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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?

A.

The drug will be most effective when given orally.

B.

The drug will be more effective when given in a non-enteral route.

C.

The drug is excreted by the kidneys at a slower rate than most medications.

D.

The kidney will metabolize some of the drug before it reaches the bloodstream.

Answer and Explanation

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. Methylprednisolone does not contain soy products and is not contraindicated for clients with a soybean allergy.

B. Ipratropium bromide is often formulated with soy lecithin as a stabilizer, making it contraindicated for individuals allergic to soybeans.

C. Montelukast is a leukotriene receptor antagonist and does not contain soy products, so it is safe for this client.

D. Albuterol does not contain soy products and is generally safe for clients with a soybean allergy.

Correct Answer is C

Explanation

A. Allopurinol is a xanthine oxidase inhibitor used for chronic gout management and prevention, not for acute attacks.

B. Febuxostat is also used for chronic management of gout and not effective for immediate relief of an acute attack.

C. Colchicine is indicated for the treatment of acute gout flares as it helps reduce inflammation and pain associated with gout attacks.

D. Physostigmine is an antidote for anticholinergic toxicity and has no role in treating gout.

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