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 ["A","B","E"]
Explanation
A. Decongestants are commonly used to relieve nasal congestion in upper respiratory tract infections by constricting blood vessels in the nasal passages.
B. Expectorants help thin mucus and are used in upper respiratory conditions to facilitate coughing up mucus.
C. H2 antagonists are primarily used to reduce stomach acid and are not indicated for upper respiratory conditions.
D. Short-acting beta agonists (SABAs) are primarily used in the management of lower respiratory tract conditions, such as asthma and COPD, rather than upper respiratory conditions.
E. H1 antagonists (antihistamines) are effective for treating allergic reactions and symptoms of upper respiratory infections, such as runny nose and sneezing.
F. Long-acting beta agonists (LABAs) are also used primarily for lower respiratory tract conditions and are not appropriate for treating upper respiratory issues.
Correct Answer is D
Explanation
A. Diabetes Mellitus is not a contraindication for promethazine, although caution may be needed regarding metabolic control.
B. Chronic Kidney Disease does not specifically contraindicate the use of promethazine, but dosage adjustments may be necessary due to altered drug metabolism.
C. Iron Deficiency Anemia does not contraindicate the use of promethazine and would not raise significant concerns for its administration.
D. Narrow-Angle Glaucoma is a contraindication for promethazine due to its anticholinergic properties, which can increase intraocular pressure and worsen glaucoma.