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OBJECTIVES
After completing this chapter, the student will be able to:
1. Given patient data of the following types, the student will be able to properly con-
struct (III) a graph and compute (III) the slope using linear regression: response
(R) vs. concentration (C), response (R) vs. time (T), concentration (C) vs. time (T)
2. Given any two of the above data sets, the student will be able to compute (III) the
slope of the third by linear regression.
3. Give response vs. time and response versus concentration data, the student will be
able to compute (III) the terminal (elimination) rate constant and half life of the
drug.
[ D ]E max
E = ---------------------
- (EQ 4-34)
KR + [D ]
If E is plotted against [D] a hyperbolic curve will result; the asymptote will be
E
0.4
0.2
E max .
0.0
0.0 0.8 1.6 2.4 3.2 4.0
D
a. If linear pharmacokinetics hold, the molar concentration of free drug at the
active site is proportional to the plasma concentration of the drug once equilibrium
has been established. Hence, a plot of E against Cp will also be hyperbolic.
c. For a series of doses the value of X at the same given time after dosing is propor-
tional to the dose (D). Thus, a plot of E against D will also be hyperbolic at a spe-
cific time.
0.4
0.2 this is the clinical range of responses, linear equations may be written. For exam-
0.0 ple,
10 -810-710 -610-510 -410-310-210-1
Plot of Response vs. This example equation shows that, in the clinical range, the intensity of a pharma-
Ln(C) is a straight line in cological response is proportional to the logarithm of the administered dose, pro-
the middle (if you viding response is measured at a consistent time after dosing. The proportionality
squint), but only
between 20% and 80%
constant (slope, m ) is a function of the affinity of the drug for the receptor. In fact,
maximum response equation 4-35 yields a log-dose response plot. Note that doubling the dose does not
double the response.
Pharmacological Response (R), Concentration (C), and Time (t) are interrelated.
The response and concentration relationship is studied in pharmacology. The con-
centration and time relationship is studied in pharmacokinetics. The response and
time relationship is applied in therapeutics.
Remember: Use only You should know what the various graphical relationships look like. Response vs.
the data between 20% natural log of concentration is sigmoidal. (S shaped). We are interested in the mid-
and 80% of maximum dle almost straight part. The slope is dR ⁄ d ln c .
response for the straight
part of both response
vs. Ln(c) and response Response vs. time is a straight line. The slope is dR ⁄ dt .
vs. t.
Natural log of concentration vs. time (drug given by IV bolus) is a straight line.
The slope is d ln c ⁄ dt .
You should be able to obtain the slope of each of these relationships from data sets.
You should be able to obtain the third slope’s relationship given the other two (or
data sets with which to get the other two).
dR dR- d----------
ln c- (EQ 4-36)
------- = ---------- ⋅
dt d ln c dt
dR - dR ⁄ dt
---------- = -------------------- (EQ 4-37)
d ln c d ln c ⁄ dt
d----------
ln c- dR ⁄ dt
= ---------------------- (EQ 4-38)
dt dR ⁄ d ln c
NOTE: Only between You should be able to apply the equation y = mx + b to each of the above relation-
20% and 80% of maxi- ships. Given the slope (or having obtained the slope) and two of the three variables
mum response!!!!!! (y, x, b), you should be able to find the third.
or
Ln ( X ) = Ln ( D ) – Kt (EQ 4-40)
Substituting twice from eq. 4-35 once at time t and once at zero time
E – b- E 0–b
----------- = --------------- – Kt → E = E0 – Rt (EQ 4-41)
m m
Rearranging,
ln --------
D
X eff
t dur = -------------------- (EQ 4-43)
K
ln ( Dose ) ln ( Xeff )
t dur = ----------------------- – ------------------
- (EQ 4-44)
K K
Thus a plot of duration of action vs ln dose would result in a straight line with a
ln ( X ef f )
slope of 1/K and an x intercept of – ------------------- .
K
R
e. Calculate K = ---- .
m
t 1 ⁄ 2 = -------------
0.693
f. Calculate K
.
Thus a plot of E against X1 (or E against Cp ) will show a hysteresis loop with time,
most noticeably during an intravenous infusion.
DRUG RANGE
digoxin 0.8-2.0 ng ⁄ ml
gentamicin 2-10 µg ⁄ ml l
lidocaine 1-4 µg ⁄ ml
lithium 0.4-1.4 mEq ⁄ L
phenytoin 10-20 µg ⁄ ml
phenobarbitol 10-30 µg ⁄ ml
procainamide 4-8 µg ⁄ ml
quinidine 3-6 µg ⁄ ml
theophylline 10-20 µg ⁄ ml
If we were to give an identical dose of drug to a large group of patients and then
measure the highest plasma drug concentration we would see that due to individual
variability, the resulting plasma drug concentrations differ. This variability can be
attributed to factors influencing drug absorption, distribution, metabolism, and
excretion. Therefore, drug dosage regimens must take into account any disease
altering state or physiological difference in the individual.
