THINGS TO KNOW Arthur G. Roberts
Benzodiazepine and benzodiazepine-like drugs
diazepine azepine benzo-di-azepine benzene 8 9
Benzodiazepines GABA GABA A receptor Properties Sedation/hypnosis Decreased anxiety Anterograde amnesia (negative) Anticonvulsant Muscle relaxation -aminobutyric acid 4
Benzodiazepines Therapeutic and Efficacy half life Anticonvulsants long half-lives CNS and Status epilepticus Sleep short half-lives Anti-anxiety long half-life, except aprazolam (Xanax) ~12 hours 5 alprazolam (Xanax)
( site ) 6 Chloride Conductance A B C -aminobutyric acid (GABA) D
K D ’s of GABA A agonists Compound 11 22 33 55 Diazepam16 nM Clonazepam Triazolam Ro Zolpidem >15000 L How to Use the Table
Rules and 5 non-selective 1 - 3 anticonvulsant 1 sedation and hypnosis 2 and 5 anxiolytic 8
9 Benzodiazepines SAR 1 47 Know the SAR rules basic characteristics Know names of BZD from class
Flumazenil (Anexate) GABA A receptor antagonist BZD overdoses hypersomnia X Patent Liver Carboxylic Acid Metabolite + Glucuronidation ADR: headache and insomnia 10 5
METABOLISM 11
12 diazepam (Valium) clorazepate prazepam halazepam NH 2
13 OH midazolam hydroxymethyl midazolam
Non-benzodiazepines (Non- BZD) imidazopyridines pyrazolopyrimidine cyclopyrrolones 14
Insomnia Melatonin receptor (MT 1 and MT 2 ) agonist (No GABA A ) sleep-wake cycle and circadian rhythm Onset 30 mins Bioavailable is 1.8% Metabolized by CYP1A2, first pass converts to active metabolite M-II Food delays absorption 82% protein bound ADR: headache, depression, insomnia worsened Melatonin 15 Alternative: Ramelteon (Rozerem) 1/10 M-II
Bisphosphonates (BP)
Ionization AB C
Bisphosphonates (BP) Ca 2+ BP complexed with Ca 2+ History 1897 Von Baeyer and Hoffman 1960 Blazer and Worms- Ca 2+ and Mg 2+ complexation late 1960s Fleisch- reduced bone resorption in rats (2 x Science) and first clinical trials 1970s and 1980s- clinical development of Bisphosphonates (Procter and Gamble) Procter and Gamble prescription drug business sold to Warner Chilcott (formerly Galen)
Bone Remodeling Breakdown Formation
Bisphosphonates and Bone Remodeling Promote Osteoclast Apoptosis Stabilize Bone Matrix
Bisphosphonates and Bone Remodeling Bisphosponates FPP = Farnesyl Pyrophosphate Synthase; HMG-CoA = 3-hydroxy-3-methyl-CoA side effects ? FPP farnesyl pyrophosphate 2 x 3-isopentenyl pyrophosphate dimethylallyl pyrophosphate A B Osteoclast Formation Bone Breakdown mevalonate pathway General Understanding
Bisphosphonates and Bone Remodeling localize at sites of bone resorption. 2 phosphonates chelate exposed Ca 2+ in the bone matrix
Bisphosphonates and Bone Remodeling Normal bone is formed on top of the compounds by osteoblasts Incorporated into the matrix, but no pharmacological action Continuously administered to maintain positive bone formation balance
Bisphosphonates use and indications Osteoporosis Glucocorticoid-induced osteoporosis Paget’s disease Cancer Hypercalcemia Osteolytic bone metastases
Bisphosphonates
Pharmacophore N ~4 Å..
Bisphosphonates: General Considerations Care needed Side effects, Possible long half-life Strong acids (pKa < 1) will not chelate. Lose effectiveness. Fairly high affinity for calcium and other di- and trivalent minerals ( Mg, Fe, Al, etc. ) Plain water avoid water containing minerals (e.g. mineral, spring, tap and well water) because of chelation Food affects absorption empty stomach