Why may a client suffering from kwashiorkor (protein deficiency) respond badly to some drugs?
Lack of proteins in the blood, especially the albumins, may cause high concentrations of the free drug, the result of which can be dangerous as it is the free drug that is active. • Oestrogens are sometimes administered transdermally to combat menopausal symptoms. There are less adverse effects when they are administered this way. Why? The liver metabolises many drugs, sometimes very efficiently, but if the drug is transported to the liver before reaching other parts of the body, very little may actually get to the intended site. As absorption from most of the gastrointestinal tract is into the hepatic portal system, some drugs that are extensively metabolised by one passage through the liver can be ineffective when given by this route. This is known as hepatic first pass. Because oestrogens have a high hepatic first pass, more has to given orally in order that enough drug reaches the target tissues. If the drug is given transdermally, the hepatic first pass is avoided. • It has been n
