Medicinal Chemistry Unit V General Anesthetic

JAIPUR COLLEGE OF PHARMACY, JAIPUR
B.PHARMACY, SECOND YEAR, FOURTH SEMESTER

MEDICINAL CHEMISTRY-I
Prepared by: Mrs. Nisha Dhir
UNIT-V
GENERAL ANESTHETICS
General anaesthetics are group of drugs that produces loss of consciousness, and
therefore, loss of all sensations. The absolute loss of sensation is termed as
anaesthesia. General anaesthetics bring about descending depression of the
central nervous system (CNS), starting with the cerebral cortex, the basal
ganglia, the cerebellum, and finally the spinal cord. These drugs are used in
surgical operations to induce unconsciousness and, therefore, abolish the
sensation of pain.
Stages of General Anesthesia: When an inhalation anesthetic is administered

to a patient some of the following well defined stages are produced by
increasing the blood concentration of the agent. They are;
Stage I (Stage of analgesia): This is the period from the beginning of

anesthetic administration to the loss of consciousness. The patient progressively
loses pain. This stage is also called stage of analgesia.
Stage II (Stage of delirium): This period extends from the loss of

consciousness through a stage of irregular and specific breathing to the
reestablishment of regular breathing. Respiration is normal and regular. The
patient may laugh, vomit or struggle and for this reason it is called the stage of
excitement.
Stage III (Stage of surgical anesthesia): In this stage excitement is lost and
skeletal muscle relaxation is produced. Most types of surgeries are done in this
stage.
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Stage IV (Stage of medullary depression): Overdose of the anesthetic may

bring the patient to this stage. Respiratory and circulatory failure occur in this
stage.
Classification of GA
The general anesthetics are classified according to their nature (volatile or non-
volatile) at room temperature. They are:
A. Volatile Inhalation general anesthetics. They are administered by

inhalation and are further subdivided as;
1.Gases: Cyclopropane: Ethyl chloride, Nitrous oxide
2. Liquids: Diethyl ether, Halothane, Chloroform, Trichloroethylene
B. Non-Volatile or Intravenous anesthetics. They are non-volatile at room

temperature and are administered by intravenous route. They are;
1.Barbiturates: Thiopental sodium, Methohexital sodium.
2. Non-barbiturates: Propanidid, Propofol.
Characteristics of G.A
An ideal general anesthetic should possess the following characteristic features:
a) It should be inert
b) It should be potent and non-inflammable
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c) It should be non-irritating to mucous membrane

d) It should produce rapid and smooth anesthesia
e) It should produce analgesia and muscle relaxation in addition to
anesthesia
f) It should not produce severe hypotension
g) It should not produce nausea and vomiting
h) It should be compatible with adjuvant drugs used in anesthesia
i) It should be economical
j) It should be stable to heat, light and alkalies
Mode of action: General anaesthetics target the ligand gated ion channels and
produce the anaesthetic action. The GABA receptor gated chloride channels are
the most important sites and opens to perform the inhibitory action. N2O and
ketamine do not affect the GABA or glycine gated Cl–channel, but they
selectively inhibit the excitatory NMDA-type of glutamate receptor, which
belongs to calcium-gated channels in the neurons and leads to neuronal hyper-
polarization.
VOLATILE/INHALATION ANAESTHETICS
1. Halothane*
Synthesis
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Properties and uses: It is a clear, colourless, heavy, non-flammable liquid,

slightly soluble in water, miscible with ethanol, and with trichloroethylene.
Halothane lacks flammability. It may produce any depth of anaesthesia without
causing hypoxia. Being a non-irritant, its inherent hypotensive effect retards
capillary bleeding and renders a comparatively bloodless field. It is a potent,
relatively safe general inhalation anaesthetic used in conjunction with N 2O. For
skeletal muscle relaxation, it is used with succinyl choline or tubocurarine. It
should be stored in well-closed airtight containers, protected from light, at a
temperature not exceeding 25°C in a nonreactive metal container
2. Methoxyflurane
Properties and uses: It is a clear, colourless liquid, noninfl ammable and

nonexplosive in air or oxygen in anaesthetic concentrations. It is the most potent
of the inhalational agents. It is employed to cause light anaesthesia with deep
analgesic and muscle relaxation feature, which makes it convenient for surgical
operations.
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3. Enflurane
Properties and uses: It is a clear, colourless, volatile liquid with pleasant

hydrocarbon-like odour. Soluble in water, miscible with organic solvents,
chemically it is extremely stable. The induction of an emergence from
anaesthesia and adjustment of anaesthetic depth during maintenance is smooth
and moderately rapid. It is a noninfl ammable halogenated ether anaesthetic and
provides rapid induction with no excitement.
4. Sevoflurane
Properties and uses: Low boiling liquid with a slight odour; miscible with
most organic solvents including fats or oils; practically insoluble in water. It is a
nonfl ammable, nonirritating agent. The physical properties of this compound
result in a more rapid induction and termination of anaesthetic when observed
with the currently used agents.
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5. Isoflurane
Properties and uses: It is a clear, colourless, heavy liquid, insoluble in water,

miscible with ethanol, and trichloroethylene. It resembles isomer enflurane in its
properties. It is not flammable in air or oxygen. The depth of anaesthesia can be
rapidly adjusted with it. It is used for induction and maintenance of general
anaesthesia. Storage: It should be stored in well-closed airtight containers and
protected from light
6. Desflurane.
Properties and uses: Low boiling liquid with a slight odour; miscible with
most organic solvents including fats or oils; practically insoluble in water. It is a
non-flammable, non-irritating agent. The physical properties of this compound
result in a more rapid induction and termination of anaesthetic when observed
with the currently used agents.
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ULTRA SHORT ACTING BARBITUTRATES
1. Methohexital sodium*
Methohexital is also a derivative of barbituric acid. It is prepared by

condensation of ethylcyanoacetate with 2-chloro-3-pentyne in presence of
sodium ethylate yields ethyl-1-methyl-2-pentnyl cyanoacetate which on further
condensation with allylbromide yields ethyl(1-methyl-2-
pentynyl)allylcyanoacetate. Reaction with N-methyl urea yields the
iminobarbituric acid which on acid catalyzed hydrolysis forms methohexital.
Synthesis
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Properties and uses: White to off-white hygroscopic powder, essentially

odourless, and the solution is alkaline to litmus, soluble in water. Methohexital
produces more rapid recovery from unconsciousness than thiopental. It is more
potent and has shorter duration of action. It is used for the induction of
anaesthesia through the intravenous administration. It has two advantages over
thiopental sodium. First, being it has less affinity towards fatty tissues and
second, it has a greater potency. Its onset of action is quite speedy comparable
to thiopental sodium while its recovery is more rapid. For these reasons, this
intravenous anaesthetic is specifically useful for short surgical operations, such
as oral surgery, gynaecological investigation, genitourinary procedures, and
electroconvulsive therapy.
2. Thiamylal sodium.
Properties and uses: Thiomylal is a highly hydrophobic thiobarbiturate having

