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 B
Explanation
A. Black-colored stools may indicate gastrointestinal bleeding, which is not a common side effect of rifampin.
B. Rifampin is known to cause orange-colored secretions, including urine, sweat, and tears, which is a normal and expected side effect.
C. Rifampin does not typically cause staining of teeth; this is more commonly associated with other medications like tetracyclines.
D. Constipation is not a recognized side effect of rifampin, and patients are not typically advised to expect this as a result of the medication.
Correct Answer is D
Explanation
A. Hypertension is not a direct adverse effect of febuxostat; monitoring blood pressure is important but not the primary concern with this medication.
B. Malignant hyperthermia is a rare condition typically associated with certain anesthetic agents and is not related to febuxostat.
C. Steven's Johnson Syndrome is a serious skin reaction that can occur with some medications, but it is not specifically associated with febuxostat.
D. Renal impairment is a known risk with febuxostat, and the nurse should monitor renal function closely, as gout can also be exacerbated by kidney issues and febuxostat is primarily excreted by the kidneys.