Acknowledgement of country1
The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge.
Artist: Dr Richard Barry Walley OAM
DENT3005: assessment breakdown2
| Assessment # | Assessment Task | Weight % | Assessment Period/ date | Module assessed | Waiver |
|---|---|---|---|---|---|
| 1 | SAQ | 50% | 30/09/25 9AM – 11AM | General Medicine and Pharmacology: all lectures content | No |
| 2 | MCQ | 50% | Main Campus: Semester 2 examination period | General Medicine and Pharmacology: all lectures content | No |
Learning outcomes3
Broad
- Explain the principles of drug delivery, drug metabolism, and associated pharmacological aspects as they relate to dental practice
- Define the terms receptor, drug agonist, and drug antagonist
- Describe the different types of receptor and pharmacodynamic factors influencing drug-receptor interactions
Specific topics we will cover:
- Receptors
- Drug-induced responses
- Receptor agonist and antagonist
- Possible drug targets
- Four main drug receptors: Ion channels, G protein-coupled receptors, kinase-linked receptors, nuclear receptors
Pharmacodynamics vs. Pharmacokinetics4
| Pharmacodynamics | Pharmacokinetics |
|---|---|
| Pharmacodynamics = What the DRUG does to the BODY | Pharmacokinetics = What the BODY does to the DRUG |
Key terms5
- Receptor
- Affinity
- Agonism
- Antagonism
- Competitive and noncompetitive enzyme inhibition
- Efficacy
- Potency
- Receptors
- Specificity
What is a drug?6
- A chemical produce biological effect
How are drugs classified?
- Chemical structure
- Mechanism of action- how does it work?
- Therapeutic use – what is it designed to do?
Drug nomenclature
- Chemical name
- Eg. 7,8-didehydro-4,5a-epoxy-17-methylmorphinan-3,6a-diol sulfate!!!!!
- Generic name
- Eg. Morphine sulfate
- Brand name
- Eg. Kapanol, Ms Contin, Ms Mono…
Basic principle7
- Drug molecule exerting chemical influence pharmacological response
- Non-uniform distribution
- Drug must be bound to a critical binding site “target”
Protein targets
- Receptors
- Enzymes
- Carrier molecules (transporters)
- Ion channels
How drugs function?
- Agonist
- Antagonist
- Inverse agonist
- Toxicity?
What is a receptor?8
- Specialized proteins
- On cell surfaces/within cells
- Transmit signals in the body
Importance
- Key players in mediating the effects of drugs
- Cellular communication
Binding
- ligand-receptor interaction
Signal transduction
- ligand binding triggering cellular changes
Drug-receptor interactions:9
- Chemical structure
- Molecular size and shape
- Lipophilicity
- pH & lonization
Drug binding & receptor activation
- Affinity
- Efficacy
Drug-Receptor Binding10
Affinity
Tendency of a drug to bind to a receptor
- Affinity = Greater binding tendency
- Measured by Kd (Equilibrium dissociation constant, mol/L)
- Lower Kd = Higher affinity
Efficacy
Ability of a drug to produce an effect at the receptor
-
Efficacy = Greater maximum effect
-
More efficacious drug = Greater effect, not necessarily stronger binding
-
Agonist: Has both affinity and efficacy
-
Antagonist: Has affinity, but no efficacy
Reversible reaction
- k & k are the rate constants for association and dissociation
- Drugs with Low Kd = Affinity
- Drugs with High Kd = Affinity
Drug-Receptor interactions, EKG Science
Drug-Receptor Binding10
Potency
(the relative amount of drug that has to be present to produce an effect)
- EC –the concentration at which 50% of the max response (to the drug) is observed