its structural features very much related to thiopental. Its biological activities are
almost identical to thiopental. It is used as intravenous anaesthetic.
3. Thiopental sodium.
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Properties and uses: A yellowish-white powder, hygroscopic, freely soluble in

water, and partly soluble in ethanol. These are usually administered
intravenously for the production of complete anaesthesia of a short duration. It
belongs to the category of ultra short-acting barbiturates. Onset is rapid (about
30 sec) and duration is brief (10–30 min). By rectal route it is administered as a
solution, suspension, or suppositories as basal anaesthetic. It is also used as a
sedative, hypnotic, and anticonvulsant. It should be stored in well-closed
airtight containers and protected from light.
Dosage forms: Thiopental injection B.P.
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DISSOCIATIVE ANESTHETICS
Ketamine hydrochloride: Ketamine is a cyclohexanol derivative. Chemically

ketamine is (+) 2 (o-chlorophenyl)-2-methylaminocyclohexanone. Ketamine is
prepared by Griganard reaction of o-chlorobenzonitrilewith bromocyclopentane
in presence of strong alkali to form an expoxy compound,which converts to an
imine by the action of methylamine. The imine rearranges to ketamine on
heating with HCl.
Properties and uses: It is a white or almost white crystalline powder, freely

soluble in water, methanol, and ethanol. Its another name is ‘dissociative
anaesthetic’ because it produces unpleasant hallucinations and strong feelings of
dissociation from the environment. It is a rapidly acting nonbarbiturate general
anaesthetic that produces anaesthesia and is characterized by profound
analgesia.
Storage: It should be stored in well-closed airtight containers, protected from

light.
Dosage forms: Ketamine HCl injection I.P., B.P.
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NARCOTIC AND NON-NARCOTIC ANALGESICS.
INTRODUCTION: Analgesics are agents that relieve pain by acting centrally

to elevate pain threshold without disturbing consciousness or altering other
sensory modalities. Certain analgesics like aminopyrine and phenylbutazone
also possess anti-inflammatory properties. Such substances and the gold
compounds are used in the treatment of arthritis. Many drugs that are used to
relieve pain are not analgesics; the general anaesthetics relieves pain by
producing unconsciousness, local anaesthetics prevent pain by blocking
peripheral nerve fibres, antispasmodics relieve pain by relaxing smooth muscles
and the adrenal corticoids relieve pain associated with rheumatoid arthritis by
anti-inflammatory action. Analgesics are classified into two major categories:
1. Opioid analgesics or narcotic analgesics (centrally acting).
2. Nonopioid analgesics (peripherally acting).
Opioid Analgesics
Opioid analgesics are drugs that denote all naturally occurring, semisynthetic
and synthetic drugs, which have a morphine-like action, namely, relief from
pain and depression of CNS associated with the drug dependence. Opium is a
dark brown resinous material obtained from the poppy (Papaver somniferum)
capsule. It has two types of alkaloids; Phenanthrene derivatives and
Benzoisoquinoline derivatives.
Opium has been known from 1500 BC. Sreturner, a pharmacist isolated the
active principle of opium in 1806 and named it morphine. Narcotic analgesic
agents cause sleep in conjunction with their analgesic effect. If a narcotic is
used for a long time, it may become habit-forming (causing mental or
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psychological dependence) and physical dependence may lead to withdrawal

side effects. Opioid drugs are not only used as analgesics, but also possess
numerous other useful properties. For example, morphine is used to induce
sleep in the presence of pain, diarrhoea, suppress cough, and facilitate
anaesthesia. The term opioid is used generally to designate collectively the
drugs, which bind specifically to any of the subspecies of the receptors of
morphine and produce morphine like actions. They tend to produce euphoria,
which is an important factor in their addictive property that limits their use.
Other limitations include, respiratory depression, decreased gastrointestinal
motility leading to constipation, increased biliary tract pressure, and pruritis due
to histamine release.
Mode of action: The endogenous peptides found in central nervous system

(CNS) and gastrointestinal tract (endorphins, enkephalins, dynorphins) can
decrease pain (analgesia), produce euphoria, drowsiness, depress respiration,
depress the cough reflex, depress gastrointestinal muscle activity. Opiates
activate endorphin or enkephalin receptors, which decrease the activity of other
neurons that transmit the sensation of pain. At least 5 types of opiate receptors
identified. Analgesics are primarily employed for their ability to reduce the
perception of pain impulses by the CNS. Analgesic activity is mediated by
opiate receptors in the CNS. Five major categories of opioid receptors are
known: mu (μ), kappa (κ), sigma (σ), delta (δ), and epsilon (ε). Narcotic drugs
occupy the same receptors as endogenous opioid peptides (enkephalins or
endorphins). The actions of the narcotic analgesics now available can be defined
by their activity at three specific opiate receptor types: mu (μ), kappa (κ) and
delta (δ).
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μ-(mu) receptors mediate analgesia, euphoria, respiratory and physical

depression, miosis, and reduced gastrointestinal motility. These receptors have
been further subtyped as μ1, which are supraspinal and mediate analgesia, and
μ2 which mediate respiratory depression. The μ1 receptor is morphine
selective.δ-(delta) receptors mediate spinal and supraspinal analgesia,
dysphoria, psychotomimetic effects (e.g., hallucinations), and respiratory and
vasomotor stimulation caused by drugs with antagonist activity. These receptors
have been subtyped as δ1 and δ2 and are thought to be relatively unimportant in
terms of analgesia.
κ-(kappa) receptors mediate pentazocine like spinal analgesia, sedation, miosis

and respiratory depression and dysphoria. These receptors have been further
subtyped as κ1 which mediates spinal analgesia, κ3 which mediates supraspinal
analgesia and κ2 whose function is unknown. These receptors are proposed to
mediate a sedating analgesia with reduced addiction liability and respiratory
depression.
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Classification: Narcotic analgesics will be classified on the basis of their

structural derivation from morphine. They may be classified into following
categories:
1. Natural alkaloids of opium: Morphine and codeine.
2. Semisynthetic analogs: Hydromorphone, oxymorphone, oxycodone.
3. Synthetic agents: Meperidine, levorphanol, methadone, sufentanil, alfentanil,

fentanyl, remifentanil, levomethadyl.
Morphine and its derivaties.
1. A rigid pentacyclic structure consisting of a benzene ring (A), two partially

