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Ebook Ebook PDF Rowland and Tozers Clinical Pharmacokinetics and Pharmacodynamics Concepts and Applications 5th Edition PDF
Ebook Ebook PDF Rowland and Tozers Clinical Pharmacokinetics and Pharmacodynamics Concepts and Applications 5th Edition PDF
7
PREFACE
8
advances in the field are elaborated in the current edition. Measures and
quantification of drug response, including biomarkers, are increasingly
being used in drug research and therapeutic monitoring. However, the
resulting data represent a challenge for appropriate analysis and
interpretation. Pharmacokinetic studies almost always focus on drug
concentrations. In contrast, for pharmacodynamics, the number of
different response measures and biomarkers is unlimited, resulting in
many different mathematical and statistical models.
A newly added topic to this book is an introduction to population
pharmacokinetics, an approach to quantitate and characterize the
variability of drug exposure in different patients and patient populations.
This type of analysis only became feasible with the advent of more
powerful computer systems.
Variability does, of course, also exist in pharmacodynamics, not only
in the patients’ ability to respond to treatment but also as the result of
disease progression. The Impact of Disease on Pharmacodynamics was
added as a new section to the book.
Another recent change has been the transition from developing drug
products based primarily on small molecules to using protein drugs.
These large molecules come with distinctive pharmacokinetic and
pharmacodynamic considerations, which have been more extensively
covered in this new edition.
We also expanded on the use of physiologically based
pharmacokinetic modeling and simulation approaches for the prediction
and refinement of human kinetics from in vitro, preclinical, and early
clinical data.
Finally, we updated all chapters and examples and continued to
provide study questions at the end of each chapter as well as the
respective answers at the end of the book. This text is accompanied with
web-based material including computer-based simulations of many of
the concepts. These simulations allow the reader to explore the influence
of changes in parameter values in both pharmacokinetics and
pharmacodynamics on drug concentration and response with time
following drug administration.
9
ACKNOWLEDGMENTS
HARTMUT DERENDORF
Gainesville, Florida
STEPHAN SCHMIDT
Orlando, Florida
10
CONTENTS
11
Systemic Absorption
Disposition
Distribution
Elimination
Biliary Secretion and Fecal Excretion
PHARMACODYNAMICS
Classification of Response
Assessment of Drug Response
Relating Response to Exposure
Graded Response
Quantal Response
Desirable Characteristics
DOSE–TIME–RESPONSE RELATIONSHIPS
Turnover Concepts in Drug Response
KEY RELATIONSHIPS
STUDY PROBLEMS
12
Distribution and Elimination: Competing Processes
PATHWAYS OF ELIMINATION
Renal Clearance
Renal Excretion as a Fraction of Total Elimination
ESTIMATION OF PHARMACOKINETIC PARAMETERS
Plasma Data Alone
Plasma and Urine Data
A Question of Precision
Measurement Fluid
Use of Computers
CHANGE IN DOSE
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 4 Membranes and Distribution
MEMBRANES
TRANSPORT PROCESSES
Protein Binding
Diffusion
Drug Properties Determining Permeability
Membrane Characteristics
Carrier-Mediated Transport
REVERSIBLE NATURE OF TRANSPORT
RATE OF DISTRIBUTION TO TISSUES
Perfusion Rate Limitation
Permeability Rate Limitation
EXTENT OF DISTRIBUTION
Apparent Volume of Distribution
