Title: Master of Pharmacy Degree at King’s College London
1Master of Pharmacy Degreeat Kings College
London
2The College
- Kings is one of the two founding Colleges of the
University of London a major international
university in the heart of London with
approximately 14,000 undergraduate students and
more than 5,000 postgraduates in nine Schools and
five campuses. - School of Biomedical and Health Sciences
- Dental Institute
- School of Humanities
- School of Law
- School of Medicine
- Florence Nightingale School of Nursing
Midwifery - School of Physical Sciences Engineering
- Institute of Psychiatry
- School of Social Science Public Policy
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4The Department of Pharmacy
- Master of Pharmacy
- Master of Science Programmes
- Biopharmacy
- Pharmaceutical Technology
- Pharmaceutical Analysis Quality Control
- Master of Science / Diploma Programmes
- Primary Care Community Pharmacy
- Supplementary Prescribing
- Research Degrees in the Pharmaceutical Sciences
- Pharmacy Practice
-
5Pharmaceutical Education Training in the UK
- Master of Pharmacy (MPharm) Degree
- Four Years
-
- Pre-Registration Training One Year
- Hospital Pharmacy
- Community Pharmacy
- Hospital or Community / Industry or Academic
Pharmacy - Professional Examination
- Registration Member of the Royal Pharmaceutical
Society of GB (RPSGB)
6MPharm 1 Principles of Pharmacy
- Pharmacy orientation course
- (First three weeks)
- Interprofessional Education
- (Throughout the Year)
- Biochemical Basis of Therapeutics
- Pharmacy Practice Biopharmacy
- Physical Pharmaceutics
- Chemistry of Drugs
7- MPharm 2 Pharmacy Therapeutics
- Formulation Analysis of Drugs
- Nervous System
- Respiratory Musculoskeletal Systems
- Cardiovascular Renal Systems
-
- MPharm 3 Pharmacy Therapeutics
- Medicines Discovery Design
- Gastrointestinal System Skin
- Infection Pharmaceutical Microbiology
- Endocrine System Cancer
- Pharmacy Law Ethics
8MPharm 4 Pharmacy into Practice
- Semester 1 Research Project
- Semester 2 Preparation for Practice
- Electives - Two from
- Chemical Mediators Disease
- Plants Pharmacy
- Drug Development from Natural Sources
- Drug Delivery
- Science of Dosage Form Design
- Drug discovery Design
- Drug Metabolism
- Drug Toxicity
-
9Department of Pharmacy and Overseas Study
European Union Erasmus-Socrates
- Undergraduate students
- PhD students
- Post-doctoral staff
- Academic staff
- Austria
- University of Vienna
- France
- Joseph Fourier University, Grenoble
- Germany
- Johann Wolfgang Goethe University,
- Frankfurt
- Philipps University, Marburg
- Hungary
- Semmelweis University, Budapest
- Italy
- University of Bologna
- University of Calabria
- University of Padova
- University of Parma
- Poland
- Medical University of Lódz
- Spain
10Stereochemistry Biological Activity
- Andrew J. Hutt
- Department of Pharmacy,
- Kings College London.
11Pharmaceutical Medicinal Chemistry
- No drug was ever used because it had an
- Interesting synthetic pathway
- An unusual stability profile
- Required a particularly sophisticated
- analytical technique.
- Drugs are used because they do something!
12- .. and they do something as a result of
their molecular structure, which determines - Physicochemical properties
- Chemical / biochemical reactivity
- Shape
- STEREOCHEMISTRY.
13- Stereochemistry
- Concerned with the three dimensional spatial
arrangement of the atoms within a molecule. - Stereoisomers
- Compounds with the same molecular
connectivity but differ in the spatial
arrangement of their constituent atoms or groups.
14- Enantiomers
- Stereoisomers which are non-superimposable
mirror images of one another. - Diastereoisomers
- Stereoisomers which are not enantiomeric.
