A nurse reads in a drug information guide that PO morphine has a high first-pass effect. Which of the following would the nurse expect?
The drug will be most effective when given orally.
The drug will be more effective when given in a non-enteral route.
The drug is excreted by the kidneys at a slower rate than most medications.
The kidney will metabolize some of the drug before it reaches the bloodstream.
The Correct Answer is B
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.
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Correct Answer is C
Explanation
A. Macrolides, such as azithromycin and erythromycin, have a low cross-reactivity with penicillin and are typically safe alternatives for those with penicillin allergies.
B. Sulfonamides are not structurally similar to penicillins and generally do not have cross-sensitivity issues with penicillin allergies.
C. Cephalosporins share a similar beta-lactam structure to penicillins, which can result in cross-sensitivity in some individuals with a penicillin allergy. For this reason, they should be avoided or used with caution in these clients.
D. Tetracyclines have a different structure from penicillins and are usually safe for clients with penicillin allergies.
Correct Answer is B
Explanation
A. Methylprednisolone does not contain soy products and is not contraindicated for clients with a soybean allergy.
B. Ipratropium bromide is often formulated with soy lecithin as a stabilizer, making it contraindicated for individuals allergic to soybeans.
C. Montelukast is a leukotriene receptor antagonist and does not contain soy products, so it is safe for this client.
D. Albuterol does not contain soy products and is generally safe for clients with a soybean allergy.