Anaes SAQs · Applied cardiovascular & respiratory physiology
Plasma protein binding and drug interactions
Primary — only free drug active; albumin binds acids, alpha-1-acid glycoprotein binds bases and rises in inflammation; free fraction in hypoalbuminaemia/renal failure; highly bound drugs (warfarin, phenytoin, diazepam); interaction classification (pharmaceutical, pharmacokinetic, pharmacodynamic); CYP inhibition (rapid, raises levels — ketoconazole, macrolides, grapefruit) vs induction (slow via PXR, lowers levels — rifampicin, phenytoin, carbamazepine); serotonin syndrome.
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Prompt
Explain the significance of plasma protein binding for drug action. Describe how altered binding and enzyme induction or inhibition produce drug-drug interactions, giving perioperative examples.
Question
Explain the significance of plasma protein binding for drug action. Describe how altered binding and enzyme induction or inhibition produce drug-drug interactions, giving perioperative examples.
[1]References4ShowHide
- [1]Enlo-Scott Z, et al. A framework for plasma protein binding. J Pharm Sci, 2026.PMID 42309206
- [3]Sensenhauser C, et al. In vitro enzyme inhibition assays to predict drug-drug interactions. Drug Metab Dispos, 2026.PMID 42275929
- [4]Cohen H, et al. Induction of cytochrome P450 2C9 and P-glycoprotein activity by antiseizure medications: A systematic review and network meta-analysis. Epileptic Disord, 2026.PMID 41948839
- [7]Xu S, et al. Detection of clinically significant drug-drug interactions in serotonin syndrome: a multisource real-world data and pharmacovigilance study. Ther Adv Drug Saf, 2026.PMID 42317468