Principles of Therapeutics
Indiviualization of Dosage
Compliance
Herbal/Botanical Suppliments
Faraza Javed
Mphill Pharmaco...
Therapeutics
The treatment and care of a patient for the purpose of
both preventing and combating disease or alleviating
p...
Drug
A chemical substance of known structure, which, when
administered to a living organism, produces a
biological effect.
Most common parameters evaluated to check the action
and therapeutic activity of the drug.
Pharmacodynamic
Pharmacokinet...
Pharmacodynamics
Pharmacodynamics
Study of how drug act on living body.
How drug act…
General Principles: Binding Postulate
Such binding l...
How Drugs Act: GeneralPrinciples
The Binding Postulate
Paul Ehrlich
“A drug will not work unless it is bound”
Drug Targets
Receptor
s
Enzyme
s
IIon
Channels
Carrier
Molecule
(Transpo
rter)
Miscellaneou
s
Receptors
The cellular Assembely which recognizes chemical mediators.
Binding Activation
Chain of
Reaction
Physiological
A...
Enzymes
Ion Channels
Transporter
Miscellaneous:
Drugs that act without being bound to any tissue
constituent (e.g. osmotic diuretics, antacids and heavy
m...
Pharmacokinetics
Pharmacokinetics
Absorption
Distribtion
Metabolism
Excretion
Bioassays and Clinical Trials
Bioassay
Biological testing procedure for estimating the
concentration of a pharmaceutical drug substance
in a formulated ...
Objective
Bioassays are commonly applies to characterised:
Substance Biological Properties
To study a Biological Process...
Clinical Trials
Clinical Trials
A rigorously controlled test of a new drug or a new
invasive medical device on human subjects; it is
condu...
Phases of Clinical Trials
Phase I
Phase II
Phase III
Phase IV
Phase I
The object of the first clinical
trials in humans is to find out
if the new drug is safe.
These first trials, call...
Phase II
This second phase of testing
may last from several months
to 2 years, and involve up to
several hundred patients....
Phase II trials are aimed at elucidating dose
response relationships, safety and efficacy of the
compound treating the dis...
Phase III
In a Phase 3 study, a drug is tested in several
hundred to several thousand subjects. This large-
scale testing ...
Phase IV
Phase IV trial is also known as postmarketing
surveillance Trial. Phase IV trials involve the safety
surveillance...
Indiviualization of Drug
Therapy OR
Dosage Indiviualization
Dosage Indiviualization
Adaptation of the dosage regimen in function of clinical
characteristics of the indiviual aiming t...
Factors
Factors responsible for variation in drug response:
Ethinicity
Age
Genetic Factor
Idiosyncratic Reactions
Dis...
Ethnicity
“Pertaining to Race”
Examples:
African-American with heart failure gain a mortality
benefits from treatment wit...
Age
The main reason that age effect drug action is that
elimination is less efficient in new born babies and in
old people...
 Other age related factor like Physiological
factors(altered CV reflexes) and Pathological
factors(Hypothermia, common in...
Effect of Age on Renal
Excretion of Drug
Gentamycin has a plasma half life of 18 hours or greater
in new born as compared ...
Drugs Neonates Adults Elders
Gentamycin 10-18 2 4
Digoxin 200 40 80
Diazepam 25-100 15-25 50-150
Mean Half Life of some Dr...
Genetic Factors/Pharmacogenomics
The study of genetic variation that influence indiviual
response to the drug.
Cytochrome...
Clopidogrel(Plavix)
R
It is a Platelet inhibitor used in the treatment of no.
of CV diseases. However, despite of Clopidog...
Patients who carry certain variations in CYP2C19 are
considered poor metabolizer and show decreased
ability to convert cl...
Idiosyncratic Reactions
An IR is abnormal and usually harmful drug effect that
occurs in a small proportion of individuals...
Examples
Chloramphenicol causes Aplastic Anemia in approx. 1
in 50,000 patients.
Primaquine, Dapsone, Doxorubicin and so...
Effect of Diseases
Impaired Renal or Hepatic function predispose to
toxicity causing unexpectedly intense or prolonged
dr...
Drug Interactions
Polypharmacy in case of chronic diseases may interact
and results in toxicity.