Binding within Blood
Plasma Protein Binding
Tissue Distribution
Tissue Binding
Transporters
SMALL VOLUME OF DISTRIBUTION
Model
Location in Body
13
Altered Binding and Loading Dose
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 5 Elimination
PROCESSES OF ELIMINATION
CLEARANCE IN GENERAL
Description of Clearance by Organ, Process, or Site of
Measurement
Plasma or Serum versus Blood Clearance
Additivity of Clearance
HEPATIC CLEARANCE
Perfusion, Protein Binding, and Hepatocellular Activity
Intrinsic Clearance
Perfusion
Plasma Protein Binding
Hepatocellular Eliminating Activity
A Memory Aid
Some Complexities
Permeability
Location of Transporters
Biliary Excretion and Enterohepatic Cycling
RENAL CLEARANCE
The Nephron: Anatomy and Function
Glomerular Filtration
Active Secretion
Protein Binding and Perfusion
Tubular Reabsorption
Renal Metabolism
DEPENDENCE OF ELIMINATION KINETICS ON CLEARANCE
AND DISTRIBUTION
Half-life in Plasma
Half-life in Blood and Plasma Water
INTEGRATION OF KINETIC AND PHYSIOLOGIC CONCEPTS
Interrelationships among Pharmacokinetic Parameters and
Physiologic Variables
14
Primary Parameters and Physiologic Variables
Secondary Pharmacokinetic Parameters and Derived Values
Induction of Metabolism
Metabolic Inhibition
Altered Blood Flow
Altered Active Tubular Secretion
Altered Plasma Protein Binding
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 6 Kinetics Following an Extravascular Dose
ROUTES OF EXTRAVASCULAR ADMINISTRATION
KINETICS OF ABSORPTION
EXPOSURE–TIME AND EXPOSURE–DOSE RELATIONSHIPS
Comparison with Intravenous Administration
CHANGES IN DOSE OR ABSORPTION KINETICS
Changing Dose
Changing Absorption Kinetics
Disposition Is Rate-Limiting
Absorption Is Rate-Limiting
Distinguishing between Absorption and Disposition Rate
Limitations
Changing Disposition Kinetics
Predicting Changes in Peak Concentration and Peak Time
ASSESSMENT OF PRODUCT PERFORMANCE
Formulation
Bioequivalence Testing
ASSESSMENT OF PHARMACOKINETIC PARAMETERS
Plasma Data Alone
Bioavailability
Relative Bioavailability
Fraction Eliminated
Other Pharmacokinetic Parameters
Urine Data Alone
Plasma and Urine Data
Virtual Bioequivalence
15
Local Bioequivalence
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 7 Absorption
ABSORPTION FROM SOLUTION
Gastrointestinal Absorption
Gastric Emptying
Intestinal Absorption and Permeability
Causes of Loss in Oral Bioavailability
Competing Intestinal Reactions
First-Pass Loss
Separating Gut Wall from Hepatic First-Pass Loss
Hepatic First-Pass Predictions
Saturable First-Pass Metabolism
Absorption from Intramuscular and Subcutaneous Sites
ABSORPTION FROM SOLID DOSAGE FORMS
Dissolution
Gastric Emptying and Intestinal Transit
Gastric Emptying
Rapid Dissolution in Stomach
Rapid Dissolution in Intestine
Intestinal Absorption Windows
Poor Dissolution
Biopharmaceutics Classification System
Modified-Release Products
Changing Rate Control
Precipitation and Redissolution
Absorption from Other Sites
INTEGRATION OF KINETIC AND PHYSIOLOGIC CONCEPTS
Change in the Speed of Absorption
Change in Extent of Absorption
Change in Drug Disposition
Induction, Low Extraction Ratio
Induction, High Extraction Ratio
Impaired Renal Function
16
Increase in Urine pH
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 8 Response
TIME DELAYS BETWEEN CONCENTRATION AND RESPONSE
Detecting Time Delays
Causes of Time Delay
Tissue Distribution
Pharmacodynamics
Direct and Indirect Link
Indirect Response Models
Systems in Flux
Revealing the Concentration–Response Relationship
Effect Compartment
Systems in Flux
