltransferase
Carboxylic Acid metabolite
Brompheniramine N-oxide Glycine conjugate
37. Conjugation with glutathione
April 13, 2018 Phase II Reactions In Biotransformation 37
Structure of glutathione
• Glutathione is a tripeptide (Glu-Cys-Gly) – found virtually in all
mammalian tissues
• Its thiol functions as scavenger of harmful electrophilic parent drugs
or their metabolites
• Examples include SN2 reaction, SNAr reaction, and Michael addition
38. Conjugation with glutathione
Mechanisms of GSH conjugation
1. Nucleophilic substitution
RX + GSH R-S-G + H+ + x-
Ex. Sulphates, Organophosphates
2. Nucleophilic addition
R-CH=CH-R’ + GSH RCH-S-G-CH2-R’
Ex. Paracetamol
April 13, 2018 38Phase II Reactions In Biotransformation
42. Mercapturic acid Conjugate
April 13, 2018 42Phase II Reactions In Biotransformation
N
H
H
N
NH2
O
S
O
O
HO
O
OH
Drug Amino Acid
(AA)
-Glutamyl
transpeptidase
-Glutamyl-AA
NH2
H
N
S
O
O
HO
Drug
Glutathione Conjugate
Glycine
Cysteinyl
Glycinase
NH2
HO
S
O
Drug
S-substituted
Cysteine
Derivative
Acetyl
CoA CoASH
N
H
H2N
S
O
Drug
CH3
O
Mercapturic
acid conjugate
43. Acetylation reaction
• Metabolism for drugs containing a primary amino group,
(aliphatic and aromatic amines), amino acids, sulfonamides,
hydrazines, and hydrazides
• The function of acetylation is to deactivate the drug, although
N-acetylprocainamide is as potent as the parent antiarrhythmic
drug procainamide (Procanbid) or more toxic than the parent
drug, e.g., N-acetylisoniazid
• Examples:
Aliphatic amines: Histamine
Aromatic amines: PAS, PABA, Dapsone
Sulphonamide: Sulphanilamide, Sulphapyridine
Hydrazides: Isoniazide
April 13, 2018 43Phase II Reactions In Biotransformation
44. Acetylation reaction
• Acetylation is two-step, covalent catalytic process involving N-
acetyl transferase
April 13, 2018 44Phase II Reactions In Biotransformation
H3C SCoA
O CoASH
H3C X
O
H2N R
X-
H3C
O
NHR
X-
N-Acetylation of amines
46. Acetylation reaction
• Acetylation of Procainamide
April 13, 2018 46Phase II Reactions In Biotransformation
H2N
O
N
H
N N
O
N
H
N
O
H
Procainamide NAPA
Urine 85%
47. Methyl conjugation
Characteristics:
1. Metabolites formed are not polar
2. Drug and metabolite having equal pharmacological activity
3. Less important for xenobiotics
4. Important in biosynthesis of endogenous amines, ex.
Adrenaline, while as inactivation of endogenous amines, ex.
NA, 5-HT, Histamine
April 13, 2018 47Phase II Reactions In Biotransformation
48. Methyl conjugation
• Minor conjugation pathway, important in biosynthesis of
epinephrine and melatonin; in the catabolism of norepinephrine,
dopamine, serotonin, and histamine; and in modulating the
activities of macromolecules (proteins and nucleic acids)
• Except for the formation of quarternary ammonium salts,
methylation of an amine reduces the polarity and hydrophilicity of
the substrates
• A variety of methyl transferase, such as COMT (catechol O-methyl
transferase), phenol-O-methyltransferase, N-methyl transferase, S-
methyltransferase etc are responsible for catalyzing the transfer of
methyl group from SAM to RXH
April 13, 2018 48Phase II Reactions In Biotransformation
49. Methyl conjugation
Steps in methyl conjugation
1. Synthesis of an activated coenzyme SAM
2. Transfer of methyl group from SAM to substrate
April 13, 2018 49Phase II Reactions In Biotransformation
50. Methyl conjugation
Examples
1. O-methylation: Morphine, L-DOPA
2. N-methylation: Normorphine, Nicotine
3. S-methylation: Propylthiouracil, 6-mercaptopurine
April 13, 2018 50Phase II Reactions In Biotransformation
51. Fatty Acid and Cholesterol Conjugation
• Hydroxyl-containing drugs can undergo conjugation with a wide range of
endogenous fatty acids such as saturated acids from C10 to C16 and
unsaturated acids such as oleic and linoleic acids
• Cholesterol ester metabolites have been detected for drugs containing
either an ester or a carboxylic acid
April 13, 2018 51Phase II Reactions In Biotransformation
HO
O
O
O
O
N
Cl
Cl
OH
Cl O (CH2)10 COOH
Prednimustine
Fatty Acid
Cholesterol
52. Miscellaneous conjugation reactions
1. Conjugation of cyanide
2. Conjugation with ribose
Purine/Pyrimidine + Ribose Nucleotides
3. Conjugation with Taurine
Bile acid + Taurine Bile
April 13, 2018 52Phase II Reactions In Biotransformation
53. Factors affecting biotransformation of drug
1. Physicochemical properties
of drug
2. Chemical factors
a. Enzyme Induction
b. Enzyme Inhibition
c. Environmental factors
3. Biological factors
April 13, 2018 53Phase II Reactions In Biotransformation
54. Factors affecting biotransformation of drug