15Stereogenic centre
16Chiros Greek Handed
17Sequence Rule Designation
18Stereoisomers of Ibuprofen
19Stereogenic S P centres
20Stereoisomers of Phenylpropanolamine
21Phenylpropanolamine UK Confusion
- Independent risk factor for hemorrhagic stroke in
women1 - Withdrawn in the USA (FDA, Oct. 10, 2000)
- ()-norpseudoephedrine in European
preparations(?)-norephedrine in North
America(Martindale 32nd Pharm J, Nov. 11, 2000) - (?)-norephedrine in USA and Europe structure of
norpseudoephedrine presented in the British
Pharmacopoeia 2000 (Pharm J, Dec. 2, 2000)
1Kernan WN, et al. N Engl J Med.
20003431826-1832.
22Glyceraldehyde enantiomers
23Stereochemical Designations
- Spatial Arrangement
- R/S
- D/L
- Physical Properties
- d,l
- (),(-)
24Optical Rotation (1)
25Optical Rotation (2)
- Chloramphenicol
- 1R,2R-absolute configuration
- Dextrorotatory in ethanol
- Laevorotatory in ethyl
acetate - Moxalactam
- Mixture of two epimeric diastereoisomers both
of which
are laevorotatory
26Nomenclature
- Dextro / Dex () Es (S)
- Dexamethasone Esomeprazole
- Dexamfetamine Escitalopram
- Dextromethorpan Eszopictone
- Dextropropoxyphene
- Levo / Lev (-) Ar (R)
- Levamisole Arformoterol
- Levobunolol Arflurbiprofen
- Levodopa
- Levonorgestrel
27D-Glucose
28Amino Acids
29- Differences between stereoisomers are hard to
detect normally, but become much more marked in
a chiral environment
30Chiral Biological Macromolecules
- Proteins
- Enzymes
- Structural elements of membranes
- Receptors
- Carbohydrates
- Nucleic acids
- Chiral building blocks of L-amino acids and
D-carbohydrates.
31Helical structures
32Differences Between Enantiomers Odor
- R S
- Limonene Oranges Lemons
- Carvone Spearmint Caraway
33Differences Between Enantiomers Taste
- D L
- Asparagine Sweet Tasteless
- Leucine Sweet Bitter
34Enantiomeric DiscriminationEasson Stedman
Model (1933)
35Adrenaline Adrenergic Receptors
36Pharmacology Pharmacodynamics
- Stereoselectivity of drug action has been known
for a number of years. - Many natural ligands are chiral, eg,
transmitters, hormones, etc.
37 Pharmacodynamic Considerations
- Greatest differences between a pair of
enantiomers occur at the level of receptor
interactions. - Additional Terminology
- Eutomer enantiomer with higher
affinity/activity. - Distomer enantiomer with lower
affinity/activity. - Eudismic Ratio Ratio of the Eutomer/Distomer
affinities or activities. - Eudismic Ratios of 100 to 1000 fold are not
uncommon.
38Eudismic Ratio
- Terminology applies to a particular activity of a
drug. - Dual action drug the Eutomer of one activity may
be the Distomer for another. - Propranolol S-enantiomer 40-100 fold more potent
than the R- as a ß-adrenoceptor antagonist
similar activity with respect to their membrane
stabilising properties. - Eudismic Ratios may also vary with receptor
subtypes. - Noradrenaline ER (R/S) a1, 107 a2, 480.
- a-Methylnoradrenaline ER (1R,2S/1S,2R) a1,
60a2, 550.
39Amosulalol Enantiomer Activity
Eudismic Ratio
Eutomer pA2 (Enantiomer)
Tissue
Receptor
- Adrenoceptor agonist
- Nonspecific ß
- Selective a1
48
7.71 (-)
Rat atrium
ß1
Guinea pig trachea
ß2
47
7.38 (-)
14
8.31 ()
Rabbit aorta
a1
3
5.36 ()
Rat vas deferens
a2
40Stereoselectivity of TerfenadineH1-Antihistamine.
- Inhibition of mepyamine binding R-, 6.4µM S-,
7.5 µM. - Ligand binding at H1-receptors Ki values
- R-, 7.6 S-, 6.81.
- Blockade cardiac K channels R-, 1.19 µM S-,
1.16 µM. - Stereogenic centre located in a non critical
region.
41Sertraline Selective Serotonin Reuptake
Inhibitor
42Formoterol
43Pharmacodynamic Complexity activity resides in a
single enantiomer.
- (S)-?-Methyldopa, antihypertensive.
- (1R,2S)-?-methylnoradrenaline by dopa
decarboxylase dopamine ß-hydroxylase.
