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. LABAs can help prevent asthma attacks, including those triggered by exercise, so this statement is accurate and does not indicate a need for further education.
B. LABAs may cause side effects like an increased heart rate, which the client correctly recognizes.
C. LABAs are not intended for immediate relief of asthma symptoms; they are for long-term control. A short-acting beta2-agonist (SABA) should be used for acute symptoms, indicating this client needs further education.
D. Over time, tolerance can develop with some medications, and this understanding is accurate, so it does not indicate a need for additional teaching.
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.