DECLINE OF RESPONSE WITH TIME
When Pharmacokinetics Rate-Limits Decline
When Pharmacodynamics Rate-Limits Decline
ONSET AND DURATION OF RESPONSE
Onset of Effect
Duration of Effect
Impact of Transporter Polymorphism on Exposure–Response
Relationships
KEY RELATIONSHIPS
STUDY PROBLEMS
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Time Delays
ACHIEVING THERAPEUTIC GOALS
STUDY PROBLEMS
CHAPTER 10 Constant-Rate Input
EXPOSURE–TIME RELATIONSHIPS
The Plateau Value
Mean Residence Time
Time to Reach Plateau
Postinfusion
Changing Infusion Rates
Bolus Plus Infusion
SHORT-TERM INFUSIONS
CONSEQUENCE OF SLOW TISSUE DISTRIBUTION
Rapid Induction of Anesthesia
Decrease in Infusion Rate on Chronic Administration
Recovery from Anesthesia
PHARMACODYNAMIC CONSIDERATIONS
The Drug Itself
Onset of Response
Response on Stopping an Infusion
Response Infusion versus Single Dose
Turnover of Affected Systems
Altered Turnover
Establishment of a New Steady State
Interpretation of Non–Steady-State Observations
TOLERANCE
INTEGRATION OF KINETIC AND PHYSIOLOGIC CONCEPTS
Drug A. Inhibition of Hepatic Metabolism, Low Hepatic Extraction
Ratio
Drug B. Inhibition of Hepatic Metabolism, High Hepatic Extraction
Ratio
Drug C. Induction of Hepatic Metabolism, Low Hepatic Extraction
Ratio
Drug D Induction of Hepatic Metabolism, High Hepatic Extraction
Ratio
18
TRANSLATIONAL JUSTIFICATION FOR USING CONTINUOUS
INFUSIONS
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 11 Multiple-Dose Regimens
PRINCIPLES OF DRUG ACCUMULATION
Maxima and Minima on Accumulation to the Plateau
Average Level at Plateau
Rate of Accumulation to Plateau
Accumulation Index
Change in Regimen
RELATIONSHIP BETWEEN INITIAL AND MAINTENANCE
DOSES
MAINTENANCE OF DRUG IN THE THERAPEUTIC RANGE
Half-lives Less than 30 Minutes
Half-Lives between 30 min and 8 hr
Half-Lives between 8 and 24 hr
Half-Lives Greater than 24 hr
Reinforcing the Principles
ADDITIONAL CONSIDERATIONS
Extravascular Administration
Plasma Concentration versus Amount in Body
DESIGN OF DOSAGE REGIMENS USING PLASMA
CONCENTRATION
When Bioavailability and Volume Are Unknown
MODIFIED-RELEASE PRODUCTS
EVALUATION OF A MULTIPLE-DOSE REGIMEN
Clearance/Bioavailability
Half-life
Degree of Accumulation
Degree of Fluctuation at Plateau
Other Parameters
PHARMACODYNAMIC CONSIDERATIONS
Time to Achieve Therapeutic Effect
Intermittent Administration
19
Onset, Duration, and Intensity
Development of Tolerance
Modality of Administration
WHEN ABSORPTION OR DISPOSITION IS ALTERED
Sketch of Concentration–Time Profiles
Model of Multiple Intravenous Doses
Extravascular Administration
Inhibition of Hepatic Metabolism (Condition A)
Induction of Metabolism (Condition B)
TRANSLATIONAL JUSTIFICATION FOR USING SINGLE DAILY
DOSING OVER MORE FREQUENT ADMINISTRATION
Other Situations
STUDY PROBLEMS
SECTION 4 INDIVIDUALIZATION
CHAPTER 12 Variability
EXPRESSIONS OF INDIVIDUAL DIFFERENCES
Quantifying Variability
Describing Variability
POPULATION ANALYSIS
MAXIMUM LIKELIHOOD APPROACH
WHY PEOPLE DIFFER
DEFINING THE DOSE–RESPONSE RELATIONSHIP
THERAPEUTIC EXPOSURE
KINETIC MANIFESTATIONS
DYNAMIC MANIFESTATIONS
DOSE STRENGTHS
STUDY PROBLEMS
CHAPTER 13 Genetics
INHERITED VARIATION IN PHARMACOKINETICS
Oxidation
S-Methylation
Conjugation
Acetylation
Hydrolysis
20
Additional Clinical Considerations
INHERITED VARIABILITY IN PHARMACODYNAMICS
METABOLIC PHENOTYPING
PHARMACOGENETICS-BASED THERAPEUTIC
RECOMMENDATIONS
STUDY PROBLEMS
CHAPTER 14 Age, Weight, and Gender
THE TYPICAL PATIENT AND USUAL DOSAGE REGIMEN
Who Is the “Typical Patient”?
What Is the “Usual Dosage Regimen”?
