Salicylate binds albumin; what effect would prehepatic jaundice have on salicylate?

• A. Decrease in the pharmacologic response to salicylate
• B. Increase in the rate of clearance of salicylate
• C. Increase in the free concentration of salicylate
• D. No change

Answer: (C)

Salicylate’s effect depends on the fraction that is unbound to albumin, because only the unbound drug can act and distribute to tissues. In prehepatic jaundice, unconjugated bilirubin rises and binds to albumin as well. This increase for bilirubin means more competition for the same albumin-binding sites, which displaces some salicylate from binding. As a result, the unbound (free) salicylate concentration increases. Since the active pharmacologic form is the free drug, the amount available to exert effects goes up. The other options don’t capture this immediate change: the pharmacologic response would not decrease due to displacement, there isn’t a straightforward no-change scenario, and while clearance can be influenced by more unbound drug, the prompt, primary consequence is the rise in the free concentration.