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 D
Explanation
A. Galantamine is a reversible acetylcholinesterase inhibitor and would not be effective in treating a cholinergic crisis.
B. Physostigmine is also a reversible acetylcholinesterase inhibitor and would not be suitable for reversing a cholinergic crisis.
C. Flumazenil is a benzodiazepine antagonist used to reverse benzodiazepine effects, not cholinergic crises.
D. Atropine is an anticholinergic medication that is effective in reversing the effects of excessive acetylcholine during a cholinergic crisis, making it the appropriate choice in this situation.
Correct Answer is B
Explanation
A. Carvedilol is a beta-blocker that is often used in hypertension management but is not considered a first-line treatment.
B. Lisinopril, an ACE inhibitor, is a first-line treatment for hypertension due to its effectiveness and safety profile, making it a common choice for initial therapy.
C. Doxazosin is an alpha-1 blocker that can be used for hypertension but is not typically a first-line treatment due to the risk of side effects like hypotension.
D. Clonidine is a central alpha agonist used in certain situations for hypertension but is not considered a first-line therapy due to potential adverse effects and sedation.