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HORMONES) AND
THEIR PHARMACOLOGICAL MODULATION
(Summary)
Assoc. Prof. Ivan Lambev
E-mail: itlambev@mail.bg
www.medpharm-sofia.eu
Autacoids
Senyawa endogen
Memainkan peran penting dalam proses
fisiologis dan patologis
Memiliki t yang sangat pendek
Memiliki kerja lokal
1.
1. Monoamines
Monoamines
a) Histamine
Histamine
distribution
Naja naja
Folia Urticae
(Leaves of Nettle)
Ikan basi(busuk)
Mengandung histidine!
FISH
Mengandung alergen
poten: bisa
berpotensi
berbahaya.
tetap
allergenik
walau
dimasak.
Zat yg me cAMP
(adrenaline, salbutamol,
and others) menghambat
Sekresi histamin dan
menghasilkan
bronchodilation
(effek antiasthmatic).
Stimulation of H1-receptors
Kontraksi endotel,
pe permeabilitas vascular
dan menghasilkan reaksi hipersensitif
tipe 1 (urticaria and hay fever);
Kontraksi otot polos pada bronchi, GIT,
CH2
HN
H2C
NH2
Histamine and
antagonists of
H1-receptors
(H1-blockers)
H1-blockers
Penggunaan utama u/
pengobatan urticaria
dan hay fever.
Beberapa gol ini(embramine,
promethazine)
memiliki efek antiemetic.
H1-blockers from
st
1 generation
(with sedative and
M-cholinolytic effects)
Promethazine
Dimetindene
Cyproheptadine
Embramine
(H1&5-HT2)
Chlorpyramine
Clemastine (weak sedation)
Astemizole
Loratadine
Cetirizine
Terfenadine
prolongation of QT interval
and hypokalemia
H1-blockers from
rd
3
generation
Desloratadine
(Aerius film-tab. 5 mg; t1/2 27 h)
Levocitirizine
Activation of H2-receptors:
Stimulasi cardiac
stimulasi sekresi asam
lambung
Antagonist of H2-receptors
(H2-blockers) for the treatment
of peptic ulcer:
Cimetidine (? )
Famotidine
Nizatidine
Ranitidine
Roxatidine
Rang
Rangetetal.al.
Pharmacology
Pharmacology
55ststEd.
Ed.(2003)
(2003)
HO
b) Serotonin
(5-Hydroxytryptamine: 5-HT)
Indol derivative
5-HT1-receptors:
5-HT1A 5-HT1F
Semua subtypes terdapat pd
CNS dan menyebabkan
phambatan saraf
Kerja dg phambatan
5-HT1D-receptors
terdpt di beberapa
pembuluh darah
(a. carotis externa et interna,
meningeal vessels). They
produce vasoconstriction.
pathophysiology of migraine
Rang
Rangetetal.
al.
Pharmacology
Pharmacology
55ststEd.
Ed.(2003)
(2003)
Naratriptan
Rizatriptan
Sumatriptan
Zolmitriptan
Activation of
5-HT2-receptors
pada CNS gairah/bahagia
Pd pembuluh darahkontraksi
dan agregrasi platelet
act through phospholipase C/
inositol phosphate pathway
Antagonists of
5-HT2-receptors digunakan:
for prophylaxis of migraine
- cyproheptadine
- iprazochrome
- methysergide
- pizotifen
as a peripheral vasodilator
- Naftidrofuryl (Dusodril)
Efek samping
methysergide:
Fibrosis retroperitoneal
Gagal ginjal
Tricyclic antidepressants
Mainly NA-ergic
Desipramine
Nortriptyline
Selective 5-HTRIs
Citalopram, Fluoxetine
Escitalopram, Fluvoxamine
Paroxetine, Sertraline
- - -
Selective NARIs
Reboxetine
Mainly 5-HT-ergic
Amitriptyline
Clomipramine
Imipramine
2-adrenergic
blockers
Mianserine**
Mirtazapine
Trazodone
DA&NARIs
Bupropion
Enzime
inhibitors
MAO-AIs
Moclobemide
5-HT3-receptors
Terdapat pd neuron enteric
dan CNS.
Kerja dg menstimulasi
adenylate cyclase.
Efek: excitatory, menyebabkan
motilitas GI dan vomiting.
Agonists of
5-HT4-receptors
Tegaserod (Zelmac) mengkatifkan
5-HT4- receptors pada intestine dan
menstimulasi peristalsis dan secretion.
Indication: colon irritable syndrome
(eicosi = 20)
2.
