New drug development is a highly complex, costly, and time-consuming process that can take over 10 years. It involves synthesis of new chemical entities, preclinical studies in animals and cells to evaluate safety and efficacy, followed by clinical trials in humans in 4 phases to further assess safety and efficacy. If clinical trials are successful, regulatory approval must be obtained before the drug can be marketed. The overall goal is to bring new treatments to patients while ensuring safety and effectiveness through a rigorous scientific process.
This document contains the mostly asked questions for the job interviews of drug regulatory affairs which will help the candidate ace the interview with ease
Thank me later for this :*)
COMMON JOB INTERVIEW QUESTIONS WITH ANSWERS ASKED IN DRUG REGULATORY AFFAIRS ...Pristyn Research Solutions
THESE ARE SOME COMMON JOB INTERVIEW QUESTIONS WITH ANSWERS ASKED IN DRUG REGULATORY AFFAIRS INTERVIEW
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This document contains the mostly asked questions for the job interviews of drug regulatory affairs which will help the candidate ace the interview with ease
Thank me later for this :*)
COMMON JOB INTERVIEW QUESTIONS WITH ANSWERS ASKED IN DRUG REGULATORY AFFAIRS ...Pristyn Research Solutions
THESE ARE SOME COMMON JOB INTERVIEW QUESTIONS WITH ANSWERS ASKED IN DRUG REGULATORY AFFAIRS INTERVIEW
FOR ENROLLMENT CALL US ON - 9028839789
https://pristynresearch.com/
MAIL ID - pristynresearch@gmail.com
FACEBOOK- https://www.facebook.com/pristynsolutions
INSTAGRAM- https://www.instagram.com/pristyn_res...
TWITTER- https://twitter.com/Pristynresearch
SLIDESHARE- https://www.slideshare.net/azherkhan5916
LINKEDIN- https://www.linkedin.com/in/pristyn-research-191072119/
ADDRESS-
1) Parmar Trade Centre, A-wing,105/106, Sadhu Vaswani Chowk, Pune, 411001. Email: info@pristynresearch.com Phone: 09028839789
2)T-21/4 ,Opposite To Expert Global, Garware Stadium Road , Software Technology Park of India(STPI), MIDC, Aurangabad-431001. Email: info@pristynresearch.com Call us: 09607709586
Preclinical Development, Introduction
Definition, Stages of development of a new drug, Objectives of Preclinical studies, Several steps in preclinical trials, Types of studies in Preclinical trials, Importance of preclinical trials
By
Ms. I. Sai Reddemma.
Department of Pharmacology
Medicinal and toilet preparations act and rules,1955Ganesh Shevalkar
It is an Act with provision for levy and collection of excise duties on medicinal and toilet preparations containing alcohol, opium, Indian hemp (cannabis) or other narcotic drugs.
The term “herbal drugs” denotes plants or plant parts that have been converted into phytopharmaceuticals by means of simple processes involving harvesting, drying, and storage.
IIMPORT AND REGISTRATION AS PER DRUG AND COSMETIC ACT Sagar Savale
The drug and cosmetic act was passed on 10th April, 1940.
Objective : To regulate the import, manufacture, distribution, and sale of Drug and Cosmetics.
All classes of the drugs and cosmetics imported into India, shall comply with the prescribed standards and labels.
Manufacture of all classes of drug require prior license.
objective, definition, IAEC, CPCSEA guidelines for breeding & stocking of animals, transfer of acquisition of animals for expt., power to suspect or revoke registration, offences & penalties.
A presentation outlining the various processes a chemical compound undergoes (thorough & rigorous screening procedures) before it is finally introduced into the drug market
Preclinical Development, Introduction
Definition, Stages of development of a new drug, Objectives of Preclinical studies, Several steps in preclinical trials, Types of studies in Preclinical trials, Importance of preclinical trials
By
Ms. I. Sai Reddemma.
Department of Pharmacology
Medicinal and toilet preparations act and rules,1955Ganesh Shevalkar
It is an Act with provision for levy and collection of excise duties on medicinal and toilet preparations containing alcohol, opium, Indian hemp (cannabis) or other narcotic drugs.
The term “herbal drugs” denotes plants or plant parts that have been converted into phytopharmaceuticals by means of simple processes involving harvesting, drying, and storage.
IIMPORT AND REGISTRATION AS PER DRUG AND COSMETIC ACT Sagar Savale
The drug and cosmetic act was passed on 10th April, 1940.
