Ch 2.7 Drug Assimilation into Blood

Background

  • We readily take pills without necessarily having a good understanding of how these drugs are absorbed into the bloodstream or for how long they have an effect on us.

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Background

  • The warnings on the packaging list some of the effects and are intended to ensure safety for all users.

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Background

  • We will see that different drugs are absorbed into, and extracted from, the blood at very different rates.
  • Some may affect us for hours after medication has ceased.

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Background

  • The drug dissolves in the gastrointestinal tract (GI-tract) and each ingredient is diffused into the bloodstream.
  • They are carried to the locations in which they act and are removed from the blood by the kidneys and the liver.
  • The assimilation and removal may occur at different rates for the different ingredients of the same pill.

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General compartmental model

Our compartmental model has two compartments:

  • GI-tract
  • Bloodstream.

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General Compartmental Model

  • The GI-tract compartment has a single input and output.
  • The bloodstream compartment has a single input and output.

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Word Equations

  • Balance law yields two word equations, one for each compartment.

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Variables & Scenarios

For the our variables, let

  • x(t) be the amount of a drug in the GI-tract at time t
  • y(t) the amount in the bloodstream at time t.

Consider two scenarios to model:

  • A single cold pill taken once (Model I).
  • A course of cold pills where drug intake occurs continuously (Model II).

Cold Medicines

  • The common cold remains without a cure.
  • However, there are pills that can be taken to relieve some of the congestion and symptoms, such as watering eyes and a running nose.
  • This is achieved through the action of a decongestant and an antihistamine.

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Cold Pill

The cold pill contains:

  • decongestant
  • antihistamine.

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Both pass through:

  • GI-tract (digestive)
  • Bloodstream (cardiovascular)

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Model Variables: GI-Tract

  • \( x_d(t) = \) amount of decongestant (mg) in GI-tract at \( t \) (hours).
  • \( x_a(t) = \) amount of antihistamine (mg) in GI-tract at \( t \) (hours).

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Model Variables: Bloodstream

  • \( y_d(t) = \) amount of decongestant (mg) in blood at \( t \) (hours).
  • \( y_a(t) = \) amount of antihistamine (mg) in blood at \( t \) (hours).

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Model I: Assumptions

  • In GI-tract, pill has been swallowed and enters GI-tract.
  • Pill dissolves quickly and enters bloodstream from GI-tract.
  • Thus for GI-tract there is only an output term.

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Model I: Relate Variables

  • Output rate proportional to GI-Tract drug concentration, and is in turn proportional to amount of drug in bloodstream.

\[ \frac{dx}{dt} = -k_1x, \,\,\, x(0)= x_0 \]

  • Here, \( x_0 \) is amount of drug in pill, and \( k_1 >0 \) is diffusion rate.
  • Pill dissolves instantaneously in GI-tract, so \( x(0) = x_0 \).

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Model I: Relate Variables

  • In bloodstream, initial amount of drug is zero, so \( y(0) = 0 \).
  • Bloodstream level increases as drug diffuses from GI-tract and decreases as kidneys and liver remove it.

\[ \frac{dy}{dt} = k_1x - k_2 y, \,\,\, y(0)= y_0 \]

  • Here, \( k_1 >0 \) is same diffusion rate and \( k_2 \) is removal rate.

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Model I: System of Differential Equations

  • System of equations for drug for both compartments:

\[ \begin{align*} \frac{dx}{dt} &= -k_1x, \,\,\, x(0)= x_0 \\ \frac{dy}{dt} &= k_1x - k_2 y, \,\,\, y(0)= y_0 \end{align*} \]

  • Table from book:

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Model I: System of Differential Equations

  • \( x_d(t) = \) amount of decongestant (mg) in GI-tract at \( t \) (hours).
  • \( x_a(t) = \) amount of antihistamine (mg) in GI-tract at \( t \) (hours).
  • \( y_d(t) = \) amount of decongestant (mg) in blood at \( t \) (hours).
  • \( y_a(t) = \) amount of antihistamine (mg) in blood at \( t \) (hours).

\[ \begin{align*} \frac{dx}{dt} &= -k_1x, \,\,\, x(0)= x_0 \\ \frac{dy}{dt} &= k_1x - k_2 y, \,\,\, y(0)= y_0 \end{align*} \]

Model I: System of Differential Equations

  • System of equations for both drugs and both compartments:

\[ \begin{align*} \frac{dx_d}{dt} &= -k_{1d}x_d, \,\,\, x_d(0)= x_{d0} \\ \frac{dx_a}{dt} &= -k_{1a}x_a, \,\,\, x_a(0)= x_{a0} \\ \frac{dy_d}{dt} &= k_{1d}x_d - k_{2d} y_d, \,\,\, y_d(0)= y_{d0} \\ \frac{dy_a}{dt} &= k_{1a}x_a - k_{2a} y_a, \,\,\, y_a(0)= y_{a0} \end{align*} \] title

Model I: GI-Tract

Ch27model1(10,100) 

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Model I: Bloodstream

Ch27model1(10,100) 

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Model I: Discussion

  • Both \( x \) and \( y \) approach zero as \( t \) increases.

