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The two-state receptor model describes receptors existing in equilibrium between inactive (Ri) and active (Ra) conformations. The inactive form produces no response, while the active form generates a basal effect called constitutive activity. This equilibrium exists even without drug binding, allowing receptors to maintain baseline signaling capacity.

An agonist drug has high affinity for the active receptor conformation and shifts the equilibrium toward Ra. Increasing agonist concentration enhances the receptor's efficacy to elicit maximum cellular response. This preferential binding to the active state amplifies the biological signal beyond constitutive activity levels.

An antagonist has equal affinity for both Ri and Ra conformations, maintaining equilibrium while preventing agonist binding and limiting response to constitutive activity. An inverse agonist preferentially binds the inactive state, shifting equilibrium toward Ri and reducing constitutive activity below baseline. Both block agonist effects, but inverse agonists actively suppress basal signaling.

A drug's binding affinity determines which receptor conformations it binds and its efficacy in producing a response. Drugs with high affinity for active conformations generate strong responses, while those with equal or preferential affinity for inactive states produce weaker or suppressive effects. Affinity directly controls the magnitude of cellular response.

Constitutive activity is the basal biological effect produced by the active receptor conformation (Ra) in the absence of any drug or endogenous ligand. This baseline signaling occurs because receptors naturally exist in an equilibrium mixture of inactive and active states. Inverse agonists reduce this constitutive activity by shifting equilibrium toward the inactive conformation.

The two-state receptor model applies to G protein-coupled receptors and ligand-gated ion channels. Both receptor classes undergo conformational changes between inactive and active states in response to drug binding. This model explains how drugs modulate these major receptor families to evoke or prevent biological responses.

The two-state model explains selectivity through differential binding affinity: drugs preferentially bind specific conformations based on their chemical structure. An agonist selectively binds active states, while an antagonist binds both equally, and an inverse agonist favors inactive states. This conformational selectivity underlies dose response relationship selectivity and specificity in drug action.