Objective : To regulate the import, manufacture, distribution, and sale of Drug and Cosmetics.
All classes of the drugs and cosmetics imported into India, shall comply with the prescribed standards and labels.
Manufacture of all classes of drug require prior license.
objective, definition, IAEC, CPCSEA guidelines for breeding & stocking of animals, transfer of acquisition of animals for expt., power to suspect or revoke registration, offences & penalties.
A presentation outlining the various processes a chemical compound undergoes (thorough & rigorous screening procedures) before it is finally introduced into the drug market
Drug discovery and development is and always has been the most exciting part of clinical pharmacology. It is my attempt to compile the basic concepts from various books, articles and online journals. Feel free to comment.
When a new drug/device/surgical procedure/treatment or other potential medical innovation is developed it must be thoroughly tested to ensure that it is safe and does what it is supposed to be.
This presentation will provide a basic overview of clinical research process.
Pharmacology is study of the substances which interact with living system by activating or inhibiting normal body processes. It includes physical and chemical properties, biochemical and physiological effects, mechanism of action, therapeutic uses and adverse effects of drugs.
. Introduction to Pharmacology Course Title: Pharmacology I Course No.: PHAR 2113 Prepared by: Biswajit Biswas Reference: Goodman & Gilman’s Manual of Pharmacology and Therapeutics
2. Pharmacology Greek pharmakon : "drug“ ; and logia : "the study of“. Greek: Pharmacon (Drug) Modern Latin: Pharmacologia 18th Century: Pharmacology The branch of medicine concerned with the uses, effects, and modes of action of drugs.
3. Historic development of pharmacology Worlds oldest pharmacology - from India and China Materia medica (2735 B.C.) by Pan Tsao- contained mainly Plant and metal with few animal products Ayurveda - described by Charaka accordig to Rigveda (3000 B.C.) - includes 300 vegetable drugs , classified into 50 groups according to their effects on symptoms. Papyrus (1500 B.C.) discovered by Eber -700 drugs Modern medicine (from 450 B.C.) by Hippocrates- concept of disease as a pathologic process and organize pharmacology on the basis of observation, analysis and deduction.- use simple and efficacious drugs.
4. Allopathay (James gregory, 1753-1821) -treatment without any rational basis- use symptomatic treatment with obnoxious remedis. Homeopathy (Hanneman, 19th century)-
This was the introductory class for BNS Ist yr on General Pharmacology. It tries to explain the evolution of the subject and the possible future. Hoping that this will help develop some interest on the subject.
This is the presentation for B. Pharm. IV semester students.
It includes Introduction of Medicinal Chemistry, History and Development of Medicinal Chemistry
A review on stages of drug development and alternative methods for animal stu...Frinto Francis
Various Stages of drug development, anaesthesia ,euthanasia, animals used for preclinical analysis, clinical trials, alternative methods for animal testing, blood withdrawal methods, ethical guidelines
1.1 Pharmacology- An Introduction
The word pharmacology is derived from two Greek words, pharmacon meaning a drug, and logos meaning an opinion or reason. It can be defined as
“The science which deals with the history, source, physical properties, chemical properties, compounding, biochemical effects, physiological effects, mechanism of action, absorption, distribution, biotransformation, excretion, therapeutic and other uses of drugs, is called pharmacology.”
“The study of a substance that interacts with the living system through chemical processes especially by binding to regulatory molecules and activates or inhibits normal body processes”
“The science of substances used to prevent, diagnose and treat disease.”
Drug:
The word drug comes from Drogue meaning a dry herb. A drug can be defined as:
“A substance, material or product used for the purpose of diagnosis, prevention and relief of symptoms or cure of disease.”
WHO defines drug as:
“A substance, material or product used or intended to be used to modify or explore the physiological processes or pathological states for the benefit of the recipient.”
General Features of a Drug:
• Variability in molecular size
• Variability in shape
• Variability in chemical nature
• Variability in lipid/water partition coefficient
• Variability in degree of ionization
• Physical Properties
• Variability in molecular size
Smaller sized molecules are easily absorbed than larger molecules. Normally the molecular weight is between 100-1000 but may be higher or lower. Streptokinase is an example of large molecular weight drug while lithium or nitric oxides are of small molecular weight.
• Variability in shape
Immunosupressants and Immunostimulants their pharmacology, uses etc. Basics of immunology, innate immune response, acquired immune response, role of complement in innate immune response. Major histocompatibility complex, antibody structure. classification of immunosupressants, their mechanism of action, uses and adverse effects.