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Model I: Discussion

  • Both \( x \) and \( y \) approach zero as \( t \) increases.

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Model I: Discussion

  • Both \( x \) and \( y \) for the two drugs approach zero as \( t \) increases.
  • See analytical solutions in reading:

\[ \begin{align*} \frac{dx}{dt} &= -k_1x, \,\,\, x(0)= x_0 \\ & \implies x(t) = x_0 e^{-k_1 t} \\ \frac{dy}{dt} &= k_1x - k_2 y, \, \,\, y(0)= y_0 \\ & \implies y(t) = \frac{k_1 x_0}{k_1-k_2}\left( e^{-k_2 t} - e^{-k_1 t} \right) \end{align*} \]

Model I: Discussion

  • Values of \( k_1 \) and \( k_2 \) depend on age and health of person.
  • Concentration of drug may depend on person's body mass.
  • Doses may peak higher and/or faster than for average person.

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Model I: R Script (Page 1 of 7)

Ch27model1 <- function(T,n) {

#Chapter2.7 Model I
#Perform Rk4 for decongestant & antihistamine

#T is the time length for [0, T]
#n is the number of time steps
h = T/n  #This is the time step size

Model I: R Script (Page 2 of 7)

#System Parameters
t0 <- 0
xd0 <- 1   #initial GI decongestant
xa0 <- 1   #initial GI antihistamine
yd0 <- 0   #initial blood decongestant
ya0 <- 0   #initial blood antihistamine
k1d <- 1.3860  #k1 for GI decongestant
k1a <- 0.6931  #k1 for GI antihistamine
k2d <- 0.1386  #k2 for blood decongestant  
k2a <- 0.0231  #k2 for blood antihistamine

Model I: R Script (Page 3 of 7)

#System of ODEs
f1d <- function(x) {-k1d*x}   
f1a <- function(x) {-k1a*x}   
f2d <- function(x,y) {k1d*x - k2d*y}   
f2a <- function(x,y) {k1a*x - k2a*y}   

#Initialize time, GI-tract x, and bloodstream y
t <- rep(0, n)
xd <- rep(0, n)
xa <- rep(0, n)
yd <- rep(0, n)
ya <- rep(0, n)
t[1] <- t0
xd[1] <- xd0
xa[1] <- xa0
yd[1] <- yd0
ya[1] <- ya0

Model I: R Script (Page 4 of 7)

  #Runge-Kutta Loop: GI-Tract Compartment
  for(i in 1:n) {
    a1 <- h*f1d(xd[i])    #f1d = slope of xd
    a2 <- h*f1a(xa[i])    #f2a = slope of xa
    b1 <- h*f1d(xd[i]+0.5*a1) #Half-step predictor 
    b2 <- h*f1a(xa[i]+0.5*a2) #Half-step predictor 
    c1 <- h*f1d(xd[i]+0.5*b1) #Half-step predictor 
    c2 <- h*f1a(xa[i]+0.5*b2) #Half-step predictor 
    d1 <- h*f1d(xd[i]+c1) #Full-step predictor 
    d2 <- h*f1a(xa[i]+c2) #Full-step predictor 
    xd[i+1] <- xd[i]+(1/6)*(a1+2*b1+2*c1+d1) 
    xa[i+1] <- xa[i]+(1/6)*(a2+2*b2+2*c2+d2) 
    t[i+1] <- t[i] + h
  }

Model I: R Script (Page 5 of 7)

  #Runge-Kutta Loop: Bloodstream Compartment
  for(i in 1:n) {
    a1 <- h*f2d(xd[i],yd[i])          
    a2 <- h*f2a(xa[i],ya[i])          
    b1 <- h*f2d(xd[i]+0.5*a1,yd[i]+0.5*a1) 
    b2 <- h*f2a(xa[i]+0.5*a2,ya[i]+0.5*a2) 
    c1 <- h*f2d(xd[i]+0.5*b1,yd[i]+0.5*b1)  
    c2 <- h*f2a(xa[i]+0.5*b2,ya[i]+0.5*b2)  
    d1 <- h*f2d(xd[i]+c1,yd[i]+c1)          
    d2 <- h*f2a(xa[i]+c2,ya[i]+c2)          
    yd[i+1] <- yd[i]+(1/6)*(a1+2*b1+2*c1+d1) 
    ya[i+1] <- ya[i]+(1/6)*(a2+2*b2+2*c2+d2) 
  }

Model I: R Script (Page 6 of 7)

