Protein Binding

[ivikatasha]

i had my first test today in pharmacology today and one of the questions was about what the nurse should know in regard to drug actions. it was a select all question and one of the answers was protein binding. can't remember what the other answers were.

most of the class put protein binding as an answer but when we did the test review the professor said it was wrong. that we don't look at that and it doesn't matter. which confused us all because our book said we have to check albumin levels before giving drugs that highly bind, 90% or more.

so based on her logic, i can administer a drug like warfarin and not check the albumin levels.... which doesn't seem right to me....

thoughts?

[nurseprnRN, BSN, RN]

warfarin dose is individualized by checking coag studies (ptt). so it really doesn't matter what a patient's albumin is. why doesn't it matter for the first dose? because patients start on warfarin while they are still on heparin, and the warfarin dose is adjusted until the ptt is perfect, and then the heparin is d/c'd.

you ask a reasonable question, though i am sure the faculty included it in your choices just to fool you. nclex will do that too. while it is true that some drugs bind heavily to protein, the therapeutic effect isn't usually an issue since the pharmacodynamics have long since been worked out and doses for effective levels are prescribed. therefore, although an answer may be factually true, it may not be a good answer even in a sata question.

i hope you understand my answer.

[ivikatasha]

Thanks! Yes I do understand now. This was a much better explanation then what my class got, I will pass this on to my classmates.