A nurse is caring for a client who is currently 34-weeks gestation. Which of the following medications would be avoided due to its category X classification?
morphine
famotidine (Pepcid)
misoprostol (Cytotec)
ibuprofen (Advil)
The Correct Answer is C
A. Morphine is a category C medication, which means it may be used if the benefits outweigh the risks; it is not contraindicated in pregnancy.
B. Famotidine (Pepcid) is also a category B medication and is generally considered safe to use during pregnancy.
C. Misoprostol (Cytotec) is classified as category X due to its association with causing uterine contractions and the potential for fetal harm; thus, it should be avoided during pregnancy.
D. Ibuprofen (Advil) is a category C medication, and while it is not typically recommended in the third trimester, it is not classified as category X.
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Correct Answer is B
Explanation
A. A high first-pass effect means that a significant amount of the drug is metabolized by the liver before reaching systemic circulation, making oral administration less effective.
B. Morphine with a high first-pass effect will be more effective when administered via non-enteral routes, such as IV or subcutaneous, to bypass the liver's initial metabolism.
C. The first-pass effect does not influence the kidney’s rate of excretion but rather the liver’s initial metabolism of the drug.
D. The liver, not the kidneys, is responsible for the first-pass metabolism, which occurs before the drug reaches systemic circulation when taken orally.
Correct Answer is C
Explanation
A. A history of hypertension is not a direct contraindication for propofol, although it should be monitored as part of overall management.
B. Benzodiazepine abuse/dependence does not contraindicate the use of propofol but may require careful assessment of sedation and anesthesia needs.
C. Propofol contains soy lecithin and egg phosphatide, making allergies to these products a significant contraindication, as they can lead to severe allergic reactions.
D. An allergy to latex is not a contraindication for propofol use but should be addressed in the overall anesthesia plan regarding equipment and supplies.