The nurse obtains the patient's history to identify factors that may affect drug pharmacokinetics. which patients who are on highly protein-bound drugs are likely to experience drug toxicity?

There are choices for this question namely:

A patient with liver cirrhosis
A patient with kidney disease
A patient with a nutritional deficiency
A patient who has had gastric surgery
A patient with peripheral vascular disease

The correct answers are:
(1) A patient with liver cirrhosis
(2) A patient with kidney disease
(3) A patient with a nutritional deficiency

Drugs in general is metabolized by the liver and the kidneys. In patients with liver cirrhosis, the metabolism of most drugs is inhibited therefore the concentration of the active drug will remain high in the circulation. A patient with kidney disease will have decreased excretion of the active drug and its metabolites therefore contributing to toxicity. A patient will a nutritional deficiency will present with a decrease in albumin in blood which will increase the levels of active, unbound drug in the blood.