Why can a reduction in albumin synthesis that may occur with aging result in exaggerated effects of a medication?
1. Blood flow to the liver decreases.
2. More unbound drug will be present.
3. Pharmacodynamics will be altered.
4. Renal elimination of the drug will be decreased.
Correct Answer: 2
Rationale 1: Blood flow to the liver is indeed decreased, but this is not related to protein binding.
Rationale 2: If the drug is protein-bound, a decrease in albumin will result in higher concentrations of free drug and increased pharmacologic effects.
Rationale 3: Pharmacodynamics is unrelated to protein binding.
Rationale 4: Renal elimination will be unchanged or increased.
Global Rationale: If the drug is protein-bound, a decrease in albumin will result in higher concentrations of free drug and increased pharmacologic effects. Blood flow to the liver is indeed decreased, but this is not related to protein binding. Pharmacodynamics is unrelated to protein binding. Renal elimination will be unchanged or increased.
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