- EC: more drug req = lower potency
Specificity
(relates to degree of selectivity)
- Specificity: targeted action, lowered side-effects
Fundamentals of Pharmacology
Drug-Receptor Binding10
Agonist
An agonist is a drug that binds to and activates a receptor
Partial agonist
- can bind to and activate the receptor
- Lower efficacy – cannot produce the same maximum effect as a full agonist
Antagonist
An antagonist is a drug that binds to the receptor & does NOT cause activation
- Competitive antagonist: reversible/ surmountable
- Non-competitive antagonist: irreversible/ insurmountable
- Physiological antagonism: 2 drugs have effects that are functionally the opposite
RECAP Efficacy: The ability of the agonist- receptor complex to initiate changes that induce a response
Drug-Receptor interactions, EKG Science
flowchart TD subgraph Drug A Binding and Effect A["Drug A (agonist)"] --> B(R) B -- Affinity, k1 --> C(AR) B -- k-1 --> A C -- Efficacy, β --> D(AR*) C -- α --> B D --> E[Response] end subgraph Agonist Action Agonist[Agonist] --> Receptor1(Receptor) Receptor1 --> F[Full activation & Response] end
flowchart TD subgraph Drug B Binding and Effect G["Drug B (antagonist)"] --> H(R) H -- Affinity, k1 --> I(BR) H -- k-1 --> G I --> J[No Response] end subgraph Antagonist Action Antagonist[Antagonist] --> Receptor2(Receptor) Receptor2 --> K[No activation & response] end
Inverse Agonist11
- Inverse agonist are special
- Pharmacological agonist
- Decrease level of receptor activation
- Negative efficacy
- NOT an antagonist
- Do not cause activation (zero efficacy)
Pharmacologic Agonists
| Drug | Receptor | Effect |
|---|---|---|
| Full agonist | ||
| Partial agonist | ||
| Inverse agonist |
Drug-Receptor Binding10
Concentration-response curves (CRC)
Tool for understanding the connection between a drug and its biological effects
Agonists
- Emax – is the maximum response that can be achieved by the drug under the given conditions
- EC50 – is the drug concentration at which 50% of the maximum response (to the drug) is observed
- EC50 provides a measure of drug potency
RECAP Potency: measure of drug activity/ amount of drug that is required to produce a particular effect
- Lower EC50 = Higher potency
- Low potency – requires a higher concentration
Concentration-Response Curve Diagram
The image displays a graph illustrating a concentration-response curve (CRC) and associated concepts.
- Y-axis: % response (from 0 to 100)
- X-axis: [Agonist] (M) (from to )
Key labels on the graph:
- Emax
- Increased risk of adverse reactions
- Therapeutic range
- EC50
- Sub-therapeutic effect
Drug-Receptor interactions, EKG Science
Drug-Receptor Binding10
Concentration-response curves (CRC) for Antagonists
Competitive Antagonist
- Agonist and antagonist compete for the same Orthosteric site
- Surmountable – increasing the con. of the agonist can overcome the binding of the competitive antagonist
- Increasing con. of a competitive antagonist will cause a parallel rightward shift in the agonist CRC
Non-competitive antagonist
- Insurmountable – antagonist drug reduces the maximum effect of the agonist
- Irreversibly alters the target receptors (e.g. forming covalent bonds)
- High affinity for the receptor- dissociates slowly.
- Maximum response cannot be achieved
Lambert DG. (2004). Drugs and receptors. Continuing Education in Anaesthesia Critical Care & Pain; 4(6):181–184.