The risk of bleeding spe...
Compliance
Compliance
It is the act of taking medication on schedule or taking
medication as prescribed.
Resons for Medication Non
Compliance
Outcomes
Unnecessary disease progression and complication
Reduced functional abilities and quality of life
An additiona...
Botanical and Nutritional
Suppliments
Botanicals
Botanicals are plant preparations which have become
widely available in the form of food suppliments.
Examples:...
Natural does not mean It is Safe!
Botanicals are safe.. Consumer tend to believe that
because they are natural, Botanicals...
Green Tea
Green Tea has a relationship
with metabolism of lipids.
It is a natural and useful aid
to maintain normal body
w...
Ginkgo(Ginkgo Biloba)
Ginkgo has been used to treat
circulatory disorders and enhance
memory, specially effective in
treat...
Hence, Ginkgo may increase the effect of some blood
thining medicine including Aspirin. People taking
blood thining medica...
St. John’s Wort(Hypericum Perforatum)
Well known for its
anti-depressent effect.
Effective treatment for mild
to moderat...
Epedra
 Uses: Bronchial asthma, Athletic Performance
Enhancer
Likely safe in low doses for 7 days
Likely unsafe in high...
140 Events, 1/3 definitely-related to supplement,
10 deaths, 10 strokes, 13 permanent disabilities
Conclusion
 Polypharmacy is common among supplement users
Many assume herbs and supplements are safe
Many pharmacologic...
Future of Herbal Medicine
In some countries of Europe, herbs are classified and
regulated as drugs.
While still not wide...
References
 Rang H. P., & Dale M. M. (2007). Rang & Dale’s
Pharmacology (6th Edition). London, United Kingdom.
 Katzung ...
Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments
Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments
Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments
Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments
Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments
Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments
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Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments

This presentation briefly covers the general aspect of therapeutics and drug development then its dose adjustment according to the pt. need and checking either patient comply to that therapy or not. last portion based on herbal supplements and its use.
Published on: Mar 4, 2016
Published in: Health & Medicine      Business      
Source: www.slideshare.net


Transcripts - Priciples of therapeutics, Dosage Indiviualization, Herbal Suppliments

  • 1. Principles of Therapeutics Indiviualization of Dosage Compliance Herbal/Botanical Suppliments Faraza Javed Mphill Pharmacology
  • 2. Therapeutics The treatment and care of a patient for the purpose of both preventing and combating disease or alleviating pain or injury. The term comes from the Greek therapeutikos, which means “inclined to serve.” OR The branch of medicine concerned with the treatment of disease.
  • 3. Drug A chemical substance of known structure, which, when administered to a living organism, produces a biological effect.
  • 4. Most common parameters evaluated to check the action and therapeutic activity of the drug. Pharmacodynamic Pharmacokinetics Preclinical Study Clinical Trials
  • 5. Pharmacodynamics
  • 6. Pharmacodynamics Study of how drug act on living body. How drug act… General Principles: Binding Postulate Such binding leads to cellular response that results in pharmacological effect of drug.
  • 7. How Drugs Act: GeneralPrinciples The Binding Postulate Paul Ehrlich “A drug will not work unless it is bound”
  • 8. Drug Targets Receptor s Enzyme s IIon Channels Carrier Molecule (Transpo rter) Miscellaneou s
  • 9. Receptors The cellular Assembely which recognizes chemical mediators. Binding Activation Chain of Reaction Physiological Action Affinity Efficacy
  • 10. Enzymes
  • 11. Ion Channels
  • 12. Transporter
  • 13. Miscellaneous: Drugs that act without being bound to any tissue constituent (e.g. osmotic diuretics, antacids and heavy metal chelating agents) may fall in this category. A few other types of protein (plasma proteins) are known to function as drug targets and their exist many drugs with sites of action that are not yet known. e.g Nefopam.
  • 14. Pharmacokinetics
  • 15. Pharmacokinetics Absorption Distribtion Metabolism Excretion
  • 16. Bioassays and Clinical Trials
  • 17. Bioassay Biological testing procedure for estimating the concentration of a pharmaceutical drug substance in a formulated drug product or bulk material. The specific potency of drug is given to animal and then drug response is compared with the standards.