#Plot results
plot(t,xd,               
        main = "Model I: GI-Tract",
        xlab = "t (hours)",           
        ylab = "Amount (mg)",       
        type="l",col="blue", 
        xlim=c(0,T),                  
        ylim=c(0,1)                   
       )
lines(t,xa, type="l",col="red")  
legend("topright",
         legend = c("Decongestant", "Antihistamine"),
         col=c("blue","red"),  
         lty=c(1,1)  
         )

Model I: R Script (Page 7 of 7)

plot(t,yd,               
       main = "Model I: Bloodstream",
       xlab = "t (hours)",           
       ylab = "Amount (mg)",       
       type="l",col="blue", 
       xlim=c(0,T),                  
       ylim=c(0,1.5)                   
       )
lines(t,ya, type="l",col="red")   
legend("topright",
         legend = c("Decongestant", "Antihistamine"),
         col=c("blue","red"),  
         lty=c(1,1.5)  
         )
}

Model I: GI-Tract

Ch27model1(10,100) 

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Model I: Bloodstream

Ch27model1(10,100) 

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Model II: Assumptions

  • For a cold, we often take a course of pills rather than just one.
  • For example, take medication every 4 hours.
  • Assume that the drug is delivered to the GI-tract continuously
  • This is reasonable for pills that dissolve slowly in GI-tract.
  • Assume constant drug input rate I (ml or mg of drug per hour).
  • Since pill dissolves slowly, assume no drug initially in GI-tract.

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Model II: System of Differential Equations

  • System of equations for drug for both compartments:

\[ \begin{align*} \frac{dx}{dt} &= I - k_1x, \,\,\, x(0)= 0 \\ \frac{dy}{dt} &= k_1x - k_2 y, \,\,\, y(0)= 0 \end{align*} \]

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Model II: System of Differential Equations

  • System of equations for both drugs and both compartments:

\[ \begin{align*} \frac{dx_d}{dt} &= I -k_{1d}x_d, \,\,\, x_d(0)= 0 \\ \frac{dx_a}{dt} &= I -k_{1a}x_a, \,\,\, x_a(0)= 0 \\ \frac{dy_d}{dt} &= k_{1d}x_d - k_{2d} y_d, \,\,\, y_d(0)= 0 \\ \frac{dy_a}{dt} &= k_{1a}x_a - k_{2a} y_a, \,\,\, y_a(0)= 0 \end{align*} \]

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Model II: R Script

#System Parameters
k1d <- 1.3860    #k1 for GI decongestant
k1a <- 0.6931    #k1 for GI antihistamine
k2d <- 0.1386    #k2 for blood decongestant  
k2a <- 0.0231    #k2 for blood antihistamine
Id  <- 1
Ia  <- 1

#System of ODEs
f1d <- function(x) {Id - k1d*x}   
f1a <- function(x) {Ia - k1a*x}   
f2d <- function(x,y) {k1d*x - k2d*y}   
f2a <- function(x,y) {k1a*x - k2a*y}   

Model II: GI-Tract

Ch27model2(60,600) 

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Model II: GI-Tract

Ch27model2(10,100) 

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Model II: Bloodstream

Ch27model2(60,600) 

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Model II: Bloodstream

Ch27model2(10,100) 

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Model II: Discussion of Results

  • Both \( x(t) \) and \( y(t) \) approach \( I/k_1 \) and \( I/k_2 \), respectively, as \( t \) increases (see analytical solutions in reading):

\[ \begin{align*} \frac{dx}{dt} &= I -k_1x, \,\,\, x(0)= 0 \\ & \implies x(t) = \frac{I}{k_1} \left( 1- e^{-k_1 t}\right) \\ \frac{dy}{dt} &= k_1x - k_2 y, \,\,\, y(0)= 0 \\ & \implies y(t) = \frac{I}{k_2} \left[ 1 - \frac{1}{k_2-k_1}\left( k_2 e^{-k_1 t} - k_1 e^{-k_2 t} \right) \right] \end{align*} \]

Model II: Discussion of Results

  • \( x \) & \( y \) approach \( I/k_1 \) & \( I/k_2 \), respectively, as \( t \) increases.

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Model II: Discussion of Results

  • \( x \) & \( y \) approach \( I/k_1 \) & \( I/k_2 \), respectively, as \( t \) increases.

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Model II: Discussion of Results

  • Antihistamine levels (sleepy effect) rise slowly to higher level.
  • Decongestant levels rise quickly but to lesser level.

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Model II: Discussion of Assumptions

  • Our assumption of I = constant is valid when drugs are embedded in resins and dissolve at constant rates.
  • This allows drug to be released slowly and evenly over a period of hours.

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Model II: Discussion of Assumptions

  • In reality some pills dissolve quickly and thus I(t) should be a pulsing function.
  • This could be represented by a sinusoidal function, representing repeated doses.

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Model II: Discussion of Assumptions

  • Some other function of t could be used as well, one that provides an initial and substantial boost to the drug level and then very little during the remaining time period before the next dose is taken.

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