unsaturated cyclohexane rings (B and C), a piperidine ring (D) and a
dihydrofuran ring (E). Rings A, B and C are the phenanthrene ring system. This
ring system has little conformational flexibility. Ring A and its 3-hydroxyl
group is an important structural feature for analgesic activity. Removal of the 3-
OH group reduces analgesic activity by 10-fold.
2. Two hydroxyl functional groups, a C3-phenolic OH (pKa 9.9) and a C6-

allylic OH.
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3. An ether linkage between C4 and C5.
4. Unsaturation between C7 and C8.
5. A basic, 3°-amine function at position 17.
6. 5 Centers of chirality (C5, C6, C9, C13 and C14) with morphine exhibiting a
high degree of stereoselectivity of analgesic action. Only (-)-morphine is active.
SAR of Morphine was studied by
1. Modification of alicyclic ring
2. Modification of aromatic ring
3. Modification of 3o Nitrogen
4. Epoxide bridge
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1. Modification on alicyclic ring
• The alcoholic hydroxyl group at C-6 when methylated, esterified, oxydized,

removed, or replaced by halogen analgesic activity as well as toxicity of the
compound increased.
• The reduction of C-6 keto group to C-6 β hydroxyl in oxymorphone gives

Nalbupine, it shows antagonistic action of μ receptors.
• The saturation of the double bond at C-7 position gives more potent
compound. Examples, Dihydro morphine and Dihydro codeine.
• The 14 β hydroxyl group generally enhances μ agonistic properties and

decreases antitussive activity. However, activity varies with the overall
substitution on the structure.
• Bridging of C-6 and C-14 through ethylene linkage gives potent derivatives.
• Reaction of thebaine with dienophile (i.ediel’s alder reaction) results in 6, 14

endoethenotetrahydrothebaine derivatives, which are commonly called
‘oripavines’. Some oripavines are extremely potent μ agonist, for example,
Etorphine and Buprenorphine are the best known. These derivatives are about
thousand times more potent than morphine as μ agonist.
2. Modification on phenyl ring
• An aromatic phenyl ring is essential for activity.
• Modification on phenolic hydroxyl group decreases the activity.
• Any other substitution on phenyl ring diminishes activity.
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3. Modification of 3° nitrogen
• A tertiary amine is usually necessary for good opioid activity.
• The size of the N substitution can dictate the compounds potency and its
agonists and its reverse antagonistic property• The N-methyl substitution is
having good agonistic property, when increased the size of the substitution by
3–5 carbons results in antagonistic activity. Still larger substitutent on N returns
agonistic property of opioids, for example, N-phenyl ethyl substitution is ten
times more potent than N-methyl groups.
• N-allyl and N-cylo alkyl group leads to narcotic antagonistic property.
4. Epoxide Bridge
• Removal of 3,4 epoxide bridge in morphine structure result in the compound

that is refered to as morphinans.
• The morphinans are prepared synthetically. As the synthetic procedure yielded

compound is a racemic mixture, only levo isomer possesses opioid activity
while the dextro isomer has useful antitussive activity, for example,
Levorphanol and Butorphanol.
• Levorphanol is a more potent analgesic than morphine. Summarized SAR of

Morphine Analogues is given below:
1. Morphine analogues
A. Morphine Sulphate
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Properties and uses: It exists as a white or almost white crystalline powder or

colourless, silky needles or cubical masses, efflorescent in a dry atmosphere. It
is soluble in water, slightly soluble in ethanol, and insoluble in toluene.
Morphine is conjugated by hepatic enzyme at phenolic (3-OH) position to from
3-glucuronide metabolite. Glucuronidation of morphine also leads to N-
demethylation to normorphine, which has decreased opioid activity and it
undergoes N and O conjucation and excreted. Compounds with N-alkyl groups
larger than methyl get N-dealkylated as a major route of inactivation. It is used
as an opioid receptor agonist and analgesic.
2. Meperidine analogues
Metabolism: Meperidine( Pethidine) analogues results in rapid metabolism.

Esterase cleaves the ester bond to leave the inactive 4-carboxylate derivatives.
They also undergo N-demethylation to give normeperidine.
SAR of Meperidine Analogues
1. Placement of m-hydroxyl group on the phenyl ring increases activity. The

effect is more significant on the keto compound than on the pyridine.
2. Substitution of carbethoxy group in meperidine by acyloxy group provides

better analgesic as well as spasmolytic activity (alpha prodi ne).
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3. The presence of phenyl and ester group at 4th position of 1-methylpiperdine

results in optimum activity.
4. The replacement of C-4 phenyl group of meperidine by hydrogen, alkyl,

other aryl, aralkyl, and hetero cyclic groups reduces analgesic activity.
5. Replacement of phenyl group by phenyl ethyl derivatives is seen to be about

three times as active as the meperidine. The amino analogue, anileridine is
about four, times more active.
6. Contraction of piperidiene ring to the pyrrolidine gives a more active

compound, but causes abuse liability. For example, alphaprodine and
procilidine.
7. Enlargement of piperidine ring to a 7-membered hexahydroazepine yield

active compounds with low incidence of side effects. For example.Proleptazine.
8. The C-3 methyl analogue with an ester group at the C-4 position like
lofentanil 8,400 times more potent than meperidine as an analgesic.
9. In fentanyl, the phenyl and acyl groups are separated by nitrogen. It is 50

times stronger than morphine with minimal side effects. Its short duration of
action makes it well suited for use in anaesthesia.
10. The p-chloro analogue (loperamide) has been shown to bind to opiate
receptors in the brain, but it cannot penetrate the blood-brain barrier sufficiently
to produce analgesia.
11. Diphenoxylate, a structural hybrid of meperidine and methadone type,

devoid of analgesic activites. It is effective as an intestinal spasmolytic and is
used in the treatment of diarrhoea.
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A. Anileridine
Properties and uses: It is a narcotic analgesic, having related chemical

structure to that of pethidine. Anileridine is more active than merperidine and
has the same uses and limitations. Dose: The usual oral dose is 25 mg every 6 h.
Synthesis
B. Pethidine hydrochloride
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Synthesis.
Properties and uses: It is a white crystalline powder, soluble in water, and

freely soluble in alcohol. It may be used for the relief of a variety of moderate to
severe pain, including the pain of labour and postoperative pain. Pethidine has
atropine-like action on smooth muscle. It is normally used to induce both
sedation and analgesia simultaneously. It should be stored in well-closed
airtight containers and protected from light.
Dose: Usual dose is 50 to 100 mg I.M. Occassionally given orally.
Dosage forms: PethidineHCl injection I.P. PethidineHCl tablets I.P. Pethidine

injection B.P., Pethidinetablets B.P.
C. Diphenoxylate hydrochloride
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Properties and uses: It is a white or almost white crystalline powder, sparingly