Pharmacology of antimalarial drugs with treatment of malaria. mechanism of action, uses, adverse effects of antimalarial drugs like chloroquine, quinine, artemisinin compounds.
Antileprosy drugs have been described with their pharmacology also this topic covers Multidrug treatment for leprosy including paucibacillary and multibacillary leprosy and lepra reactions
Pharmacology of cephalosporins, monobactums and carbapenums including their mechanism of action, indications, adverse effects.
The various generations of cephalosporins and their spectrum of action
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
Drugs for treatment of Diabetes MellitusNaser Tadvi
These slides contain the brief description of Insulin and the other oral drugs indicated in the treatment of Diabetes Mellitus. Their mechanism of action, effects, uses, Adverse effects etc.
Introduction to Autonomic Nervous systemNaser Tadvi
Lecture intends to give a brief overview of autonomic nervous system.
it includes the anatomical distribution of ANS, Neurohumoral transmission, co-transmission, receptors for ANS and synthesis of the neurotransmitters, Acetylcholine and Catecholamines
Lecture covers the pharmacology of anticholinergic drugs. Includes classification, therapeutic uses, adverse effects of anticholinergics. Atropine has been described as prototype drug.
Lecture includes definition of bioassay, Types of Assay and Bioassay , Indications, principles, advantages of bioassay. Example of a Bioassay with calculations. This lecture will be of help for postgraduate pharmacology students as well as undergraduates
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. Drug
• Single chemical entity present in the
medicine used for diagnosis, prevention
or cure of a disease.
• WHO:
– Any substance or a product that is used or
intended to be used to modify or explore the
physiological systems or pathological states for the
benefit of the recipient
4. New Drug
• A substance of chemical, biological or
biotechnological origin for which adequate
data is not available for the regulatory
authority to judge its efficacy and safety for
the proposed claim.
5. Not a Easy Process
• Highly complex
• Tedious
• Competitive
• Costly (500 – 1000 million dollars)
• Commercially risky
• Time consuming (at least 10 years)
6. Stages in the new drug development
• Synthesis & isolation of compound
– New chemical entity (NCE)
– Takes 1-2 years
• Preclinical studies
– 2-4 years
• Investigational New Drug Application (IND)
– Submission & review by FDA
– 3-6 months
7. Stages in the new drug development
IND
Clinical Trials Pre clinical studies continued
•Phase 1 Plus
•Phase 2 •Long term animal toxicity
•Phase 3 •Product formulation
3 To 10 years •Manufacturing & controls
•Package & label designs
New Drug Application (NDA)
•Review & grant of marketing permission
•0.5 to 2 years
Post marketing surveillance (Phase -4)
8.
9. Old methods of Drug Discovery
• Use crude plant / animal products / minerals to
treat disease (India, China, Egypt and Babylon)
• No study before using them. Agents were
selected on the basis of their symbolic qualities
& astrological signs
– Greek physicians used iron against weakness.
– Horn of rhinoceros as a potent aphrodisiac.
– many obnoxious remedies, like flesh, excreta &
blood of various animals were used
• Drugs were added by considerable trial and
error
10. Galen
• Concept of polypharmacy
• Mixed vegetable crude drugs from
Aelius
different sources Galenus or Claudius
• Galen’s name is retained in the Galenus (AD 129 –
200/217), better
term ‘galenical’ for preparation of known as Galen
of Pergamum
crude vegetable drugs
11. Paracelcus
• Paracelsus (AD 1493 – 1541) criticized
the polypharmacy of mixed vegetable
preparations of Galen
• Pioneered the use of chemicals and
minerals in medicine.
• He introduced the use of mercury in the
treatment of syphilis.
• "All things are poison and nothing is
without poison, only the dose permits
something not to be poisonous."
12. Important contributions
– 1847: Birth of Pharmacology as a
scientific discipline by Rudolf Buchheim at
Dorpat
– 1878: Louis Pasteur’s “germ theory” of
disease at Paris
– 1890s: The “magic bullet theory” of Paul
Ehrlich
13. Approaches to drug discovery
• Natural sources
• Chemical synthesis
• Rational approach
• Molecular modelling
• Combinatorial chemistry
• Biotechnology
15. Morphine from Opium
Friedrich Wilhelm
Adam Sertürner
• 1805: Friedrich Serturner, a junior
apothecary in Westphalia, Germany
isolated and purified morphine.
