A drug has very low volume of distribution (Vd). Which of the following is the best explanation?

A. The agent is eliminated by the kidneys, and the patient has renal insufficiency

B. The agent is extensively bound to plasma proteins

C. The agent is extensively sequestered in tissue

D. The agent is eliminated by zero-order kinetics

ANSWER: b The agent is extensively bound to plasma proteins

KDT  7e/p 17

Factors affecting volume of distribution (Vd):

• Plasma protein binding
  • High Plasma protein binding decreases Vd
  • Low Plasma protein binding increases Vd
• Tissue Perfusion
  • decreased  tissue perfusion implies decreased Vd
• Water Soluble drugs have low Vd and Lipid soluble drugs have high Vd
• Acidic drugs have low Vd
• In edematous condition, water soluble drugs have high volume of distribution
• Tissue binding.
  • High Vd with higher tissue binding
• Low molecular weight drugs have high Vd 

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