April 13, 2018 54Phase II Reactions In Biotransformation
Factor Reaction type
Age (newborns,
children,
elderly)
Decreasing of metabolism speed
Pregnancy Increasing of metabolism speed
Genetic factor Various reactions
Liver pathology Decreasing of excreation speed of drugs, depending on their kinetics,
type and stage of liver disease, increasing of bioavailability and
decreasing of excretion speed of orally administered drugs with high
hepatic clearence
GI pathology Changes in metabolism in GI epithelium
Nutrition
character
Increasing of metabolism speed of certain drugs in case of diet with
dominance of proteins and carbohydrates
Decreasing of metabolism speed in case of heavy digestive disorders
linked with starvation (total or protein)
55. Factors affecting biotransformation of drug
April 13, 2018 55Phase II Reactions In Biotransformation
Environment Increasing of metabolism speed if in contact with chlorine
insecticides
Alcohol
— one time
consumption
Depressing of enzymes that metabolise drugs
— chronic
consumption
Induction of enzyme system
Smoking Increasing of metabolism of certain drugs (i.e. theophyllin)
Way of excretion Metabolism in liver before entering system circulation (first
going-through effect) after peroral administration of drugs
Time of introduction
of drugs
Circade changes in drugs metabolism
Interaction of drugs Stimulation and depression of enzyme reaction
56. Factors affecting biotransformation of drug
• Physicochemical properties of drug
• Molecular size and shape
• pKa
• Acidity/ Basicity
• Liphophilicity
• Steric and electronic characteristics
• The chemical structure (the absence or presence of certain functional
groups) of the drug determines its metabolic pathways.
April 13, 2018 56Phase II Reactions In Biotransformation
57. Factors affecting biotransformation of drug
• Physicochemical properties of drug
• Steric and electronic characteristics
April 13, 2018 57Phase II Reactions In Biotransformation
58. Factors affecting biotransformation of drugs
• Enzyme induction
• Increased drug metabolising ability of the enzymes by drug
• Properties of enzyme inducers
1. Lipophilic
2. Long half life
• Mechanism of enzyme induction
• Increased liver size and blood flow
• Increased total and microsomal protein content
• Increased stability of enzymes
• Increased synthesis of cytochrome P450
April 13, 2018 58Phase II Reactions In Biotransformation
59. Factors affecting biotransformation of drugs
• Enzyme induction
• Classification of enzyme inducers
1. Phenobarbital type inducers
Ex. Phenytoin, warfarin etc.
2. Polycyclic hydrocarbon type inducers
Ex. Cigarette smoking can cause increased metabolism and
elimination of theophylline.
• Autoinduction
Ex. Carbamazepine, Meprobamate, Rifampicin
April 13, 2018 59Phase II Reactions In Biotransformation
60. Factors affecting biotransformation of drugs
• Enzyme induction
• Consequences of enzyme induction
• Increased rate of metabolism
• Decrease in drug plasma concentration
• Enhanced oral first pass metabolism
• Reduced bioavailability
• If metabolite is active or reactive, increased drug
effects or toxicity
April 13, 2018 60Phase II Reactions In Biotransformation
62. Factors affecting biotransformation of drugs
• Enzyme inhibition
• Decrease in the drug metabolising ability
• Classification of enzyme inhibition
• Direct inhibition
• Competitive inhibition
• Non-Competitive inhibition
• Product inhibition
• Indirect Inhibition
• Repression
• Altered physiology
April 13, 2018 62Phase II Reactions In Biotransformation
63. Factors affecting biotransformation of drugs
• Enzyme inhibition
• Direct inhibition
• Competitive inhibition
Ex. Methacholine inhibit metabolism of Ach for choline esterase
• Non-Competitive inhibition
Ex. INH inhibit metabolism of Phenytoin
• Product inhibition
Ex. Xanthine oxidase inhibitor such as allopurionol
• Indirect Inhibition
• Repression
Ex. Disulphiram
• Altered physiology
Due to nutritional deficiency or hormonal imbalance
April 13, 2018 63Phase II Reactions In Biotransformation
64. Factors affecting biotransformation of drugs
• Enzyme inhibition
• Consequences of Enzyme Inhibition
• Increase in the plasma concentration of parent drug
• Reduction in metabolite concentration
• Exaggerated and prolonged pharmacological effects
• Increased liklihood of drug-induced toxicity
April 13, 2018 64Phase II Reactions In Biotransformation
65. Factors affecting biotransformation of drugs
• Enzyme inhibition
“Enzyme inhibition is more important clinically than enzyme induction for drugs
having narrow therapeutic index.”