• He barely survived the test of its
potency on himself.
• He called the isolated alkaloid "morphium" after the
Greek god of dreams, Morpheus.
• First person to isolate the active ingredient associated
with a medicinal plant or herb
16. Indian Contribution
• Rauwolfia alkaloid form
Raulwofia serpentina as
antihypertensive and
antipsychotic drug
• Gugulipid from
Tinospora as lipid-
lowering agent
17. Chinese Contribution
• Sympathomimetic Ephedrine
from Ma huang (Ephedra
vulgaris)
• Antimalaial Artemisinin from
Quinghasou (Artemisia annua)
• Anticancer drug Camptothecin
(Irinotecan and topotecan)
from Captotreca acumunata
18. Chemical synthesis
• Randomly synthesized compounds tested for
pharmacological activity
– Barbiturates, chlorpromazine synthesized by this
approach
• Synthesis of chemical congeners
– More rational
– Me too drugs fathered by lead compounds
– Thiazide drugs from acetazolamide, TCA from
phenothiazines
– Structure activity relationship
– Enantiomers
• Serendipity
20. Drug Discovery by Serendipity
• 1785: Withering’s discovery of Digitalis in
treating cardiac failure (dropsy)
• 1914: Wenkeback’s discovery of
antidysrhythmic effect Quinidine when
treating a patient with malaria who also
happened to suffer from atrial tachycardia.
• 1937: Use of amphetamine in treatment of
attention deficit hyperactivity disorder (ADHD)
by Bradley
21. Sidenafil as anti-impotence Drug
• Sildenafil citrate (vigra), an anti-
impotence drug. It was initially studied
for use in hypertension and angina
pectoris. Phase I clinical trials under the
direction of Ian Osterloh suggested that
the drug had little effect on angina, but
that it could induce marked
penile erections.
22. Enantiomers
• Many drugs are having two types of 3D structure
(chiral compounds)
– Enantiomeres: ‘R’ & ‘S’; l & d
– Combination of both (recemate)
• Enantiomers are non superimposable mirror
images (
• Enantiomers of chiral drugs differ in biological
activity, metabolic degradation etc.
• Single enantiomer of a drug may be better to its
racemate
• E.g dextro dopa more toxic than levo dopa
23. • Now Regulatory authority grants permission
after chiral separation of recemate drugs
when a single enantiomer is better than the
recemate preparation
24. Drugs as single enantiomers
• Antihypertensive
– (S) atenolol : 50% dose, better tolerated
– (S) metoprolol : 50% dose
– (S) amlodipine : 50% dose, better tolerated
• Proton-pump inhibitors in peptic ulcer
– (S) omeprazole (esomeprazole) : bioavailability
– (S) pantoprazole: More potent
• Anti-asthmatic drug
– (R) Salbutamol: More active, ‘S’ antagonizes ‘R’
25. Drugs as single enantiomers
• Antidepressant (SSRI)
– (S) Citalopram (escitalopram) : dose, S/E
• Chemotherapeutic Agent
– Levofloxacin (l –isomer): more active, slower
elimination
• Antihistamine
– Levocetirizine (l-isomer): 50% dose as ‘d’ form is
inactive
– Desloratadine (d-isomer) : 50% dose
26. Rational approach
• Depends on sound knowledge &
identification of specific target for drug action
• Receptor based approach ( target oriented)
27. Target oriented approach
• Receptors
– GPCR, Receptors with intrinsic ion channels,
enzyme linked receptors, Receptor regulating
gene expression.
• Ion channels
– Na+, K+, Ca++ and Cl–
• Transporters
– Na+/K+ ATPase, H+/K+ ATPase, Na+-K+-2Cl–
• Enzymes
28. Combinatorial Chemistry
• Chemical groups are combined in random
manner to yield innumerable compounds
• These compounds subjected to high through
put screening on cells, genetically engineered
microbes, enzymes, enzymes in robotically
controlled automated assay systems
30. Drug Development
1. Pre-clinical Study
– ADME
– Safety and Toxicity prior to human trial
– FIM (First in Man) / FHD (First Human Dose)
2. CMC (Chemistry, Manufacturing & Control)
3. Clinical Study
– Phase I, II & III
4. Registration
5. Phase IV (Post-marketing Surveillance)
31. Pre-clinical study
• Aim:
– Is it effective?
– Is it not toxic?
– Is its side effect is minimum?