The major potential advantages of therapeutic drug monitoring are the maximiza-
tion of therapeutic drug benefits and the minimization of toxic drug effects. The
formulation of drug therapy regimens by therapeutic drug monitoring involves a
process for reaching dosage decisions.
The data in Table 4-18 are population averages. Most people respond to drug con-
centrations in these ranges. There is always the possibility that the range will be
different in an individual patient.
1. Nagashima, R., O’Reilly, RA., and Levy, G, Kinetics of pharmacologic effects in man: the anticoagulant action of warfarin. Clin.
Pharm. Therap, 10 22-35 (1969).
3. Gibaldi M. and Levy, G. Dose-dependent decline of pharmacologic effects of drugs with linear pharmacokinetics characteristics.
J.Pharm.Sci, 61, 567-569 (1972).
4. Brunner, L., Imhof, P., and Jack, D. Relation between plasma concentrations and cardiovascular effects of oral oxprenolol in
man. Europ. J. Clin. Pharmacol., 8, 3-9 (1975).
5. Galeazzi, R.L., Benet, L.Z., and Sheiner, L.B. Relationship between the pharmacokinetics and pharmacodynamics of procaina-
mide. Clin. Pharm. Therap., 20, 67-681 (1976).
6. Joubert, P., et al. Correlation between electrocardiographic changes, serum digoxin, and total body digoxin content. Clin.
Pharm. Therap., 20, 676-681 (1976).
7. Amery, A., et al. Relationship between blood level of atenolol and pharmacologic effect. Clin. Pharm. Therap., 21, 691-699
(1977).
3.4 Problems
What to do.---> We want to get pharmacokinetic data (elimination rate con-
stant) from pharmacological response data (Response vs concontration and
Response vs time graphs) .
0.6
dR
14. Find the slope of the straight line, ------- , (eyeball the rise over the run or use linear regression as
0.4 dT
0.2
required). Important: you must determine the best fit line through all of the points that you will
use. Eyeball method: Get the line as close to the points as possible placing as many points
0.0
10 10 10 10 10 10
above the line as below the line. Take two points on the line (not data points) to calculate the
Time
change in Y over the change in X.
10010
10010
10 10
1
1.0
10
0.8
0
0.6
Response
0.4
0.2
Response
0.0
1010
10-810-710-610-510 -410-310 -210-1
Conc.
1
Concentration
1
10
0 1
What we are attempting to do is get the logarithm part of the paper on the x axis and have the
numbers get bigger as you go from left to right.
15. Plot concentration on the x axis and response on the y.
16. Find the slope of the line plotted this way by the rise over the run method.
Run is change in ln(C).
If you take any two concentrations such that C2 = 2*C1 then the run is (ln(C2) - ln(C1)).
Using rules of logs, when two logs are subtracted, the numbers are devided, thus: = ln(C2/C1).
If C2 = 2*C1 then ln(C2/C1) = ln(2) = 0.693.
100
10
Concentration
1010
110
0 1
Time
18. Find the slope as before, using semi log paper (Remeber the log is on the Y axis this time, so
you find two concentrations such that c2 = 2*c1 and put it in the rise this time. Thus the slop of
rise 0.693 0.693
the line is m = -------- = -------------- = ------------- = – k
run t2 – t1 –t1
---
2
3.5 Oxpranolol
Brunner et al, Europ. J. Clin. Pharmacol., 8, 3-9 (1975).
In humans, the pharmacological response to oxpranolol (a beta blocker) is a decrease in beats per minute (bpm) com-
pared to placebo during physical exercise. The following approximate mean data is from 7 healthy volunteers: beats per
minute (bpm) altered with time (t) after oral administration of three doses (D).
TABLE 4-19
Response vs Response vs
Concentration time
C p ------
ng
Time (min) ml
30 699
60 622
120 413
150 292
240 152
360 60
480 24
1. Calculate the half life ( t 1 ⁄ 2 ) of oxpranolol from the pharmacological response table.
2. Plot plasma concentration data on Cartesian graph paper directly as well as transforming Cp into ln C p .
3. Plot plasma concentration data on semilog paper. Use linear regression to find the rate constant of elimination of
oxpranolol.
4. Calculate the half life obtained from the concentration data and compare it with the half life calculation based on the
pharmacological response.