44Pharmacodynamic Complexity Both enantiomers have
similar activity.
- Promethazine antihistamine enantiomers have
similar pharmacological toxicological profiles. - Flecainide antiarrhythmic activity effect on
cardiac sodium channels similar no significant
pharmacokinetic differences.
45 Pharmacodynamic Complexity Both enantiomers
marketed with different therapeutic indications.
Propoxyphene
CH2NMe2
CH2NMe2
Me
H
H
Me
C6H5
EtCOO
C6H5
OOCEt
CH2C6H5
CH2C6H5
(-)-2S,3R Antitissive NOVRAD
()-2R,3S Analgesic DARVON
46Pharmacodynamic Complexity Enantiomers have
opposite effects at the same receptor.
- Picenadol
- Opioid analgesic
- ()-(3S,4R) enantiomer is agonist
- (-)-(3R, 4S) enantiomer is antagonist
- (?)-(3RS, 4RS) partial agonist
47Pharmacodynamic Complexity One enantiomer
antagonises the side effects of the other.
- Indacrinone
- Loop diuretic, evaluated for treatment of
hypertension and congestive heart failure - Racemate administration results in elevated uric
acid - R-enantiomer diuretic, t½ 10 12
hS-enantiomer uricosuric, t½ 2 5 h - Mixture SR 41 isouricemic SR 81
hypouricemic
48Pharmacodynamic Complexity Required activity
resides in one or both enantiomers, adverse
effects predominantly associated with one
enantiomer
- Ketamine, general anaesthetic with analgesic
properties. - S-enantiomer ca 3-fold greater affinity for the
NMDA receptor - 2-4 selectivity for µ- and ?-opioid receptors.
- Post-anaesthesia emergence reactions
- hallucinations, vivid dreams, agitation,
- mainly associated with the R-enantiomer.
- Chiral Switch, the S-enantiomer being available
in Germany.
49Configuration Activity
50Pharmacology Pharmacokinetics
- Absorption active transport
- Distribution active/selective uptake, protein
binding - Metabolism numerous examples
- Excretion active secretion or reabsorption
51Stereoselective drug absorption
52Stereoselectivity in plasma protein binding
- Acidic drugs Unbound () Ratio
- S-enantiomer
R-enantiomer (S/R) - Flurbiprofen 0.048 0.082 0.59
- Ibuprofen 0.64 0.42 1.5
- Indacrinone 0.3 0.9 0.33
- Pentobarbitone 26.5 36.6 0.72
- Phenprocoumon 0.72 1.07 0.67
- Warfarin 0.9 1.2 0.75
- Basic drugs
- Bupivacaine 4.5 6.6 0.68
- Chloroquine 33.4 51.5 0.64
- Disopyramide 22.2 34 0.64
- Methadone 9.2 12.4 0.74
- Mexiletine 28.3 19.8 1.4
- Propafenone 2.5 3.9 0.64
- Sotalol 62 65 0.95
- Verapamil 11 6.4 1.7
53Drug metabolismProchiral to chiral
transformation
54Drug metabolismChiral to chiral
55Drug metabolismChiral to diastereoisomers
56Drug metabolismChiral Inversion of
2-Arylpropionic Acid NSAIDs
57Enantiomeric Differences in Pharmacokinetic
Profile
58Use of Racemates
- Isomeric ballast
- Clean drugs
- Polypharmacy
59FDA
- The Agency is impressed by the possibility that
the use of single enantiomers may be
advantageous (1) by permitting better patient
control, simplifying dose-response relationships
(2) by reducing the extent of interpatient
variation in drug response.