soluble in alcohol, very slightly soluble in water, freely soluble in methylene
chloride. It is a synthetic analogue of pethidinewith some analgesic activity, but
is mostly used in the treatment of diarrhoea associated with gastroenteritis,
irritable bowel, acute infections, hypermotility, ulcerative colitis, and sometimes
even in food poisoning. Storage: It should be stored in well-closed airtight
containers and protected from light
D. Fentanyl Citrate
Synthesis.
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Properties and uses: It is a white or almost white powder soluble in water,

freely soluble in methanol, and sparingly soluble in alcohol. Fentanyl is related
to pethidine and also to basic anilides with analgesic properties, and is
characterized by high potency, rapid onset, and short duration of action. It is a
potent narcoticanalgesic employed for the arrest of pain and it may also be
employed as an adjuvant for all such drugs mostly used for regional and general
anaesthesia. Storage: It should be stored in well-closed airtight container and
protected from light. Dose: By I.M. in preoperative medication 0.05 to 0.1 mg,
30 to 60 min before surgical treatment, for rapid analgesic action, 0.05 to 0.1
mg by IV. Dosage forms: Fentanyl injection B.P.
E. Loperamide.
Properties and uses: It is a white or almost white powder, slightly soluble in

water, freely soluble in alcohol and methanol. It is used as a safe and effective
opioid derivative with pheripheral μ opioid and weak anticholinergic property.
Storage: It should be stored in well-closed airtight containers and protected
from light.
Dosage forms: Loperamide capsules B.P.
3. Methadone analogues.
SAR of DiphenylHeptanone (Methadone Series)

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• The reduction of keto and acetylation of resulting hydroxyl group gives the
acetyl methadol, the useful anti-diarrhoeal opioids, for example, diphenoxylate
and loperamide.
• Removal of any of the phenyl group sharply decreases the activity.
• Placement of m-hydroxy group in the phenyl ring decreases analgesic activity.
• The levo-isomer of methadone and isomethadone are twice as effective as

their racemic mixture.
• Substitution of terminal dimethylamino group by piperidine group decreases

activity.
• Substitution of propionyl group by hydrogen, hydroxyl or acetoxyldecreases

the activity, whereas amide analogue, pyrrolidinoyl and terminal morpholino
moiety enhance the activity by several time.
A. Methadone
Synthesis
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Properties and uses: It is a white or almost white crystalline powder, freely

soluble in ethanol and soluble in water. Even methadone, which looks
structurally different from other opioid agonists, has steric forces that produce a
configuration that closely resembles the opioid agonists. Methadone
metabolizes to form an active α-dinormethadol and dinor-L-α-acetylmethadol
(LAAM), then it undergoes N-demethylation to form inactive pyrrolidines, an
pyrrolines which are excreted in urine. Methadone is more active and more
toxic thanmorphine. It can be used for the relief of many types of pain. In
addition, it is used as narcotic substitute treatment because it prevents morphine
abstinence syndrome. The toxicity of methadone is three to ten times that of
morphine, but its analgesic effect is twice that of morphine and ten times that of
meperidine.
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from light.
Dosage forms: Methadone HCl injection I.P., Methadone HCl tablets I.P.,
Methadone injection B.P., Methadone Linctus B.P., Methadone oral solution (1
mg/ml), B.P., Methadone tablets B.P.
B. Propoxyphene hydrochloride
Properties and uses: It is a white or almost white crystalline powder, very

soluble in water and freely soluble in alcohol. It has no anti-inflammatory or
antipyretic action and has little antitussive activity despite the fact that its levo
isomer is used for this purpose. It is used to control mild-to-moderate pain and
used along with other analgesics having anti-inflammatory and antipyretic
properties, such as paracetamol and aspirin.

from light.
Dose: The usual does is 65 mg, 3 or 4 times/day.
Dosage forms: Co-proxamol tablets B.P.
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4. Morphan derivatives.
SAR of Benzomorphan Derivatives (Benzazocines)
• Pentazocine produces analgesia because of its agonistic action on kappa opioid

receptors. Pentazocineis a week antagonistic at μ receptors.
• The trimethyl compound (R1= R2=CH3) is more active than dimethyl (R1=H,
R2 = CH3) compound.
• Placement of N- phenyl ethyl results in more activity than N-methyl

compound.
• Placement of methyl group in 9th position increases the activity. However -

OH group decreases the activity.
• N-allyl (or) N-cycloproyl methyl group confers antagonistic activity. For

example, Levallorphanol, Naloxone, and Naltreoxane.
A. Pentazocine
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Properties and uses: It is a white or almost white powder sparingly soluble in

water, soluble in ethanol, and sparingly soluble in methylene chloride. A
synthetic analgesic agent, when administered orally in a 50 mg dose, it appears
to be equivalent in analgesic effectiveness to 60 mg of codeine. Pentazocine in a
parenteral dose of 30 mg or an oral dose of 50 mg is about as effective as 10 mg
of morphine in most patients. There is some evidence that the analgesic action
resides principally in the (–) isomer, and a dose of 25 mg is approximately
equivalent to 10 mg of morphine sulphate.
B. Levorphanol tartarate.
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Narcotic antagonists:
Narcotics are drugs that relieve pain and often induce sleep. The opiates,
including opium and drugs derived from opium, such as morphine, codeine, and
heroin are narcotics. Narcotics also include certain synthetic chemicals that
have a morphine-like action (such as methadone).
Narcotic antagonists are drugs which block the “high” and other effects of
narcotics. They also precipitate withdrawal symptoms in the narcotic addict.
This feature of narcotic antagonists makes them extremely useful in treating
overdoses. They are structurally related to morphine with the exception of the
group attached to nitrogen hence they act by competing for the same analgesic
receptor sites. Research is currently going on to determine the usefulness of
antagonists as maintenance drugs. Present narcotic antagonists (such as
naloxone and cyclazocine) have too brief an effect and too many side effects to
be completely satisfactory. A new drug, naltrexone, appears to be more
promising since its effects last longer, and it appears to be more acceptable to
the treatment clients. Narcotic antagonists prevent or abolish excessive
respiratory depression caused by the administration of morphine or related
compounds. Theyare also used to treat asphyxia neonatorum and for the
diagnosis of possible narcotic addiction.
Naloxone hydrochloride
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Properties and uses: It is white or almost white hygroscopic crystalline

powder, Soluble in water, soluble in ethanol, and insoluble in toluene. It is
almost seven times more active than nalorphine in antagonizing the effects of
morphine. It shows no withdrawal effects after long-term administration. It
lacks not only the analgesic activity shown by other antagonists, but also all of
the other agonist effects. At higher doses, Naloxone may be useful in the
treatment of shock and spinal cord injury. It should be stored in well-closed
airtight containers and protected from light. Usual dose byparenterally 0.4 mg
(1 ml)/day. Naloxone injection B.P., Neonatal naloxone injection B.P.
Nalorphine hydrochloride
Synthesis
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Properties and uses. Nalorphine is available as hydrocholoride salt. Nalorphine

hydrochloride is white colored, odorless, crystalline powder. It darkens on
exposure to light. It is soluble in water, dilute alkali hydroxide solution but
insoluble in chloroform and ether. It must be kept in tightly closed light resistant
containers. Nalorphine is a narcotic antagonist used to treat narcotic-induced
respiratory depression. It is administered by intravenous injection for treating
the overdosage of morphine, pethidine, methadone and levorphanol. Nalorphine
precipitates withdrawal symptomsand produces behavioral disturbances in
addition to the antagonism action.
Levallorphan tartarate. Levallorphan is available as tartarate salt.

