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 TaskWeight %Assessment Period/ dateModule assessedWaiver
1SAQ50%30/09/25 9AM – 11AMGeneral Medicine and Pharmacology: all lectures contentNo
2MCQ50%Main Campus: Semester 2 examination periodGeneral Medicine and Pharmacology: all lectures contentNo

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

PharmacodynamicsPharmacokinetics
Pharmacodynamics = What the DRUG does to the BODYPharmacokinetics = 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

DrugReceptorEffect
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

Agonist/substrate
Antagonist/inhibitor
Abnormal product
Prodrug

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 receptors4. 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

MillisecondsSecondsHoursHours
ExamplesMuscarinic ACh receptorCytokine receptorsOestrogen receptor
Nicotinic ACh receptor

Rang & Dale’s Pharmacology, Tenth Edition

Types of Receptors: in a nutshell!16

Type 1: Ligand gated ion channelsType 2: G-Protein coupled receptorsType 3: Receptor kinasesType 4: Nuclear receptors
LocationMembraneMembraneMembraneIntracellular
EffectorIon ChannelChannel or enzymeProtein KinasesGenes Transcription
CouplingDirectG Protein or arrestinDirectVia DNA
ExamplesNicotinic acetylcholine receptor, GABAA receptorMuscarinic acetylcholine receptors, adrenoceptorsInsulin, growth factors, cytokine receptorsSteroid receptors
StructureOligomeric assembly of subunits surround central poreMonomeric/oligomeric assembly of subunits: 7 transmembrane helices with intracellular G-Protein coupling domainSingle transmembrane helix linking extracellular receptor domain to intracellular kinase domainMonomeric 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

  1. Selectivity for particular ion species
  • Size of the pore and nature of its lining
  • Cations: , ,
  • Anions:
  1. Gating properties
  • Control transition from open to closed states
  1. 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
ElementDescription
ACH (ACh)Acetylcholine binding site
, , , Receptor subunits
a-Helices forming gateStructure controlling channel opening
Pore (~0.7 nm)The opening for ion passage
Closed channelReceptor state without ligand binding
Open channelReceptor 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

  1. GTP binds to G Activation of G protein
  2. G dissociates from G\beta$$\gamma Binds to adenylate cyclase activation of cAMP
  3. G dissociates from adenylate cyclase binds to G\beta$$\gamma inactivation of cAMP
  4. 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
sStimulates adenylyl cyclase, causing increased cAMP formationActivated by cholera toxin, which blocks GTPase activity, thus preventing inactivation
iInhibits adenylyl cyclase, decreasing cAMP formationBlocked by pertussis toxin, which prevents dissociation of αβγ complex
oLimited effects of α subunit (effects mainly due to βγ subunits)Blocked by pertussis toxin. Occurs mainly in nervous system
qActivates phospholipase C, increasing production of second messengers inositol trisphosphate and diacylglycerol thus releasing Ca 2+ from intracellular stores and activating protein kinase C (PKC)
12/13Activates Rho and thus Rho kinase
Gβγ subunits
  • Activate potassium channels
  • Inhibit voltage-gated calcium channels
  • Activate GPCR kinases (GRKs)
  • Activate mitogen-activated protein kinase cascade
  • Interact with some forms of adenylyl cyclase and with phospholipase Cβ
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

  1. Ligand binding
  2. Receptor dimerises
  3. Tyrosine autophosphorylation
  4. Binding of SH2- domain protein (Grb2)
  5. Kinase cascade (Raf, Mek, MAPkinase)
  6. Transcription factor
  7. 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 EstrogenThyroid 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.

Footnotes

  1. Original PDF page 1: L2 PHARMACODYNAMICS 2025, p.1

  2. Original PDF page 3: L2 PHARMACODYNAMICS 2025, p.3

  3. Original PDF page 4: L2 PHARMACODYNAMICS 2025, p.4

  4. Original PDF page 5: L2 PHARMACODYNAMICS 2025, p.5

  5. Original PDF page 7: L2 PHARMACODYNAMICS 2025, p.7

  6. Original PDF page 8: L2 PHARMACODYNAMICS 2025, p.8

  7. Original PDF page 9: L2 PHARMACODYNAMICS 2025, p.9

  8. Original PDF page 10: L2 PHARMACODYNAMICS 2025, p.10

  9. Original PDF page 11: L2 PHARMACODYNAMICS 2025, p.11

  10. Original PDF page 12: L2 PHARMACODYNAMICS 2025, p.12 2 3 4 5

  11. Original PDF page 15: L2 PHARMACODYNAMICS 2025, p.15

  12. Original PDF page 18: L2 PHARMACODYNAMICS 2025, p.18

  13. Original PDF page 19: L2 PHARMACODYNAMICS 2025, p.19

  14. Original PDF page 20: L2 PHARMACODYNAMICS 2025, p.20

  15. Original PDF page 21: L2 PHARMACODYNAMICS 2025, p.21

  16. Original PDF page 22: L2 PHARMACODYNAMICS 2025, p.22

  17. Original PDF page 23: L2 PHARMACODYNAMICS 2025, p.23

  18. Original PDF page 24: L2 PHARMACODYNAMICS 2025, p.24

  19. Original PDF page 25: L2 PHARMACODYNAMICS 2025, p.25

  20. Original PDF page 26: L2 PHARMACODYNAMICS 2025, p.26

  21. Original PDF page 27: L2 PHARMACODYNAMICS 2025, p.27

  22. Original PDF page 28: L2 PHARMACODYNAMICS 2025, p.28

  23. Original PDF page 29: L2 PHARMACODYNAMICS 2025, p.29

  24. Original PDF page 30: L2 PHARMACODYNAMICS 2025, p.30

  25. Original PDF page 31: L2 PHARMACODYNAMICS 2025, p.31

  26. Original PDF page 32: L2 PHARMACODYNAMICS 2025, p.32 2

  27. Original PDF page 34: L2 PHARMACODYNAMICS 2025, p.34 2 3

  28. Original PDF page 35: L2 PHARMACODYNAMICS 2025, p.35 2 3

  29. Original PDF page 38: L2 PHARMACODYNAMICS 2025, p.38

  30. Original PDF page 39: L2 PHARMACODYNAMICS 2025, p.39

  31. Original PDF page 40: L2 PHARMACODYNAMICS 2025, p.40