Depends how you are loading it.Why is it that in patients with impaired renal or hepatic function, the loading dose remains unchanged, although the maintenence dose in decreased?
In people with renal or hepatic disease, out is lower and thus in must be lower too to prevent that huge list of side effects you are memorizing from happening.
ok...albumin is mainly to transport the drug around and not for metabolism.
Maintenance dose will be decreased in hepatic failure due to decreased metabolism via Phase 1 and Phase 2 reactions. Remember cytochrome P450?
I think its beyond the scope of Step 1 on how you wud adjust this dose.