April 13, 2018 65Phase II Reactions In Biotransformation
66. Factors affecting biotransformation of drugs
• Biological Factors
• Species differences
• Strain differences
• Sex differences
• Age
• Diet
• Altered physiological factors
• Pregnancy
• Hormonal imbalance
• Disease states
• Temporal factor
• Circadian rhythm
April 13, 2018 66Phase II Reactions In Biotransformation
67. Factors affecting biotransformation of drugs
• Biological Factors
• Species differences
April 13, 2018 67Phase II Reactions In Biotransformation
68. Factors affecting biotransformation of drugs
• Biological Factors
• Species differences
• Phenylbutazone half-life is 3 h in rabbit, ~6 h in rat, guinea pig, and
dog and 3 days in humans.
• Strain differences
• Isoniazid is known to be acetylated by N-acetyltransferase into
inactive metabolite.
• The rate of acetylation in asian people is higher or faster than
that in eurpoean or north american people. Fast acetylators are
more prone to hepatoxicity than slow acetylator.
• Isoniazide (fast (Whites) and slow (Eskimos) acetylators)
April 13, 2018 68Phase II Reactions In Biotransformation
69. Factors affecting biotransformation of drugs
• Biological Factors
• Sex differences
• Responsiveness to certain drugs is different for men and
women
• Males shows greater metabolism than female
• Hormonal changes during development have a profound effect
on drug metabolism
• Metabolism of Diazepam, caffiene, and paracetamol is faster in
females than in males while oxidative metabolism of lidocaine,
chordiazepoxide are faster in men than in females
April 13, 2018 69Phase II Reactions In Biotransformation
70. Factors affecting biotransformation of drugs
• Biological Factors
• Age
• Neonates: (0-2 months)
• Slow biotransformation
• Drug eliminated as unchanged
• Caffene- Half life 4 d
• Chloramphenicol- Gray baby syndrome or cyanosis
• Sulphonamides- Renal toxicity
• Paracetamol - Hepatotoxicity
• Infants: (2 months to one year)
• Same as neonates with improved enzyme activity.
April 13, 2018 70Phase II Reactions In Biotransformation
71. Factors affecting biotransformation of drugs
• Biological Factors
• Age
• Children : (1-12 years)
• Fast biotransformation
• Require large dose of drug
• Elderly person:
• Liver size reduced
• Blood flow decreased
• Enzyme activity decreased
• Drug conjugation not affected
April 13, 2018 71Phase II Reactions In Biotransformation
72. Factors affecting biotransformation of drugs
• Biological Factors
• Diet
• Low protein diet decreases drug metabolising ability.
• High protein diet increases drug metabolising ability.
• High protein-carbohydrate ratio increases MFO activity.
• Fat free diet decreases CYP 450 levels.
• Vitamin deficiency of A,C,E, and B can result in a
decrease of oxidative pathway in case of vitamin C
deficiency , while vitamin E deficiency decreases
dealkylation and hydroxylation.
• Ca, Mg, Zn deficiencies decreases drug metabolism
capacity whereas Fe deficiency increases it.
April 13, 2018 72Phase II Reactions In Biotransformation
73. Factors affecting biotransformation of drugs
• Biological Factors
• Diet
• Essential fatty acid (esp. Linoleic acid) deficiency reduce
the metabolism of ethyl morphine and hexobarbital by
decreasing certain drug-metabolizing enzymes.
• Grapefruit juice decrease metabolism of many drugs.
• Starvation- decreases amount of glucuronide formation.
• Malnutrition in women- increases metabolism of sex
hormone.
• Alcohol ingestion results in short term decrease followed
by increase in enzyme activity.
April 13, 2018 73Phase II Reactions In Biotransformation
74. Factors affecting biotransformation of drugs
• Altered physiological factors
• Pregnancy
• Metabolising ability decreased- high levels of steroid hormons
• Metabolism of promazine and pethidine reduced.