2. EICOSANOIDS
EICOSANOIDS
(20
(20 carbon
carbon atoms!)
atoms!)
prostanoids
prostaglandins (PGs)
thromboxanes (Txs)
leucotrienes (LTs)
lipoxins
eicsanoids mediator
penting pada inflamasi dan
allergy.
Sumber utama
eicosanoids adh arachidonic acid.
It is a 20-carbon unsaturated
fatty acid.
Inflammatory stimulus
Phospholipids
Phospholipase A2
Arachidonic acid
5-lipoxygenase
Cyclooxygenase (Cox)
15-lipoxygenase
Leucotrienes
Lipoxins
Endoperoxides
PGs
TxA2
PGE1
alprostadil (prodrug digunakan u/ menjaga
patency ductus arteriosus pada neonates dgn
cacat jantung bawaan, dan u/ pengobatan
disfungsi ereksi melalui injeksi dalam
corpus cavernosum pd penis);
misoprostol (digunakan prophylaxis pd
peptic ulcer terkait dgn NSAIDs);
gemeprost
digunakan sbg pessaries u/ melunakan
cervix uterus dan melebarkan saluran servik
sebelum aspirasi vacuum pada termination
kehamilan.
PGE2 menyebabkan:
Kontraksi pregnant uterus
menghambat sekresi asam lambung
Kontraksi otot polos GI
PGE1 (gemeprost)
PGF2 (dinoprost)
PGE2 (dinoprostone)
Dorlands
DorlandsIllustrated
Illustrated
Medical
Dictionary
Medical Dictionary
(2003,
(2003,2004)
2004)
Diberikan u/:
Induksi persalinan
termination of pregnancy
Kerja utama
eicosanoids
Lllmann,
Lllmann,Color
ColorAtlas
Atlas
ofofPharmacology
Pharmacology
nd
22ndEd.
Ed.(2000)
(2000)
Aspirin-like drugs
Classical
NSAIDs
Arachidonic acid
Cyclooxygenase (Cox)
( )>1 g/24 h
Endoperoxides
Aspirin
( )100 mg/24 h
Thromboxane A2 synthase
PGs
TxA2
COX INHIBITORS
NSAIDs
Nonselective
(Aspirin-like)
COX-1/COX-2
inhibitors
COX-2
inhibitors
Selective (coxibs)
Preferential
Selective
COX-3
inhibitors
Antipyretic
analgesics
Pfizer
$2.3
billions
penalty
Coxibs selective COX-2 inhibitors. Digunakan u/
anti-inflammatory, analgesic dan antipyretic action
dgn low ulcerogenic potential. Coxibs dpt
msebabkan infertility. Memiliki resiko prothrombotic
cardiovascular. ulcerogenic potential yg khusus
COX-2 inhibitors Meloxicam, Nabumetone, dan
Nimesulide (Aulin) is significant.
Inflammatory stimulus
(+)
Phospholipase A2
Phospholipids
( )
Lipocortin
Arachidonic acid
(+)
Glucocorticoids
INFLAMMATION
alterasi
eksudasi
proliferasi
()
NSAIDs
Glucocorticoids
()
()
Arachidonic acid
5-Lipoxygenase
Leukotrienes (LTs)
LTC4-
LTD4-
LTE4-
receptor
receptor
receptor
(-)
(-)
Montelukast, Zafirlukast
3.
3. Platelet
Platelet activating
activating
factor
factor (PAF)
(PAF)
PLA2 membebaskan PAF pada
inflamasi.
PAF menyebabkan vasodilatasi,
pe permebailitas vascular,
mengkativasi agregrasi platelet .
3. Peptides
a) Vasoconstroctors
Endothelins: ET-1, ET-2, ET-3
b) Vasodilators:
ANP
CGRP
SP
5. Cytokines
Protein yg larut dan glycoproteins
Yg berinteraksi dg reseptor selular
Yg spesifik. Cytokines berperan
dlm respon inflamasi dan imunitas.
INTERLEUKINES (ILs)
IL-18:
Mengatur produksi INF
Me NK cell cytotoxicity
IL-23:
Anti-viral activity
Stimulates T-cell, macrophage, and
NK cell activity.
Direct anti-tumor effects
Used therapeuticaly in viral and
autoimmune conditions
INTERFERONS (INFs)
Interferon alpha-2b (Intron):
- in chronic hepatitis B and C
- lymphomas, melanomas, etc.
Colony-stimulating factors
(rHuCSFs):
- Filgrastim, Molgramustim, Lenograstim
(to treat agronulocytosis and leukopenia)
TNF-alpha (alfa)
TNF-beta
VEGF
PDGF,
EGF, etc.
Colorectal cancer