• Test is done on
– Cultured cell line
– Isolated organ
– Intact animals
33. Pre-clinical Studies
• Screening Tests
• Tests on isolated organs
• Tests on bacterial cultures
• Tests on animal models of human diseases
– Diabetic rats / dogs by diazoxide
– Kindled animals for anti-epileptic drugs
• General observational tests on intact animals
34. Preclinical Studies
• Pharmacokinetics
• Systemic pharmacodynamics
• Study of Mechanism of Action
• Quantitative tests
– Dose-Response Relationship
– Maximal Effect
– Efficacy testing in relation to existing drugs
• Toxicity Studies
36. Good Laboratory Practice (GLP)
• Embodies a set of principles that provides a
framework within which laboratory studies
are planned, performed, monitored, recorded,
reported and archived.
37. Before Clinical Studies
• Drug is formulated into a suitable dosage form
• The clinical trials are done under the guideline
of Good Clinical Practice (GCP) laid down by
International Conference on Harmonization
(ICH)
38. Investigational New Drug (IND)
• IND license is obtained after successful
completion of pre-clinical studies from
regulatory authorities.
• Regulatory Authority
– India: Drug Control General of India (DCGI)
– USA: FDA (Food and Drug Administration)
39. Good Clinical Practice (GCP)
• GCP include
– protection of human rights as a subject in clinical
trial.
– provides assurance of the safety and efficacy of
the newly developed compounds.
• Good Clinical Practice Guidelines include
standards on
– how clinical trials should be conducted,
– define the roles and responsibilities of clinical
trial sponsors, clinical research investigators, and
monitors.
40. Why Clinical Trials?
• To discover or verify:
– Pharmacodynamics (how it works)
– Pharmacokinetics (what happens to it)
– Therapeutic effects (efficacy)
– Adverse reactions (safety)
41. History of Clinical Trial
Clinical trials for cure
of scurvy in 1747
James Lind
43. Regulatory Process in Drug trial
• 1937: Use of diethylene glycol as a solvent for
sulfonamide preparation caused death of 107
in USA.
• 1938: FDA revised its old rules and made it
compulsory to demonstrated safety before
marketing
44. Regulatory Process in Drug trial
• 1959: Thalidomide
Disaster in Europe and
Australia
• 10,000 cases of severe
congenital malformation
cases were seen
Phocomelia = Greek phoco-, "seal (flipper)" +
Greek melia, "limb, extremity" = human limb like a seal's
45.
46. Unethical trial
• In 1932, a clinical trial named Tuskegee was
conducted in patients with syphilis in USA. Study
group comprised of 400 African-American poor
men with syphilis. Control group was 200 healthy
men. The doctors offered treatment without
paying; but they only observed the patients
without treatment during many years without
telling anything. Ten years later, death rate was
two-fold in the study group. Penicillin was
developed in 1952. No patient was administered
any antibiotics including penicillin until the end of
study in 1972.
47. New York Times described this study as
“The longest clinical trial in human
body without treatment in the
medical history”
48. May 16, 1997
Tuskegee trial
President Clinton apologised from USA citizens
because of Tuskegee trial
49. Phases of Clinical Trials
• Phase I
Early Clinical Pharmacology & Safety
• Phase II
Therapeutic exploration and dose ranging
• Phase III
Therapeutic confirmation and comparison
• Phase IV
Post-marketing Surveillance / Studies
50. Phases of Clinical Trials
• In Each Phase
– Exposure to greater numbers of human
subjects to the drug
– Collection of increasing amounts of data on
safety and efficacy of the drug
I II III IV
51. PHASE I
• First study done on healthy human volunteers
(sometimes in patients)
• N = 20 – 40
• Carried out by qualified clinical pharmacologists
or trained physicians
• Venue: A place where all vital functions are
monitored and emergency / resuscitative facilities
are available
• No blinding, open label
• Duration of study: 1 yr (approximately)
52. PHASE I
• Emphasis : Safety and Tolerability
• Started with lowest estimated dose and stepwise
increased to effective dose.