PHARMACODYNAMICS
PHARMACOKINETICS
Absorption
Disposition
Body Weight and Composition
Loading Dose
Maintenance Dosing Rate
CHANGE IN PHYSIOLOGIC FUNCTIONS AND DRUG
DISPOSITION WITH AGE
Creatinine Clearance and Renal Function
Neonates and Infants
Children
Adults and the Elderly
Metabolism
Neonates and Infants
Children
Adults and the Elderly
Entire Lifespan
GENDER DIFFERENCES
Pharmacokinetics
Pharmacodynamics
ADJUSTMENT OF DOSAGE FOR AGE
Neonates and Infants
Children
Adults
21
The Elderly
DOSAGES EXPRESSED PER KILOGRAM BODY WEIGHT OR
PER 1.73 SQUARE METERS
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 15 Disease
IMPACT OF DISEASE ON PHARMACOKINETICS
Hepatic Diseases
Cardiovascular Diseases
Renal Diseases
The Pharmacotherapeutic Problem
Decrease in Unbound Clearance
Decrease in Binding to Plasma Proteins
Estimation of Renal Function
Adjustment of Dosage Regimens
General Guidelines and Additional Considerations
HEMODIALYSIS
Dialysis Clearance
Extraction from Blood
Rate of Recovery in Dialysate
Amount Recovered in Dialysate
Extraction Coefficient
Drug Elimination
Effectiveness of Procedure
DRUG ADMINISTRATION TO DIALYSIS PATIENTS
PERITONEAL DIALYSIS
Dialysis Clearance
Route of Administration
DIALYSIS IN DRUG OVERDOSE
Toxic Metabolites
Other Considerations
IMPACT OF DISEASE ON PHARMACODYNAMICS
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 16 Nonlinearities
22
DEFINITION OF NONLINEAR KINETIC BEHAVIOR
CAUSES OF NONLINEARITY
SATURABLE PROCESSES
Saturable Metabolism
Saturable Transport
Saturable Binding to Plasma Proteins
Pharmacodynamics
NONLINEAR ABSORPTION
Solubility
Saturable Active Transport
SATURABLE FIRST-PASS METABOLISM
CAPACITY-LIMITED METABOLISM
Alcohol
Phenytoin
Plateau
Time to Plateau
Alterations in Metabolism
CONCENTRATION-DEPENDENT RENAL EXCRETION
SATURABLE TRANSPORT
SATURABILITY OF PLASMA PROTEIN AND TISSUE BINDING
Binding to Plasma Proteins
Tissue Binding
TIME-DEPENDENT DISPOSITION
RECOGNITION OF NONLINEARITIES
Urinary Recovery
Analysis
Concentration–Time Profile
Analysis
Protein-Binding Data
Analysis
KINETICS IN DRUG OVERDOSE
THERAPEUTIC CONSEQUENCES OF NONLINEARITIES
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 17 Drug Interactions
23
CLASSIFICATION
ALTERED ABSORPTION
ALTERED DISTRIBUTION
Conditions Favoring Displacement
Therapeutic Implications
Acute Events
Events at Plateau
Kinetic Features
ALTERED CLEARANCE
Inhibition
Competitive Inhibition
Mechanism-Based Inhibition
Induction
Other Causes of Altered Clearance
MULTIFACETED INTERACTIONS
Warfarin–Phenylbutazone Interaction
Digoxin–Quinidine Interaction
Atorvastatin–Rifampicin Interaction
PHARMACODYNAMIC INTERACTIONS
KEY RELATIONSHIPS
STUDY PROBLEMS
CHAPTER 18 Initiating and Managing Therapy
ANTICIPATING SOURCES OF VARIABILITY
Pharmacodynamic Variability
Pharmacokinetic Variability
INITIATING THERAPY
Choosing the Starting Dose
When Is a Loading Dose Needed?
What Should the Loading Dose Be?
Dose Titration
MANAGING THERAPY
Low Therapeutic Index
Use of Biomarkers, Surrogates, and Clinical Endpoints
Tolerance
Dose Strengths and Stratification of Patients
24
Another random document with
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member of the religious society of Friends. A letter which Mr.
Rittenhouse wrote to his brother-in-law Mr. Barton, in October 1762,
announcing this event, indicates the keenness of his sensibility on
the occasion. Mrs. Shoemaker was a woman of intrinsic worth; she
died in the prime of life; and it is believed, she was the first of Mr.
