A client newly prescribed niacin (Nicotinic Acid) presents to the healthcare setting with complaints of flushing following doses. Which of the following medications would the nurse anticipate being administered?
Beta Blockers
Calcium Channel Blockers
NSAIDs
Fibric Acid Derivatives
The Correct Answer is C
A. Beta blockers are used to manage blood pressure and heart rate but are not effective in reducing niacin-induced flushing.
B. Calcium channel blockers help to relax blood vessels but do not address the flushing side effect caused by niacin.
C. NSAIDs, like aspirin, can help reduce the flushing associated with niacin. This flushing occurs due to prostaglandin release, which NSAIDs can inhibit.
D. While fibric acid derivatives are used to lower cholesterol, they do not alleviate the flushing side effect of niacin.
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Correct Answer is ["B","C","F"]
Explanation
A. Morphine administered intravenously bypasses the gastrointestinal tract and liver, avoiding the first-pass effect entirely.
B. Diphenhydramine in tablet form is absorbed through the gastrointestinal tract and undergoes significant first-pass metabolism in the liver, affecting its bioavailability.
C. Famotidine in tablet form is also subject to first-pass metabolism, which can reduce its effectiveness.
D. Nitroglycerin sublingual tablets are designed to bypass the first-pass metabolism by being absorbed directly into the bloodstream through the mucous membranes.
E. The same applies to nitroglycerin 10mg sublingual tablets; they also avoid the first-pass effect due to sublingual administration.
F. Acetaminophen is taken orally and undergoes first-pass metabolism in the liver, which can significantly affect its overall bioavailability.
Correct Answer is D
Explanation
A. Hydralazine is a vasodilator that does not directly replace ACE inhibitors and is not the preferred alternative for managing hypertension or heart failure.
B. Metoprolol is a beta-blocker that is used for different indications and is not a direct substitute for ACE inhibitors.
C. Furosemide is a loop diuretic used for fluid management, not as an alternative to ACE inhibitors.
D. Losartan is an angiotensin II receptor blocker (ARB) and serves as a suitable alternative to ACE inhibitors for patients who experience a cough from them, as ARBs do not typically cause this side effect.