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. While maintaining blood pressure within the expected range is important, it does not specifically indicate the effectiveness of sertraline, which is an antidepressant.
B. Weight gain can occur with some antidepressants, but it is not a direct indicator of their effectiveness.
C. An increase in mood is a primary goal of treatment with sertraline, and reporting this improvement suggests that the medication is having a positive effect.
D. The absence of swollen legs is not a relevant indicator for assessing the effectiveness of sertraline, as it does not relate to mood or depression symptoms.
Correct Answer is B
Explanation
A. Tardive dyskinesia is primarily associated with long-term use of antipsychotics, not SSRIs like sertraline.
B. Serotonin syndrome is a serious condition that can occur with overdose or interaction of SSRIs, leading to symptoms such as agitation, confusion, rapid heart rate, and increased muscle tone.
C. Hypertensive emergency is not typically associated with SSRIs; it is more related to the use of MAOIs and certain foods.
D. Extrapyramidal syndrome is also primarily linked to antipsychotics rather than SSRIs and would not be a concern with sertraline use.