Rittenhouse’s affectionate little band of brothers and sisters who had
attained to the age of maturity, that he had then lost. After giving a
circumstantial account of his sister’s illness and death, he informs
Mr. Barton, that Mr. Daniel Stanton, an eminent public speaker in the
society of Friends,[100] attended her in her last illness, at her
particular request;—and, added Mr. Rittenhouse, “the same worthy
gentleman who visited her in her sickness, delivered an excellent
exhortation at the grave,—giving, in a few words, a very just
character, I think, of our deceased sister.”
So early, however, as about the close of the year 1763, four or five
years before the running and marking of Mason and Dixon’s line, Mr.
Rittenhouse was employed by the Penn family in making some
geographical arrangements, preparatory to the final establishment of
those boundaries. He was engaged to perform this service, by the
Rev. Mr. Richard Peters, (afterwards D. D. and rector of the united
churches of Christ-Church and St. Peters, in Philadelphia,) who then
officiated as the Governor’s provincial secretary; a gentleman of
learning and great worth; and one who, on various occasions,
manifested a friendship for Mr. Rittenhouse, as well the high opinion
he entertained of his abilities.
It appears that about this time, Mr. Rittenhouse’s friends had some
beneficial object in view for him; perhaps some official situation,
which they conceived to be adapted to the nature of his pursuits, and
such as might more permanently promote his interests. But whatever
that object may have been, he seems to have hesitated about it. If it
were a public appointment of a permanent kind, it would probably
have required his removal to the city,—a measure which he did not
contemplate at that time; and he might, besides, have been
disinclined to undertake any official duties, which would be likely to
occupy the greater part of his time. He expressed himself thus to Mr.
Barton, on the subject, in the letter just quoted:—“I am greatly
obliged to you, my dear brother, for pointing out any prospect of
advantage to me: I shall consider the matter you mention in your
last, and let you know my opinion. The objections you have so well
answered, are those which would most readily occur to me.
Considering the crazy state of my constitution, a retired life would
certainly suit me best. Since death, to use John Bunyan’s[102] phrase,
does usually knock at my door once a day, would it not be a folly for
me to take up the load of any public business?”
About the time that he projected his Orrery (which shall be duly
noticed in its place), it appears he had been speculating on the
doctrine of the compressibility of water. For in a letter to Mr. Barton,
dated from Philadelphia the 27th of March, 1767, he mentions,—that
he had not then met with any person, who had seen Mr.
Kinnersley’s[106] experiment on that theory; but that he understood it
was made with the air-pump, and conjectured it to have been similar
to the one made by a member of the Royal Society, related in
Martin’s Magazine: which is thus quoted in Mr. Rittenhouse’s letter:
“I took a glass ball of about an inch and 6/10 in diameter, which was
joined to a cylindrical tube of 4 inches and 2/10 in length, and in
diameter 1/100 of an inch; and by weighing the quantity of mercury
that exactly filled the ball, and also the quantity that filled the tube, I
found that the mercury in 23/100 of an inch of the tube was the
10000th part of that contained in the ball; and with the edge of a file,
I divided the tube accordingly. This having been done, I filled the ball
and part of the tube with water exhausted of air: Now, by placing this
ball and tube under the receiver of an air-pump, I could see the
degree of expansion of the water, answering to any degree of
rarefaction of the air; and by putting it into a glass receiver of a
condensing engine, I could see the degree of compression of the
water, answering to any degree of condensation of the air, &c.”—
Then adds. Mr. Rittenhouse—“Indeed I do not doubt the
compressibility of water, although the above experiment does not
much please me. If the particles of water were in actual contact, it
would be difficult to conceive how any body could much exceed it in
specific gravity; yet we find that gold does, more than eighteen
times.”
The other circumstance, just referred to, was the then approaching
Transit of Venus over the Sun’s disk; an event which was to take
place on the 3d day of June, 1769: And of Mr. Rittenhouse’s
participation in the arduous labours of the astronomical world, on
that very interesting occasion, the following narrative will furnish
some account.
“Dear Sir,
“Dear Brother,