Other considerations1213
- Drugs that work by simple chemical or physical action
- Neutralization of acidic environment
- Chelating
- Osmosis
Protein Targets for Drug Action14
mermaid flowchart TD subgraph A RECEPTORS A1(Agonist/inverse agonist) ⇒|Direct| A1.1(lon channel opening/closing) A1 ⇒|Transduction mechanisms| A1.2(Enzyme activation/inhibition) A1 ⇒|Transduction mechanisms| A1.3(lon channel modulation) A1 ⇒|Transduction mechanisms| A1.4(DNA transcription) A2(Antagonist) ⇒ A2.1(No effect Endogenous mediators blocked) end
subgraph B ION CHANNELS
B1(Blockers) --> B1.1(Permeation blocked)
B2(Modulators) --> B2.1(Increased or decreased opening probability)
end
subgraph C ENZYMES
C1(Inhibitor) --> C1.1(Normal reaction inhibited)
C2(False substrate) --> C2.1(Abnormal metabolite produced)
C3(Prodrug) --> C3.1(Active drug produced)
end
subgraph D TRANSPORTERS
D1(Normal transport) --> D1.1(Transported compound)
D2(Inhibitor) --> D2.1(Transport blocked)
D3(False substrate) --> D3.1(Abnormal compound accumulated)
end
Rang & Dale’s Pharmacology, Tenth Edition
Types of Receptors15
Receptor: Specialized proteins located on cell surfaces/within cells that are responsible for transmitting signals in the body
| 1. Ligand-gated ion channels (ionotropic receptors) | 2. G protein-coupled receptors (metabotropic) | 3. Kinase-linked receptors | 4. Nuclear receptors |
|---|
graph TD A[Ions] --> B{Hyperpolarisation or depolarisation}; A --> C{Change in excitability}; C --> D[Ca²⁺ release]; R(R) --> E{Second messengers} E --> F[Protein phosphorylation]; E --> G[Other]; R/E(R/E) --> H[Protein phosphorylation]; H --> I[Gene transcription]; I --> J[Protein synthesis]; N(NUCLEUS: R) --> K[Gene transcription]; K --> L[Protein synthesis]; B --> M[Cellular effects]; D --> M; F --> M; G --> M; J --> M; L --> M; subgraph Time Scale style Time Scale fill:#f0f0f0 Mmillisecond[Milliseconds] Ssecond[Seconds] Hhour[Hours] H2hour[Hours] end subgraph Examples style Examples fill:#f0f0f0 N(Nicotinic ACh receptor) M2(Muscarinic ACh receptor) C(Cytokine receptors) O(Oestrogen receptor) end Mmillisecond --> N Ssecond --> M2 Hhour --> C H2hour --> O
Time scale
| Milliseconds | Seconds | Hours | Hours |
|---|---|---|---|
| Examples | Muscarinic ACh receptor | Cytokine receptors | Oestrogen receptor |
| Nicotinic ACh receptor |
Rang & Dale’s Pharmacology, Tenth Edition
Types of Receptors: in a nutshell!16
| Type 1: Ligand gated ion channels | Type 2: G-Protein coupled receptors | Type 3: Receptor kinases | Type 4: Nuclear receptors | |
|---|---|---|---|---|
| Location | Membrane | Membrane | Membrane | Intracellular |
| Effector | Ion Channel | Channel or enzyme | Protein Kinases | Genes Transcription |
| Coupling | Direct | G Protein or arrestin | Direct | Via DNA |
| Examples | Nicotinic acetylcholine receptor, GABAA receptor | Muscarinic acetylcholine receptors, adrenoceptors | Insulin, growth factors, cytokine receptors | Steroid receptors |
| Structure | Oligomeric assembly of subunits surround central pore | Monomeric/oligomeric assembly of subunits: 7 transmembrane helices with intracellular G-Protein coupling domain | Single transmembrane helix linking extracellular receptor domain to intracellular kinase domain | Monomeric structure with receptor and DNA binding domains |
Rang & Dale’s Pharmacology, Tenth Edition
Type 1: Ligand-gated Ion Channel receptors17
- Ionotropic
- Neurotransmitters
- Timescale: milliseconds
- Localization: membrane
- Effector: ion channel