Minoxidil (Problem 4 - 1)
Minoxidil is a potent antihypertensive which lowers the mean arterial blood pressure (MAP) in certain patients.
dR
1. Graph and find ------------ (slope of (R)esponse vs. ln(C)oncentration graph).
d ln C
dR
2. Graph and find ------- (slope of (R)esponse vs. (T)ime graph).
dt
dR
-------
dt
3. Find the ln(C)oncentration vs. (T)ime slope : ------------- : Note that your slope m = – K . If you are having problems
dR
------------
d ln C
understanding this, refer to Sections 2.4.2 -2.4.4. K is the elimination rate constant.
4. Calculate t 1 ⁄ 2 = 0.693
------------- .
K
Propranolol (Problem 4 - 4)
Citation?
Beta blockers can be considered first line drugs of choice in the treatment of hypertension in certain patients. The fol-
lowing data was obtained regarding Propranolol used to treat hypertension in a group of patients.
20 50
16 40
11 30
5 20
dR
1. Graph and find ------------ (slope of (R)esponse vs. ln(C)oncentration graph).
d ln C
dR
2. Graph and find ------- (slope of (R)esponse vs. (T)ime graph).
dt
dR
-------
dt
3. Find the ln(C)oncentration vs. (T)ime slope : ------------- : Note that your slope m = – K . If you are having problems
dR
------------
d ln C
understanding this, refer to Sections 2.4.2 -2.4.4.
4. Calculate t 1 ⁄ 2 = 0.693
------------- .
K
Oxpranolol
22
20
Response (BPM)
18
16
14
12
10
1 2 3
10 10 10
Dose (mg)
TABLE 5.
X Y 2
ln(Dose) Dose Response X X⋅Y
3.689 40 10 13.61 36.89
4.094 60 13.5 16.76 55.27
4.382 80 16 19.20 70.11
4.787 120 19 22.92 90.96
5.075 160 21 25.75 106.58
ΣX = 22.03 ΣY = 79.5 2
ΣX = 98.25 ΣXY = 359.82
2
( ΣX ) = 485.23
ΣX Σy
)
dR -
---------- = 7.93 the slope is equal to the linear regression of the change in response vs. ln concentration.
d ln c
OXPRANOLOL
18
16
Response (BPM)
14
12
10
6
1.0 1.5 2.0 2.5 3.0 3.5 4.0
Time (hr)
1 R –R 2 16 – 10 dR
The slope of this plot is m = ------------------ = --------------------------- = – 3.71 therefore, ------- = – 3.71 .
T1 – T 2 1.45 – 3.07 dt
dR
-------
dt d ln c –3.71 –1 ln 2 0.693 -
----------- = ----------- = – k = ------------- = – 0.4678hr t 1 ⁄ 2 = -------- = -------------------------- = 1.48hr half life (89 min).
dR dt 7.93 k –1
----------- 0.4678hr
d ln c
2. Plot plasma concentration data on Cartesian graph paper directly as well as transforming Cp into ln C p .
640
Concentration (ng/mL)
480
2
10
320
Concentration (ng/ml)
160
1
10
0 0 100 200 300 400 500
0 100 200 300 400 500
Time (min)
Time (min)
3. Plot plasma concentration data on semilog paper. Use linear regression to find the rate constant of elimination of
oxpranolol.
Using linear regression, as described above, the elimination rate constant is approximately
R vs Ln(C)
80
60
40
20
0
10 10 10
Dose (mg)
dR
------------ = 32.96
d ln C
dR
2. Graph and find ------- (slope of (R)esponse vs. (T)ime graph).
dt
R vs T
75
70
65
60
55
50
45
20 25 30 35 40 45 50
Time (hr)
dR
------- = – 0.91
dt
dR
-------
dt
3. Find the ln(C)oncentration vs. (T)ime slope : ------------- : Note that your slope m = – K .
dR
------------
d ln C
–1
K = 0.028hr
–-------------
0.91
= – ( 0.028 )
32.96
4. Calculate t 1 ⁄ 2 = 0.693
------------- .
K
t 1 ⁄ 2 = -----------------------
0.693 -
– 1
= 24.75hr
0.028hr
20
15
10
0
10 10
dR
------------ = 16.36
d ln C
dR
2. Graph and find ------- (slope of (R)esponse vs. (T)ime graph).
dt
25
20
15
10
5
0 1 2 3 4 5 6
dR
------- = – 2.93
dt
dR
-------
dt
3. Find the ln(C)oncentration vs. (T)ime slope : ------------- : Note that your slope m = – K .
dR
------------
d ln C
–1
K = 0.179hr
–-------------
2.93
= – 0.179
16.36
4. Calculate t 1 ⁄ 2 = 0.693
------------- .
K
t 1 ⁄ 2 = -----------------------
0.693 -
– 1
= 3.87hr
0.179hr