Levallorphan tartarate occurs as white colored, odorless, crystalline powder. It
melts at 175°C and is slightly soluble in water but insoluble in ether and
chloroform.
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ANTI-INFLAMMATORY AGENTS
(Non-Steroidal Anti-inflammatory Drugs) (NSAIDs)
Introduction: The non-steroidal anti-inflammatory drugs (NSAIDs) are widely

used for the treatment of minor pain and for the management of edema and
tissue damage resulting from inflammatory joint disease (arthritis). A number of
these drugs possess antipyretic activity in addition to having analgesic and anti-
inflammatory actions, and thus have utility in the treatment of fever. Some of
the primary indications for NSAID therapy include: Rheumatoid arthritis,
osteoarthritis (OA), acute gouty arthritis, ankylosing spondylitis, dysmenorrhea
and tissue damage resulting from inflammatory joint disease (arthritis).
Role of COX enzymes in inflammation
Two COX isoenzymes have been identified: COX-1 and COX-2.
COX-1 constitutive enzyme is present in a wide variety of cell types and

influences the “housekeeping” functions of prostaglandins. This activity is
particularly important in the gastrointestinal (GI) tract, the kidneys, and the
circulatory system.
COX-2, on the other hand, is inducible enzyme, is found in only a few cell
types, especially macrophages and other leukocytes, fibroblasts, and endothelial
cells, including those of the vascular system. COX-2 is involved in those
aspects of the inflammatory process that are mediated by prostaglandins.
P a g e | 33
1. The major mechanism by which the NSAIDs elicit their therapeutic effects
(antipyretic, analgesic, and antiinflammatory activities) is inhibition of
prostaglandin (PG) synthesis. Specifically NSAIDs competitively (for the most
part) inhibit cyclooxygenases (Prostaglandin synthetase), the enzymes that
catalyze the synthesis of cyclic endoperoxidesfrom arachidonic acid to form
prostaglandins.
2. Generally, the NSAIDs inhibit both COX-1 and COX-2. Most NSAIDs are
mainly COX-1 selective (e.g., aspirin, ketoprofen, indomethacin, piroxicam,
sulindac). Others are considered slightly selective for COX-1 (e.g., ibuprofen,
naproxen, diclofenac) and others may be considered slightly selective for COX-
2 (e.g., etodolac, nabumetone, and meloxicam). The mechanism of action of
celecoxib and rofecoxib is primarily selective inhibition of COX-2; at
therapeutic concentrations, the COX-1 isoenzyme is not inhibited thus GI
toxicity may be decreased.
P a g e | 34
3. Other mechanisms that may contribute to NSAID anti-inflammatory activity

include the reduction of superoxide radicals, induction of apoptosis, inhibition
of adhesion molecule expression, decrease of nitric oxide synthase, decrease of
pro-inflammatory cytokine levels (tumornecrosis factor-α, interleukin-1),
modification of lymphocyte activity, and alteration of cellular membrane
functions.
Classification of NSAID’S
1.Salicylic acid derivatives: Aspirin, Diflunisal, Salsalate, Sulphasalazine.
2. p-Amino phenol derivatives: Paracetamol, Phenacetin.
3. Pyrazolidinedione derivatives: Phenyl butazone, Oxyphenbutazone,

Sulphin-pyrazone.
4. Anthranilic acid derivatives: Mefenemic acid, Flufenemic acid,

Meclofenamate.
5. Aryl alkanoic acid derivative.
a. Indole acetic acid: Indomethacin.
b. Indene acetic acid: Sulindac.
c. Pyrrole acetic acid: Tolmetin, Zormipirac.
d. Phenyl acetic (propionic) acid: Ibuprofen, Diclofenac, Naproxen,

Caprofen, Fenoprofen, Keto-profen, Flurbiprofen, Ketorolac, Etodaolac.
6. Oxicams: Piroxicam, Meloxicam, Tenoxicam.
P a g e | 35
7. Selective COX-2 inhibitors: Celecoxib, Rofecoxib, Valdecoxib.
8. Gold compounds: Auronofin, Aurothioglucose, Aurothioglucamide,

Aurothiomalate sodium.
9. Miscellaneous: Nabumetone, Nimesulide, Analgin.
10. Drug used in gout: Allopurinoll, Probenecid, sulphinpyrazone.
1. Salicylates:
Structure and chemistry: The salicylates are derivatives of 2-hydroxybenzoic

acid (salicylic acid). They were discovered in 1838 following the extraction of
salicylic acid from willow bark. Salicylic acid was used medicinally as the
sodium salt but replaced therapeutically in the late 1800s by acetylsalicylic acid
(aspirin).
Structural Activity Relationship (SAR) of Salicylates
1. The active moiety of salicylates is salicylate anion, side effects of aspirin,

particularly GIT effects appear to be associated with the carboxylic acid
functional group.
2. Reducing the acidity of the carboxy group results in a change in the potency
of activity. Example—the corresponding amide (salicylamide) retain the
analgesic action of salicylic acid, but is devoid of anti-inflammatory properties.
3. Substitution on either the carboxyl or phenolic hydroxyl group may affect the
potency and toxicity. Benzoic acid itself has only week activity.
P a g e | 36
4. Placement of the phenolic hydroxyl group at meta or para to the carboxyl

group abolish the activity
Mechanism of Action. The salicylates have potent anti-inflammatory activity

with mild analgesic and antipyretic activities. These compounds are mainly
COX-1 selective—they are bound with higher affinity to COX-1. The
therapeutic and some of the toxic actions (i.e. gut) of aspirin can be related to its
ability to inhibit COX-1 in various tissues and participate in transacetylation
reactions in vitro
a. Sodium salicylate.
Properties and uses: Sodium salicylate is a white crystalline powder, soluble in

water, sparingly soluble in alcohol. It is used for fever and for the relief of pain.
It also possesses anti-inflammatory actions similar to aspirin and symptomatic
therapy of gout.
b. Aspirin. Acetylsalicylic acid is an acetyl derivative of salicylic acid. It was