- Coupling: direct
Ion channels are characterized by
- Selectivity for particular ion species
- Size of the pore and nature of its lining
- Cations: , ,
- Anions:
- Gating properties
- Control transition from open to closed states
- Molecular structure
4-5 subunits
Examples
- Nicotinic Ach Receptor
- GABA A Receptor
- Glutamate Receptor
- Glycine Receptor
Types of receptors, EKG Science
Example: Nicotinic Acetylcholine Receptor18
Nicotine
- Outside of cell
- Cell membrane
- Inside of cell
GABA
- Outside of cell
- Cell membrane
- Inside of cell
| Element | Description |
|---|---|
| ACH (ACh) | Acetylcholine binding site |
| , , , | Receptor subunits |
| a-Helices forming gate | Structure controlling channel opening |
| Pore (~0.7 nm) | The opening for ion passage |
| Closed channel | Receptor state without ligand binding |
| Open channel | Receptor state after ligand binding (Nicotine or GABA) |
| Sodium ion flow through nAChR | |
| , | Chloride and Potassium ion flow through GABA receptor |
Type 2: G-protein coupled receptors1920
- Metabotropic
- Largest family
- Timescale: seconds
- Location: membrane
- Effector: channel or enzyme
- Coupling: G-Protein
Function
- Recognise and activate GPCRs pass message to effector system generate cellular response
- Signal amplification
- Four main classes
Binding domains
- Outside of cell
- Cell membrane
- Inside of cell
G-protein coupling domain
Examples
- Adrenoceptors
- Muscarinic Ach
- Histamine
- Serotonin
- Opioid
Example: cyclic AMP pathways2122
- G-protein coupling domain comprises of 3 subunits (,,)
- G proteins link GPCRs to effector proteins that generate intracellular second messengers
- Gs - Activates adenylate cyclase- Generates cAMP
- Gi- Inhibits adenylate cyclase
- Gq - Activates phospholipase C- Generates inositol triphosphate and diacylglycerol
Adenylate cyclase signal transduction pathway
- GTP binds to G Activation of G protein
- G dissociates from G\beta$$\gamma Binds to adenylate cyclase activation of cAMP
- G dissociates from adenylate cyclase binds to G\beta$$\gamma inactivation of cAMP
- Returning to G state
graph TD A[Agonist] --> B(GPCR); B --> C{GTP}; C --> D[Gα]; C --> E[Gαs]; C --> F[Gαi]; C --> G[Gαq]; D --> H[Gβγ]; B --> H; E --> I[AC]; F -.- I; % Inhibitory link shown by dashed line/red arrow in original figure/image I --> J[ATP]; J --> K[cAMP]; K --> L[PKA]; G --> M[PLC]; H --> N[Ion channel]; N --> O(Ions); M --> P[PIP2]; P --> Q[DAG]; P --> R[IP3]; Q --> S[PKC]; R --> T[Ca2+ from ER lumen]; S --> U[Ca2+]; T --> U; D --> V[Gα 12/13]; V --> W[RhoGEF]; W --> X[RhoA]; style E fill:#4CAF50,stroke:#333 style F fill:#4CAF50,stroke:#333 style G fill:#4CAF50,stroke:#333 style V fill:#4CAF50,stroke:#333 style I fill:#FFCC80,stroke:#333 style M fill:#4D8EDD,stroke:#333 style L fill:#FF4D4D,stroke:#333 style S fill:#FF4D4D,stroke:#333 style W fill:#AAAAAA,stroke:#333 style X fill:#AAAAAA,stroke:#333 style Q fill:#FFCC80,stroke:#333 style R fill:#FFCC80,stroke:#333 style K fill:#FF4D4D,stroke:#333 style N fill:#FFCC80,stroke:#333
Chen Y, Palczewski K. (2016). Systems Pharmacology Links GPCRs with Retinal Degenerative Disorders. Annu Rev Pharmacol Toxicol;56:273-98.Rang & Dale’s Pharmacology, Ninth Edition
Rang & Dale’s Pharmacology, Tenth Edition
| Gα subunitsb | ||
|---|---|---|
| Gα s | Stimulates adenylyl cyclase, causing increased cAMP formation | Activated by cholera toxin, which blocks GTPase activity, thus preventing inactivation |