  • 18. Objective Bioassays are commonly applies to characterised: Substance Biological Properties To study a Biological Process To detect the presence and quantity of a substance in a sample To screen for active molecules from a library of molecules
  • 19. Clinical Trials
  • 20. Clinical Trials A rigorously controlled test of a new drug or a new invasive medical device on human subjects; it is conducted under the direction of the FDA before being made available for general clinical use.
  • 21. Phases of Clinical Trials Phase I Phase II Phase III Phase IV
  • 22. Phase I The object of the first clinical trials in humans is to find out if the new drug is safe. These first trials, called "Phase 1“ trials, usually involve a small number of individuals (less than 100) who are healthy.
  • 23. Phase II This second phase of testing may last from several months to 2 years, and involve up to several hundred patients. Most Phase 2 studies are randomized trials. One group of patients will receive the experimental drug, while a second "control" group will receive a standard treatment or placebo. Often these studies are "blinded"--neither the patients nor the researchers know who is getting the experimental drug.
  • 24. Phase II trials are aimed at elucidating dose response relationships, safety and efficacy of the compound treating the disease or condition for which it is intended.
  • 25. Phase III In a Phase 3 study, a drug is tested in several hundred to several thousand subjects. This large- scale testing provides more information about the drug's effectiveness, possible side effects, and safety in a broader range of people.
  • 26. Phase IV Phase IV trial is also known as postmarketing surveillance Trial. Phase IV trials involve the safety surveillance and ongoing technical support of a drug after it receives permission to be sold. Harmful effects discovered by Phase IV trials may result in a drug being no longer sold, or restricted to certain uses. Recent examples involve Cerivastatin (brand names Baycol and Lipobay), Troglitazone (Rezulin) and Rofecoxib (Vioxx).
  • 27. Indiviualization of Drug Therapy OR Dosage Indiviualization
  • 28. Dosage Indiviualization Adaptation of the dosage regimen in function of clinical characteristics of the indiviual aiming to achieve the best possible therapeutic efficacy at the lowest risk of unwanted side effects.
  • 29. Factors Factors responsible for variation in drug response: Ethinicity Age Genetic Factor Idiosyncratic Reactions Disease Drug Interaction
  • 30. Ethnicity “Pertaining to Race” Examples: African-American with heart failure gain a mortality benefits from treatment with a combination of Hydralazine+Nitrates whereas White Americans do not. Overal effectiveness of Gefitinib in treating patients with advanced lung cancer has been disappointing but in 10% of patients, lung tumor shrinks rapidly. Japenese patients are 3 times as likely as whites to fall into this group.
  • 31. Age The main reason that age effect drug action is that elimination is less efficient in new born babies and in old people hence drug produce greater or prolonged effect.
  • 32.  Other age related factor like Physiological factors(altered CV reflexes) and Pathological factors(Hypothermia, common in elder people) also influence drug effect. Fat contributing a greater proportion to body mass in elderly with consequent changes in distribution volume of drug.
  • 33. Effect of Age on Renal Excretion of Drug Gentamycin has a plasma half life of 18 hours or greater in new born as compared with 1 to 4 hours for adults. It is therefore necessary to reduce the doses to avoid toxicity.
  • 34. Drugs Neonates Adults Elders Gentamycin 10-18 2 4 Digoxin 200 40 80 Diazepam 25-100 15-25 50-150 Mean Half Life of some Drugs(h)
  • 35. Genetic Factors/Pharmacogenomics The study of genetic variation that influence indiviual response to the drug. Cytochrome P450(CYP) Genes
  • 36. Clopidogrel(Plavix) R It is a Platelet inhibitor used in the treatment of no. of CV diseases. However, despite of Clopidogrel treatment, upto one quarter of patients experience a sub therapeutic antiplatelet response, resulting in higher risk for an ischemic event. Clopidogerl is a prodrug, its antiplatelet properties exerted once it is converted to an active metabolite. A Cytochrome P450 enzyme CYP2C19 mediate the conversion of clopidogrel into its active metabolite.
  • 37. Patients who carry certain variations in CYP2C19 are considered poor metabolizer and show decreased ability to convert clopidogrel into its active metabolite resulting in a diminshed antiplatelet effect. Hence Patient are more likely to have an ischemic event following clopidogrel therapy. Approx. 2-20% of patients are likely to carry CYP2C19 variations.