introduced into medicine by Dreser in 1899. Acetyl salicylic acid (aspirin) can
be prepared by the reaction between salicylic acid and acetic anhydride. In this
reaction, the hydroxyl group on the benzene ring in salicylic acid reacts with
acetic anhydride to form an ester functional group. Thus, the formation of acetyl
P a g e | 37
salicylic acid is referred to as an esterification reaction. This reaction requires

the presence of an acid catalyst.
Properties and uses: Aspirin is a white crystalline powder, slightly soluble in

water and soluble in alcohol, indicated for the relief of minor aches and mild-to-
moderate pain in the conditions such as arthritis and related arthritic condition.
Also used in myocardial infarction prophylaxis. Usual adult dose: 300 to 650
mg every 3 or 4 h orally or 650 mg to 1.3 g as the sustained-release tablet every
8 h; rectal, 200 mg to 1.3 g three or four times a day. Dosage forms: Aspirin
tablets I.P., B.P., Dispersible aspirin tablets B.P., Effervescent soluble aspirin
tablets B.P., Gastro-resistant aspirin tablets B.P., Aspirin and Caffeine tablets
B.P., Co-codaprin tablets B.P., Dispersible co-codaprin tablets B.P.
2. Anthranilic acid derivatives: Anthranilates are considered to be N-aryl

substituted derivatives of anthranilic acid, which is a bioisostere of salicylic
acid. These agents retain the acidic properties that are characteristic of this class
of agents. The most active fenamates have small alkyl or halogen substituents at
the 2′, 3′ and/or 6′ position of the N-aryl moiety (meclofenamate is 25 times
more potent than mefenamate). Among the disubstituted N-aryl fenamates the
2′, 3′-derivatives are most active suggesting that the substituents at the 2′, 3′-
positions serve to force the N-aryl ring out of coplanarity with the anthranilic
acid. Hence this steric effect is proposed to be important in the effective
interaction of the fenamates at their inhibitory site on cyclooxygenase.
P a g e | 38
SAR of Anthranilic Acid Derivatives (Fenamates)
1. The position of the carboxyl function is important for the activity of

anthranilic acid derivatives that are active, whereas the 3 and 4 amino benzoic
acid analogues are not active.
2. Replacement of carboxylic acid function with the tetrazole results in the

retention of antiinflammatory activity.
3. Placement of substitution on the anthranilic acid ring generally reduces the

activity.
4. Substitution on the N-aryl ring can lead to conflicting results. In the

ultraviolet erythema assay for anti-inflammatory activity, the order of activity
was generally 3´ > 2´ > 4´ for mono substitution with CF3 group (flufenamic
acid) being particularly potent.
5. In disubstituted derivatives, where the nature of the two substitutes is the

same 2´, 3´-disubstitution appears to be the most effective (mefenemic acid).
P a g e | 39
6. The NH moiety of anthranilic acid is essential for the activity as the

replacement of NH function with O, CH2, S, SO2, N-CH3, or NCOCH3
functionalities significantly reduced the activity.
MODE OF ACTIONS. The anthranilates have primarily antiinflammatory

with some analgesic and antipyretic activity and are non-COX selective. The
anthranilates are used as mild analgesics and occasionally to treat inflammatory
disorders. Diclofenac is used for rheumatoid arthritis, osteoarthritis and post-
operative pain and mefenamic acid as an analgesic for dysmennorhea. The
utility of this class of agents is limited by a number of adverse reactions
including nausea vomiting, diarrhoea, ulceration, headache, drowsiness and
hematopoietic toxicity.
a. Mefenamic acid*
P a g e | 40
Properties and uses: Its metabolism occurs through regioselective oxidation of

3-methyl group and glucuronidationof mephanamic acid. Majority of the 3-
hydroxy methyl metabolite and dicarboxylic acid products areexcreted.It is used
as an analgesic and anti-inflammatory agent.
b. Meclofenamate.
Properties and uses: Its metabolism occurs through regioselective oxidation of

3-methyl group and glucuronidation of mephanamic acid. Majority of the 3-
hydroxy methyl metabolite and dicarboxylic acid products are excreted. It is
used as an analgesic and anti-inflammatory agent.
3. Arylalkanoic Acids
SAR of Arylalkanoic Acids
P a g e | 41
1. The centre of acidity is usually located one carbon atom adjacent to a flat
surface represented by an aromatic or hetero aromatic ring.
2. The distance between these centres is critical because increasing this distance
to two or three carbons generally decreases activity.
3. All agents possess a centre of acidity, which can be represented by a

carboxylic acid and hydroxamic acid, a sulphonamide or a terazole.
4. Substitution of a methyl group on the carbon atom separating the aromatic

ring leads to enhancement of anti-inflammatory activity.
A. Indole acetic acid derivatives
a. Indomethacin.
SAR of Indole Acetic Acid Derivatives.
P a g e | 42
1. Placement of other acidic functionalities instead of the carboxyl group

decreases activity and the amide derivatives are inactive.
2. Substituents of R1 useful for increasing anti-inflammatory activity are ranked

as C6H4CH2 > alkyl > H.
3. Acylation of the indole nitrogen with aryl/alkyl carboxylic acids results in the
decrease of activity.
4. Presence of substituents on the N-benzoyl derivatives in the p-position with

F, Cl, CF3, or S-CH3 groups provide greatest activity.
5. X substituents activity are ranked as 5-OCH3 > N (CH3)2 > CH3 > H.
6. The presence of indole ring nitrogen is not essential for activity because the
corresponding 1-benzylidenylindene analogue (sulindac) is also active.
7. Alkyl groups especially methyl group at 2nd position is much active than aryl
substituted analogues.
8. Substitution of a methyl group at the α position of the acetic acid side chain
leads to equiactive analogues.
9. Anti-inflammatory activity was displayed only by the dextrorotatory

enantiomer with similar absolute configuration; it has 25 times the activity of
phenylbutazone.
Properties and uses: It is a white or yellow crystalline powder, insoluble in

water and sparingly soluble in alcohol. Indomethacin is more effective than
aspirin. The most frequent side effects are gastric distress and headache. It also
has been associated with peptic ulceration, blood disorders, and possible death
P a g e | 43
(these side effects appear to be closely related and sometimes can be minimized
by reducing the dose). It is not recommended for use in children because of
possible interference with the resistance to infection. Used as anti-inflammatory
and analgesic in rheumatic arthritis, spondylitis, and to lesser extent in
gout.relieved. As an antirheumatic by oral route, the dose is 50 mg two or three
times a day. And as an antipyretic, the dose is orally 25–50 mg three times a
day. Indometacin capsules I.P., B.P., Indometacin Suppositories I.P., B.P.
B. Indeneacetic acid derivatives
a. Sulindac.
Properties and uses: Suindac is a yellow crystalline powder, very slightly