| Gα i | Inhibits adenylyl cyclase, decreasing cAMP formation | Blocked by pertussis toxin, which prevents dissociation of αβγ complex |
| Gα o | Limited effects of α subunit (effects mainly due to βγ subunits) | Blocked by pertussis toxin. Occurs mainly in nervous system |
| Gα q | Activates phospholipase C, increasing production of second messengers inositol trisphosphate and diacylglycerol thus releasing Ca 2+ from intracellular stores and activating protein kinase C (PKC) | |
| Gα 12/13 | Activates Rho and thus Rho kinase | |
| Gβγ subunits |
| Many βγ isoforms identified, but specific functions are not yet known |
Type 3: Kinase linked receptors232425
Large heterogenous group responding mainly to protein mediators
- Time scale: hours
- Location: membrane
- Effector: protein kinases
- Coupling: direct
- Structure: single transmembrane helix- linking extracellular receptor domain to intracellular kinase domain
Receptor types
- Receptor tyrosine kinase – growth factors, insulin and IGF (insulin-like growth factor)
- Receptor serine/threonine kinase – transforming growth factor
- Cytokine receptor – interleukins and interferons
- Receptor guanylate cyclase – natriuretic peptides
Examples
- Insulin
- Growth Factors
- Cytokine
- ANF receptors
Receptor tyrosine kinase26
Ras/Raf/MAP kinase pathway
- Ligand binding
- Receptor dimerises
- Tyrosine autophosphorylation
- Binding of SH2- domain protein (Grb2)
- Kinase cascade (Raf, Mek, MAPkinase)
- Transcription factor
- Gene transcription
*Grb2- Growth factor receptor bound protein 2 (an adaptor protein); SH – Src homology
Rang & Dale’s Pharmacology, Tenth Edition
graph TD A[Growth factor] --> B{Receptor domain}; B --> C[Conformation change / Dimerisation]; C --> D[Tyrosine autophosphorylation]; D --> E[Phosphorylation of Grb2 / Binding of SH2-domain protein (Grb2)]; E --> F[Ras-GDP/GTP exchange Activation of Ras]; F --> G[Raf]; G --> H[Mek Phosphorylation]; H --> I[MAP kinase Phosphorylation]; I --> J[Various transcription factors Phosphorylation]; J --> K[Gene transcription NUCLEUS]; %% Other labels from the diagram subgraph Receptor B_receptor(Receptor domain); C_dimer(Dimerised receptor); D_phosph(Autophosphorylated receptor); E_grb2(Grb2 bound); B_receptor---Trans(Transmembrane $\alpha$ helix); B_receptor---TyrKinase(Tyrosine kinase domain); TyrKinase---TyrRes(Tyrosine residue); end subgraph KINASE CASCADE G; H; I; end
Receptor tyrosine kinase26
Jak/stat pathway
graph TD A[Cytokine] --> B{Receptor} B -- Ligand binding --> C{Dimerisation<br>Conformation change<br>activation of Jak} C --> D{Phosphorylation of receptor<br>+ Jak} D -- Binding and phosphorylation of SH2-domain (Stat) --> E[Stat<br>SH2-domain protein] E --> F{Dimerisation of Stat} F --> G[Gene transcription<br>in NUCLEUS] D -- Location --> MEMBRANE subgraph Steps 1(Ligand binding) 2(Receptor dimerises) 3(Phosphorylation of receptor and Jak) 4(Binding of SH2- domain protein (Stat)) 5(Dimerization of Stat) 6(Gene transcription) end
*JAK – Janus kinase; STAT – signal transducer and activator of activator of transcription Rang & Dale’s Pharmacology, Tenth Edition
Type 4: Nuclear receptors2728
Regulate gene transcription, metabolic and developmental processes Not always in the nucleus
- Time scale: Hours
- Location: intracellular
- Effector: Gene transcription
- Coupling: via DNA
- Structure: monomeric proteins typically composed of several domains each with distinct functions
- N-terminal domain
- Core domain
- Hinge Region
- C-terminal domain
Examples