• Data collection on
– Pharmacokinetics
– Systemic pharmacodynamics
– General adverse effects
• Acceptable dosing level is found
• Provisional safe dosage established
53. PHASE II
• Patients suffering from the disease
• Inclusion and exclusion criteria are fixed
• N = 100 – 400
• Carried out by physicians who are trained as
clinical investigators
• Duration: 2-3 years
• Type: Open label / Blind
• Venue: 2 - 4
54. PHASE II
• Establishment of therapeutic efficacy
• Define most appropriate dose range
and ceiling effect in a controlled setting
• Study of tolerability and
pharmacokinetics as an extension of
Phase I
55. PHASE III
• Randomized
• Placebo controlled
• Comparative
• Double-blind
• Multi-centric
• Patients study
• Involves several physicians
• N = 500 to 3000
56. PHASE III
• Value of the drug in relation to existing
therapy
• Safety, tolerability, drug interactions
• Additional information on
pharmacokinetic data
• Finalization of indication
• Formulation of guidelines for therapeutic use
57. Registration
• New Drug Application (NDA) along with the
Data (safety and efficacy) of Clinical Trials are
submitted to relevant Regulatory Authority
– India: DCGI (Drug Controller General of India)
– USA: FDA (Food and Drug Administration)
• Chirality of drug is considered by RA
• Regulatory Authority, in convinced, gives a
‘marketing permission
• Average time for approval: 2.5 yr
58. PHASE IV:
Post-marketing Surveillance (PMS)
• Clinical trials do not end with approval
• Practicing physicians are indentified and
from them data are collected on a
structured proforma regarding
– Efficacy
– Acceptability
– Adverse effects
• n = 4000 – 5000 patients or more
59. PHASE IV:
Post-marketing Surveillance (PMS)
• Uncommon adverse effects
• Long term adverse effects
• Adverse drug reactions (e.g. idiosyncrasy etc.)
• Unsuspected drug interactions
• Patterns of drug utilization
• Additional indications
60. PHASE IV:
Post-marketing Surveillance (PMS)
• Effect on special groups
– Elderly & Neonates
– Pregnancy & Lactation
– Liver &Renal impairment
• Exploration of possibilities
– Modified release dosage form
– Additional route of administration
– Fixed dose combination
• Even drugs / formulations are withdrawn from
the market if found to be injurious to health
61. Examples of drug withdrawal
• Antihistamine: Terfenadine, Astemizole for
producing “torsa de pointes”
• Selective COX-II inhibitor: Rofecoxib and
Celecoxib for producing cardiotoxicity
• NSAIDs: Nimesulide is banned for all age
groups in Western countries and for paediatric
age group in India
• Aspirin liquid formation: due to possibilities
of producing Reye’s Syndrome in children
62. Phase 0
(Human Micro-dosing)
• Offers a way of developing drugs in a
faster, more cost effective and ethical way
than ever before.
Editor's Notes
Qualities of A DrugEffectiveSuitableSafeAffordable
Since the sword symbolizes strength and power, the early
Paracelsus: He was a controversial figure who has been portrayed as both ignorant and superstitious. He had no medical degree. He burned the classical medical works of Galen and Avicenna before his lectures in Basel (Switzerland) and had to leave the city following a dispute about fees with a prominent churchman. He died in Salzburg (Austria) either as a result of a drunken debauch or because he was thrown down a steep decline by ‘hitmen’ employed by jealous local physicians. But he was right about the dose, “The dose alone decides that something is no poison”
Made its debut in 19th century Isolation of streptomycin by Waksman (1944) from Streptomycesgriseus after screening of 10,000 microorganism samples(random screening )
physiological., biochemical
Antimetabolites
Computer analysis is done to identify putative drugs which are then subjected to conventional tests
Therapeutic proteins produced by genetic engineeringStarted with synthesis of Human Insulin in 1982Scope broadened with time which includes proteins, nucleic acids, vaccines and even cell-based therapies
["first-in-man" (FIM) or First Human Dose (FHD)].
Screening Tests: Simple, rapid tests – indicate presence / absence of a pharmacodynamic activityGeneral observational test: Performed either in the beginning in case of totally novel compounds or after detecting usefulness in screening test. The drug is injected in tripling doses to small group of animals (mice) and the animals are observed for any overt effects. Preliminary clues are drawn from the profile of effects observed.
Acute toxicity studies:single escalating doses are given to small group of animals that are observed for overt effects and mortality for 1- 3 days. The dose which kills 50 % of animals LD50 is calculated
These studies are undertaken to generate data by which the hazards and risks to users, consumers and third parties, including the environment, can be assessed for pharmaceuticals (only preclinical studies), GLP helps assure regulatory authorities that the data submitted are a true reflection of the results obtained during the study and can therefore be relied upon when making risk/safety assessments.
Adherence to GCP provide assurance thatRights, integrity and confidentiality of trial subjects are protectedData and reported results are credible and accurate