soluble in water, soluble in methylene chloride, and dilute solutions of alkali
hydroxides, sparingly soluble in alcohol. The (Z) isomer ofsulindac showed
much more potent anti-inflammatory activity than the corresponding (E)-
isomer. Themore polar and inactive sulphoxide is virtually the only form
excreted. It is a prodrug to form active metabolites of sulphite. In addition to it,
sulindac is oxidized to corresponding sulphone and other sulphone-glucuronide
conjugates. It has analgesic, antipyretic, and anti-inflammatory properties. It is
usually employed in the treatment of rheumatic and muscular skeletal disorders,
acute gouty arthritis, and osteoarthritis.
P a g e | 44
C. Pyrrole acetic acid derivative: Replacement of the p-tolyl group with a p-

chloro benzoyl moiety produced little effect on activity, whereas introduction of
a methyl group in the 4th position and 5-p-chloro benzoyl analogues
(zomeapirac) proved to be four times potent as tolmetin.
a. Tolmetin
Properties and uses: It is a light yellow, crystalline powder, soluble in water,

slightly soluble in alcohol. It has antipyretic, analgesic, and anti-inflammatory
actions. It is employed in the treatment of rheumatic and musculoskeletal
disorders. The drug is, however, comparable to indomethacin and aspirin in the
control and management of disease activity. Adult oral dose initially is 400 mg
three times a day, subsequently adjusted as per patient’s response.
b. Zomepriac
Properties and uses: A greater degree of analgesia for severe pain is claimed
for Zomepirac. It is used as an analgesic and an ant-inflammatory drug. It is
four times as potent as tolmetin. Dose is 400 to 600 mg of zomepirac daily
(zomepirac sodium 1.2 g is approximately equivalent to 1 g of zomepirac).
P a g e | 45
D. Aryl and heteroaryl acetic/propionic acid derivatives.
a. Diclofenac.
Properties and uses: Diclofenac sodium is a white or slightly yellowish

crystalline slightly hygroscopic powder, sparingly soluble in water, soluble in
methanol and alcohol, slightly soluble in acetone. Used in the treatment of
rheumatic arthritis. The usual dose is 20–50 mg three times a day. It can also be
given as a suppository
b. Ketorolac.
Properties and uses: Ketorolac is a white crystalline powder, soluble in water

and in methanol, slightly soluble in ethanol, practically insoluble in methylene
chloride. Ketorolac is a potent analgesic indicated for the treatment of
moderately severe and acute pain.The dose for ocular itching, which is
associated with seasonal allergic conjunctivitis, for reduction of ocular pain, and
for photophobia in patients undergoing incisional refractive sugery, instil one
drop of a 0.5% solution into the affected eyes four times daily.
P a g e | 46
Ibuprofen*
Synthesis
Properties and uses: Ibuprofen is a white crystalline powder or colourless

crystals, practically insoluble in water, soluble in acetone, methanol, methylene
chloride, and dilute solutions of alkali hydroxides and carbonates. The precursor
Ibufenac, which was abandoned owing to hepatotoxicity, was less potent.
Furthermore, these isomers are the more potent inhibitors of PG synthetase. It is
an anti-inflammatory drug that possesses antipyretic and analgesic action and is
used for the treatment of rheumatoid arthritis and osteoarthritis. Usual oral adult
dose as an analgesic (dysmenorrhoea) is 200–400 mg four to six times a day; in
rheumatoid arthritis and osteoarthritis. The dose is 300–400 mg three or four
times a day. Ibuprofen tablets I.P., B.P, Ibuprofen cream B.P., Ibuprofen gel
B.P., Ibuprofen oral suspension B.P.
P a g e | 47
d. Naproxen
Properties and uses: Naproxen is a white crystalline powder, practically

insoluble in water, soluble in ethanol and in methanol. The drug is fairly
comparable to aspirin both in the management and control of disease symptoms.
Nevertheless, it has relatively lesser frequency and severity of nervous system
together with milder GI-effects. It possesses analgesic, anti-inflammatory, and
antipyretic actions, and it is used in the treatment of rheumatic arthritis,
dysmenorrhea, and acute gout. Dose: For adult in rheumatoid arthritis, 250–375
mg as initial dose two times a day; in acute gout, 750 mg as loading dose
followed by 250 mg three times a day until relieved. Dosage forms: Naproxen
oral suspension B.P., Naproxen suppositories B.P., Naproxen tablets B.P.,
Gastro resistant naproxen tablets B.P.
4. Oxicams: The term oxicam described the relatively new enolic acid class of
4-hydroxyl -1,2benzothiazinecarboxamidewith anti-inflammatory and analgesic
properties.
P a g e | 48
Piroxicam.
Properties and uses: Piroxicam is a white or slightly yellow crystalline

powder, practically insoluble in water, soluble in methylene chloride, and
slightly soluble in ethanol. It is employed for acute and long-term therapy for
the relief of symptoms of osteoarthritis and rheumatoid arthritis. It also
possesses uricosuric action and has been used in the treatment of acute gout.
5. SAR of p-amino Phenol Derivatives
1. Etherifi cation of the phenolic function with methyl or propyl groups

produces derivatives with greater side effects than ethyl derivatives.
2. Substituents of the nitrogen atom, which reduce the basicity, also reduce
activity unless the substituent is metabolically labile. Example—acetyl groups.
3. Amides derived from aromatic acid. Example—N-phenyl benzamides that

are less active or inactive.
Phenacetin
P a g e | 49
Properties and uses: It exists as a white glistering powder with a bitter taste,
sparingly soluble in water and soluble in chloroform. It is an analgesic and an
antipyretic with similar effectiveness as an aspirin. It has a greater potential for
toxicity (hemolytic anaemia and methemoglobinaemia) than paracetamol. Usual
dose as oral for adults is 300 mg to 2 g per day.
Acetaminophen.
Properties and uses: Paracetamols exist as white crystalline powder, sparingly

soluble in water, soluble in alcohol, and very slightly soluble in methylene
chloride. Paracetamols produce antipyresis by acting on the hypothalamic heat-
regulating centre and analgesia by elevating the pain threshold. Hepatic necrosis
and death have been observed following over dosage; hepatic damage is likely
in an adult who takes more than 10 g in a single dose or if a 2-year old child
takes more than 3 g.: Usual oral adult dose is 500 mg to 1 g for three or four
times a day. Paracetamol tablets I.P, B.P., Paracetamol syrup I.P., Co-codamol
tablets B.P., Effervescent Co-codamol tablets B.P., Co-dydramol tablets B.P.,
P a g e | 50
Co-proxamol tablets B.P., Paracetamol capsules B.P., Paediatric paracetamol