- Steroid hormones
- Thyroid hormones
- Retinoic acid
- Vitamin D receptors
| Class I: Steroid Receptors (SR) | Class II: Retinoid X Receptor (RXR) Heterodimers |
|---|---|
| Glucocorticoid Mineralocorticoid Progesterone Estrogen | Thyroid hormone RAR |
| Class III: Dimeric Orphan Receptors (DOR) | Class IV: Monomeric Orphan Receptors (MOR) |
Type 4: Nuclear receptors2728
Steroid Receptors (Class I)
- Steroid hormones are lipophilic and can easily enter cell membranes
- Lipophilic ligands interact with nuclear receptors once inside the cell
- Functional effects of nuclear receptors are slow due to their role in gene transcription and protein synthesis
- In the absence of ligand, nuclear receptors are mostly in the cytoplasm, bound to heat shock proteins (HSPs)
graph TD subgraph Cell direction TB Outside_of_cell Cell_membrane Inside_of_cell end Steroid_hormone(Steroid hormone) Steroid_hormone --> Inside_of_cell Inside_of_cell --> Steroid_receptor_inactive(Steroid receptor) Steroid_hormone --> Hormone_receptor_complex_active(Hormone-receptor complex) Steroid_receptor_inactive --- Hormone_receptor_complex_active Hormone_receptor_complex_active --> Nucleus_membrane[Inside Nucleus] Nucleus_membrane --> Complex_binds_to_sites_on_DNA(Complex binds to sites on DNA) Complex_binds_to_sites_on_DNA --> Cellular_response(Cellular response)
Type 4: Nuclear receptors2728
Steroid Receptors (Class II)
- Operate as heterodimers with RXR
- Two types of heterodimers:
- Non-permissive: activated only by RXR ligand
- Permissive: activated by retinoic acid or partner ligand
- Typically bound to co-repressor proteins to suppress gene expression
- Ligand binding causes dissociation of co-repressors and recruitment of co-activators
- Co-activator recruitment initiates gene expression
graph TD subgraph Nucleus M[Nucleus]; C; D; E; F; end subgraph Cytoplasm K[Cytoplasm]; L[Nuclear envelope]; end A[Hormone] --> B(Nuclear pore); B --> C{Receptor Heterodimer with Corepressor (LBD: Ligand Binding Domain, DBD: DNA Binding Domain, RXR: Retinoid X Receptor, T/R: Thyroid/Retinoic Acid Receptor) bound to HRE on target gene}; style C fill:#faa, stroke:#ff0000, color:#000000; A --> C; C --> D[Dissociation of Corepressor and Recruitment of Coactivator and RNA Polymerase]; style D fill:#ddf, stroke:#00aa00, color:#000000; D --> E[Transcription of target gene: mRNA]; D --> F[RNA Polymerase]; E --> G(Nuclear pore); G --> H[Ribosome in Cytoplasm]; H --> I[Protein synthesis]; I --> J[Changed cell function];
Key information2930
- Most drugs bind to, and act through receptors
- Majority of drugs receptors are proteins
- Four superfamilies of receptors are presented
- Effects of drug after binding to a receptor is called signal transduction
- Agonists at a given at a given receptor can be distinguished based upon affinity and efficacy
- Antagonists are drugs that bind to receptors and block the effects of agonists
References31
- Ritter JM, Flower RJ, Henderson G, Loke YK, MacEwan D, Robinson E, editors. Rang & Dale’s pharmacology. 10th ed. Edinburgh: Elsevier; 2023
- Becker DE, Reed KL. Pharmacology and Therapeutics for Dentistry. 7th ed. St. Louis: Elsevier; 2017.
- Bullock S, Manias E. Fundamentals of pharmacology. 8th ed. Frenchs Forest, NSW: Pearson Australia; 2017
- Stringer JL. Basic concepts in pharmacology. 6th ed. New York (US): McGraw Hill Medical; 2022 Feb 18
Images of people suffering from illnesses and medication jars.
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