• Metabolism of anticonvulsants increased- induction by circulating
progesterone.
• Hormonal imbalance
• Enzyme induction or inhibition
April 13, 2018 74Phase II Reactions In Biotransformation
75. Factors affecting biotransformation of drugs
• Altered physiological factors
• Disease states
• Liver- Primary site for metabolism, Diseases like hepatic
carcinoma, hepatitis, cirrhosis, obstructive jaundice decreases
metabolism.
• Kidney: Glycine conjugation of salicylates, oxidation of vitamin D,
hydroysis of procaine impaired in renal disease.
• CCF and MI: decrease blood flow to liver- decrease metabolism of
high extraction ratio drugs- Propranolol, lidocaine
• Diabetes: decreased glucuronidation
April 13, 2018 75Phase II Reactions In Biotransformation
76. Factors affecting biotransformation of drugs
• Temporal factor
• Circadian rhythm
• Diurnal variations or variations in enzyme activity with light cycle
• Enzyme activity maximum in early morning.
• Enzyme activity minimum in late afternoon.
• Ex: aminopyrine, hexobarbital, imipamine
April 13, 2018 76Phase II Reactions In Biotransformation
77. Factors affecting biotransformation of drugs
• Genetic Variation
• wide variability in the response to drugs between individuals
• consequences of such variation may be therapeutic failure or an
adverse drug reaction
• genetic diversity is the rule rather than the exception with all
proteins, including drug metabolizing enzymes
• allelic variants with different catalytic activities from that of the
wild-type form have been identified
• inheritance leads to subpopulations (genetic polymorphisms) with
different drug metabolizing abilities
lack of activity
reduction in catalytic ability
enhanced activity
April 13, 2018 77Phase II Reactions In Biotransformation
78. Factors affecting biotransformation of drugs
• Genetic Variation
• frequency of the polymorphism often varies according to the
ethnic ancestry of the individual
• CYP2D6 is extensively studied, the gene for CYP2D6 is highly
polymorphic
• It’s expression leads to 3 phenotypes (phenotype is the expression
of genetic make-up)
• Extensive metabolizers (EMs) have functional enzyme activity
• Intermediate metabolizers (IMs) have diminished enzyme activity
• Poor metabolizers (PMs) have little or no activity
• 5-10% of Caucasians and 1-2% of Asians exhibit the PM phenotype
April 13, 2018 78Phase II Reactions In Biotransformation
79. Factors affecting biotransformation of drugs
• Genetic Variation
• Debrisoquine, formerly used in the treatment of
hypertension, is metabolized by CYP2D6 to 4-
hydroxydebrisoquine
• Remarkable interindividual variation in pharmacological
effect of the drug
• Urine of volunteers given debrisoquine was examined for
presence of 4-hydroxydebrisoquine
• One subject had a very low conversion of parent drug to
metabolite
• was very sensitive to the antihypertensive effects of
debrisoquine
April 13, 2018 79Phase II Reactions In Biotransformation
80. Factors affecting biotransformation of drugs
• Drug dosing
• 1- An increase in drug dosage would increase drug concentration and
may saturate certain metabolic enzymes.
• 2- when metabolic pathway becomes saturated, an alternative
pathway may be pursued.
April 13, 2018 80Phase II Reactions In Biotransformation
81. Factors affecting biotransformation of drugs
• Route of administration
• Orally administered drugs are absorbed from the GIT and
transported to the liver before entering the systemic circulation.
Thus the drug is subjected to hepatic metabolism (first pass effect)
before reaching the site of action.
• Sublingually and rectally administered drugs take longer time to
be metabolized than orally taken drugs. Nitroglycerine is
ineffective when taken orally due to hepatic metabolism.
• IV administration avoid first pass effect because the drug is
delivered directly to the blood stream.
April 13, 2018 81Phase II Reactions In Biotransformation
82. References
• Brahmankar DM , Jaiswal SB. Biopharmaceutics and Pharmacokinetics A
Treatise. 2nd edition. Vallabh Prakashan;New Delhi, 2009 Page No. 139-
169.
• Gibson G. Gordon, Skett Paul. Introduction to drug Metabolism. 3rd
edition, Nelson Thorne Publishers; Chetenham, 2001 Page No. 1-13, 37-
62.
• Wilson and Gisvold’s Textbook of Organic Medicinal and Pharmaceutical
Chemistry 11th ed. Lippincott, Williams & Wilkins ed.
• Foye’s Principles of Medicinal Chemistry
April 13, 2018 82Phase II Reactions In Biotransformation
83. April 13, 2018 83Phase II Reactions In Biotransformation