oral solution B.P., Paracetamol oral suspension B.P., Paracetamol suppositories
B.P., Dispersible paracetamol tablets B.P., soluble paracetamol tablets B.P
Antipyrine.Antipyrine.Antipyrine is 2, 3-dimethyl-1-phenyl-3-pyrazolin-5-one.
It was one of the first synthetic compounds to be used in medicine.
Properties and uses:Antipyrine is available as colorless, crystalline powder or

white powder. It is odourless and having slightly bitter taste. It is freely soluble
in water, alcohol, and chloroform. Antipyrinehas analgesic, antiinflammatory
and antipyretic activities.
6. 3, 5-Pyrazolidinediones.
SAR of 3, 5-Pyrazolidinediones.
1.Replacement of one of the nitrogen atom in the pyrazolidinediones with an

oxygen atom yields isoxazoleanalogues, which are as active as
pyrazolidinediones derivatives.
2. In 3, 5-pyrazolidinedione derivatives, pharmacological activities are closely

related to their acidity, the dicarbonyl function at the 3rd and 5th positions
enhance the acidity of hydrogen atom at the 4 thposition.
P a g e | 51
3. Presence of a keto group in the γ-position of the butyl side chain produces the
active compound.
4. Decreasing or eliminating acidity by removing the acidic proton at 4th

position (e.g. 4, 4-dialkyl derivatives) abolishes anti-inflammatory activity.
Thus, if the hydrogen atom at the 4th position of phenyl butazone is replaced by
substituents, such as a methyl group, antiinflammation activity is abolished.
5. If acidity is enhanced too much, anti-inflammatory and sodium-retaining

activities decrease while other properties, such as the uricosuric effect increases.
6. Introduction of polar function in these alkyl groups give mixed results. The γ-
hydroxy-n-butyl derivative posseses pronounced uricosuric activity, but give
fewer anti-inflammatory effects.
7. Substitution of 2-phenyl thio ethyl group at the 4th position produces antigout
activity (sulphinpyrazone).
8. Presence of both the phenyl groups is essential for neither anti-inflammatory

nor analgesic activity.
9. m-Substitution of aryl rings of the phenyl butazone gives uniformly inactive

compounds. p-Substitution, such as methyl, chloro, nitro, or OH of one or both
rings retains activity
a. Phenylbutazone
P a g e | 52
Properties and uses: Phenylbutazone is a white crystalline powder, practically

insoluble in water, sparingly soluble in alcohol, and soluble in alkaline
solutions. It is a pyrazole derivative that has antipyretic,analgesic, and anti-
inflammatory actions, because of its toxicity it is not used as a general
antipyretic or analgesic. It is a usual practice reserved for use in the treatment of
osteoarthrosis, ankylosing spondylitis, arthritis, acute superficial
thrombophlebitis, painful shoulder, and Reiter’s disease, where less toxic drugs
have failed. The usual dose is 100–600 mg per day.
P a g e | 53

Medicinal Chemistry Unit V General Anesthetic

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Medicinal Chemistry Unit V General Anesthetic

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JAIPUR COLLEGE OF PHARMACY, JAIPUR

B.PHARMACY, SECOND YEAR, FOURTH SEMESTER

Stages of General Anesthesia: When an inhalation anesthetic is administered

Stage I (Stage of analgesia): This is the period from the beginning of

Stage II (Stage of delirium): This period extends from the loss of

Stage IV (Stage of medullary depression): Overdose of the anesthetic may

A. Volatile Inhalation general anesthetics. They are administered by

1.Gases: Cyclopropane: Ethyl chloride, Nitrous oxide

2. Liquids: Diethyl ether, Halothane, Chloroform, Trichloroethylene

B. Non-Volatile or Intravenous anesthetics. They are non-volatile at room

1.Barbiturates: Thiopental sodium, Methohexital sodium.

2. Non-barbiturates: Propanidid, Propofol.

An ideal general anesthetic should possess the following characteristic features:

c) It should be non-irritating to mucous membrane

Properties and uses: It is a clear, colourless, heavy, non-flammable liquid,

Properties and uses: It is a clear, colourless liquid, noninfl ammable and

Properties and uses: It is a clear, colourless, volatile liquid with pleasant

Properties and uses: It is a clear, colourless, heavy liquid, insoluble in water,

ULTRA SHORT ACTING BARBITUTRATES

Methohexital is also a derivative of barbituric acid. It is prepared by

Properties and uses: White to off-white hygroscopic powder, essentially

Properties and uses: Thiomylal is a highly hydrophobic thiobarbiturate having

Properties and uses: A yellowish-white powder, hygroscopic, freely soluble in

Dosage forms: Thiopental injection B.P.

Ketamine hydrochloride: Ketamine is a cyclohexanol derivative. Chemically

Properties and uses: It is a white or almost white crystalline powder, freely

Storage: It should be stored in well-closed airtight containers, protected from

Dosage forms: Ketamine HCl injection I.P., B.P.

NARCOTIC AND NON-NARCOTIC ANALGESICS.

INTRODUCTION: Analgesics are agents that relieve pain by acting centrally

1. Opioid analgesics or narcotic analgesics (centrally acting).

2. Nonopioid analgesics (peripherally acting).

psychological dependence) and physical dependence may lead to withdrawal

Mode of action: The endogenous peptides found in central nervous system

μ-(mu) receptors mediate analgesia, euphoria, respiratory and physical

κ-(kappa) receptors mediate pentazocine like spinal analgesia, sedation, miosis

Classification: Narcotic analgesics will be classified on the basis of their

1. Natural alkaloids of opium: Morphine and codeine.

2. Semisynthetic analogs: Hydromorphone, oxymorphone, oxycodone.

3. Synthetic agents: Meperidine, levorphanol, methadone, sufentanil, alfentanil,

Morphine and its derivaties.

1. A rigid pentacyclic structure consisting of a benzene ring (A), two partially

2. Two hydroxyl functional groups, a C3-phenolic OH (pKa 9.9) and a C6-

3. An ether linkage between C4 and C5.

4. Unsaturation between C7 and C8.

5. A basic, 3°-amine function at position 17.

SAR of Morphine was studied by

1. Modification of alicyclic ring

2. Modification of aromatic ring

1. Modification on alicyclic ring

• The alcoholic hydroxyl group at C-6 when methylated, esterified, oxydized,

• The reduction of C-6 keto group to C-6 β hydroxyl in oxymorphone gives

• The 14 β hydroxyl group generally enhances μ agonistic properties and

• Reaction of thebaine with dienophile (i.ediel’s alder reaction) results in 6, 14

2. Modification on phenyl ring

• An aromatic phenyl ring is essential for activity.

• Modification on phenolic hydroxyl group decreases the activity.

• Any other substitution on phenyl ring diminishes activity.

• A tertiary amine is usually necessary for good opioid activity.