  • 38. Idiosyncratic Reactions An IR is abnormal and usually harmful drug effect that occurs in a small proportion of individuals. Reaction may occur with low doses Genetic factor may be responsible Cause is poorly understood
  • 39. Examples Chloramphenicol causes Aplastic Anemia in approx. 1 in 50,000 patients. Primaquine, Dapsone, Doxorubicin and some Sulfonamide cause Hemolysis leading to severe anemia in 5-10% of Afrocarribean men.
  • 40. Effect of Diseases Impaired Renal or Hepatic function predispose to toxicity causing unexpectedly intense or prolonged drug effect as a result of increased drug conc. Hypothermia markdely reduce the clearance of many drug.
  • 41. Drug Interactions Polypharmacy in case of chronic diseases may interact and results in toxicity. The risk of bleeding specially from stomach caused by Warfarin is increased by drugs that cause bleeding by different mechanism like Aspirin. Sulfonamide prevent the synthesis of folic acid by bacteria and other MCOs. Trimethoprim Inhibits its reduction to THF. Given together, drugs have synergistic action in treatig Pneumocystis carinii.
  • 42. Compliance
  • 43. Compliance It is the act of taking medication on schedule or taking medication as prescribed.
  • 44. Resons for Medication Non Compliance
  • 45. Outcomes Unnecessary disease progression and complication Reduced functional abilities and quality of life An additional medical cost and physician visit
  • 46. Botanical and Nutritional Suppliments
  • 47. Botanicals Botanicals are plant preparations which have become widely available in the form of food suppliments. Examples: Ginkgo Green Tea Ephedra St. John Wort Ginseng
  • 48. Natural does not mean It is Safe! Botanicals are safe.. Consumer tend to believe that because they are natural, Botanicals are safe. But interaction b/w herbal substances and conventional drugs have been reported.
  • 49. Green Tea Green Tea has a relationship with metabolism of lipids. It is a natural and useful aid to maintain normal body weight. It regulate cholesterol and boost your immunity.
  • 50. Ginkgo(Ginkgo Biloba) Ginkgo has been used to treat circulatory disorders and enhance memory, specially effective in treating Dementia. Studies have shown that ginkgo improves blood circulation by dilating blood vessels and reduce the platelet activity.
  • 51. Hence, Ginkgo may increase the effect of some blood thining medicine including Aspirin. People taking blood thining medication should ask their doctors before using Ginkgo.
  • 52. St. John’s Wort(Hypericum Perforatum) Well known for its anti-depressent effect. Effective treatment for mild to moderate depression. Interact with a variety of medications including antivirals. Take it only under the guidance of Health Care Provider.
  • 53. Epedra  Uses: Bronchial asthma, Athletic Performance Enhancer Likely safe in low doses for 7 days Likely unsafe in higher doses for longer periods, associated with MI, stroke, seizures and death Interact with drugs including MAO inhibitors, SSRIs, Glycosides and Caffeine. Banned by FDA in February 2004.
  • 54. 140 Events, 1/3 definitely-related to supplement, 10 deaths, 10 strokes, 13 permanent disabilities
  • 55. Conclusion  Polypharmacy is common among supplement users Many assume herbs and supplements are safe Many pharmacological actions but dangerous side effects and interactions exist
  • 56. Future of Herbal Medicine In some countries of Europe, herbs are classified and regulated as drugs. While still not widely accepted, but herbal medicine is being taught more in medical or pharmacy schools. Researchers will be looking at their health effects and in particular their anti-oxidant, anti-diabetic and memory mediating activities, which, it is hoped, will contribute to the development of new food and supplimentation offering a +ve effect on the maintenance of health.
  • 57. References  Rang H. P., & Dale M. M. (2007). Rang & Dale’s Pharmacology (6th Edition). London, United Kingdom.  Katzung B. G., & Masters S. B. (2012). Basic & Clinical Pharmacology (12th Edition). Califonrnia, San Francisco.  Dietary Supplementation Health and Education Act of 1994.  Natural Medicines Comprehensive Database 2006.

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