60Potential Advantages of Single Isomer Products
- Less complex and more selective pharmacological
profile - Potential for an improved therapeutic index
- Less complex pharmacokinetic profile
- Reduced potential for complex drug interactions
- Less complex relationships between plasma
concentration and effect
61Racemates vs Enantiomers
- No requirement from any regulatory authorities
for marketing single isomers - Choice of stereoisomeric form must be justified
on scientific grounds
62Racemates vs Enantiomers (Contd)
- Configurational stability
- Preparation not technically feasible on a
commercial scale - Enantiomers have similar pharmacological and
toxicological profiles - One enantiomer is shown to be inactive and not
provide an additional body of burden - The use of a racemate produces a therapeutic
effect superior to that of the individual
enantiomers
63Penicillamine
- Originally introduced for the treatment of
Wilsons disease - Animal toxicity weight loss, intermittent fits,
death in rats L gtgt D - Mutagenicity L gt D
- Optic neuritis with racemate in man, drug
withdrawn (USA)
64Dopa
decarboxylation
L-Dopa
Dopamine (natural neurotransmitter)
- Side effects nausea, vomiting, anorexia, mental
effects,involuntary movements, granulocytopenia
65Thalidomide
66Thalidomide Enantiomers
- Both are sedative in the mouse, only
(S)-thalidomide is teratogenic. - Mouse is a poor model for teratogenicity.
- Both are teratogenic in NZW rabbits.
- Enantiomers undergo rapid racemization in vivo
and in vitro. - In man following administration of the R- and
S-enantiomers ca 25 and 43 of the total AUC is
due to the alternative stereoisomer.
67Drug Chirality The 1980s
Non chiral 6
Sold as single isomer
Naturalsemisynthetic 475
461
Chiral 469
Sold as racemate
Drugs 1675
8
Sold as single isomer
Non chiral 720
58
Synthetic 1200
Chiral 480
Sold as racemate
422
68New Chemical Entities Assessed by the UK
Medicines Control Agency (MCA/MHRA) between
1996-2000
Non-chiral 2
Naturalsemisynthetic 19
Single isomer 16
Chiral 17
NCEs 95
Racemate 1
Non-chiral 31
Synthetic 76
Single isomer 30
Chiral 45
Racemate 15
Shah Branch, 2003.
69Racemate to Enantiomer Racemic or Chiral
Switches
- Drug Name Class Approval Status
- Dexfenfluramine Anoretic Withdrawn
- Levofloxacin Antimicrobial Japan, UK, USA
- Dilevalol ?-blocker Development stopped
- Dexibuprofen NSAID Austria (1994), Switzerland,
EU (2005) - Dexketoprofen NSAID Spain, UK
- Levobupivacaine Local anesthetic UK
- (S)-Ketamine Anesthetic Germany
- Esomeprazole H-pump inhibitor UK, USA
- (R)-Salbutamol ?2-agonist USA
- (R)-Fluoxetine Antidepressant Development stopped
- Cisatracurium Neuromuscular blockade UK,
USALevocetirizine Antihistamine UK, - (R,R)-Methylphenidate ADHD USA
- Escitalopram Antidepressant UK, USA
- (S)-Amlodipine Dihydropyridine India
- Eszopiclone Insomnia USA
- Arformoterol ?2-agonist USA (April 2007)
- Armodafinil Antinarcoleptic USA (Approvable
letter, April 2007)
70Body of Evidence
- Im not sure I get it, Marino said, rubbing his
eyes. How can compounds be the same but
different? - Think of dextromethorphan and levomethorphan as
identical twins, I said. Theyre not the same
people, so to speak, but they look the same
except one is right-handed and the other
left-handed. One is benign, the other strong
enough to kill. Does that help? Dr Kay
Scarpetta - Patricia Cornwell, 1991
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72Further Reading
- A. Slovakova A.J. Hutt (1999) Chiralne
zluceniny a ich farmakologicke ucinky. Czech
Slovak Pharmacy, 48, 107-112. - A.J. Hutt J. Valentová (2003) The chiral
switch the development of single enantiomer
drugs from racemates. Acta Facultatis
Pharmaceuticae Universitatis Comenenianae, 50,
7-23. - R. Cižmáriková, J. Valentová A.J. Hutt (2004)
Blokátory ß-adrenergických receptorov skupina
chirálnych liecivenantioseparácie v skupine
ß-blokátorov. Czech Slovak Pharmacy, 53, 9-17. - J. Valentová A.J. Hutt (2004) Chirálni zámena
chiral switch cisté enantiomery léciv místo
racemických smesí. Czech Slovak Pharmacy, 53,
285-293. - R. Cižmáriková, J. Valentová, A.J. Hutt S.
Sedáková (2005) Blokátory ß-adrenergických
receptorov skupina chirálnych lieciv
stereoselektivna syntéza ß-blokátorov. Czech
Slovak Pharmacy, 54, 201-206.
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