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. A BMI greater than 30 is a consideration, but it is not an absolute contraindication for the use of POPs.
B. Ginger does not interact adversely with progestin-only pills and is not a contraindication.
C. A history of hypertension can increase the risk of cardiovascular events, and while POPs are generally safer than combined hormonal contraceptives for women with hypertension, it should still be monitored and reported to the healthcare provider.
D. Having no intention of conceiving is not a contraindication; in fact, it is a common reason for using contraceptive methods like POPs.
Correct Answer is B
Explanation
A. Bradycardia is not a common side effect of atorvastatin and would not necessarily require immediate reporting unless it is significantly low and symptomatic.
B. Dark-red urine could indicate the presence of myoglobinuria, which can occur due to rhabdomyolysis, a serious side effect of statins like atorvastatin that necessitates immediate medical attention.
C. Elevated HDL cholesterol is generally a positive finding and does not require reporting unless it is part of a larger adverse effect context.
D. A migraine headache, while concerning, is not a known side effect specifically associated with atorvastatin and may not require immediate intervention unless severe or persistent.