A nurse is teaching a group of nurses about the administration of nitroglycerin. Which of the following routes of administration has the most rapid onset for the client?
Topical ointment
Sublingual
Transdermal patch
Sustained-release
The Correct Answer is B
A. Topical ointment has a slower onset as it must be absorbed through the skin before it can exert its effects.
B. Sublingual nitroglycerin provides rapid relief of angina symptoms because it is absorbed quickly into the bloodstream through the mucous membranes in the mouth, allowing for an immediate effect.
C. Transdermal patches release nitroglycerin slowly over time, leading to a delayed onset of action.
D. Sustained-release formulations are designed for prolonged effects rather than rapid onset, making them slower to take effect compared to sublingual administration.
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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. Epinephrine is primarily used for anaphylaxis and severe asthma attacks; it is not effective in reversing opioid overdose.
B. Protamine is an antidote for heparin, not for opioid overdose.
C. Flumazenil is a benzodiazepine antagonist and is not indicated for opioid overdose; it can potentially precipitate seizures in patients with mixed drug overdoses.
D. Naloxone is an opioid antagonist specifically indicated for reversing the effects of opioid overdose, including respiratory depression, making it the appropriate choice in this scenario.