The nurse is preparing to administer medications to a 54-year-old client. Which medications taken would be affected by the first-pass effect? (Select All that Apply.)
Morphine 2mg IV (Intravenously)
Diphenhydramine (Benadryl) 25mg Tablet
Famotidine 10mg Tablet
Nitroglycerin 4mg Sublingual Tablet
Nitroglycerin 10mg Sublingual Tablet
Acetaminophen 325mg Capsule
Correct Answer : B,C,F
A. Morphine administered intravenously bypasses the gastrointestinal tract and liver, avoiding the first-pass effect entirely.
B. Diphenhydramine in tablet form is absorbed through the gastrointestinal tract and undergoes significant first-pass metabolism in the liver, affecting its bioavailability.
C. Famotidine in tablet form is also subject to first-pass metabolism, which can reduce its effectiveness.
D. Nitroglycerin sublingual tablets are designed to bypass the first-pass metabolism by being absorbed directly into the bloodstream through the mucous membranes.
E. The same applies to nitroglycerin 10mg sublingual tablets; they also avoid the first-pass effect due to sublingual administration.
F. Acetaminophen is taken orally and undergoes first-pass metabolism in the liver, which can significantly affect its overall bioavailability.
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Correct Answer is C
Explanation
A. Lithium is not considered addictive in the traditional sense, and it does not need to be discontinued after six months unless clinically indicated.
B. Diuretics are generally avoided in patients taking lithium due to the risk of lithium toxicity from altered renal clearance, rather than being a routine prescription for difficulty urinating.
C. Close monitoring of lithium levels is crucial to avoid toxicity and ensure therapeutic efficacy, making this statement correct and essential for the patient’s education.
D. While weight gain can occur with lithium therapy, it is not an indicator of lithium toxicity; symptoms of toxicity include nausea, tremors, and confusion rather than weight gain.
Correct Answer is D
Explanation
A. Ciprofloxacin is an antibiotic used to treat bacterial infections and is not effective against parasitic infections such as pinworms.
B. Zidovudine is an antiretroviral medication used primarily for HIV treatment and does not target pinworms.
C. Ketoconazole is an antifungal medication that is not indicated for treating pinworm infections.
D. Mebendazole is an anthelmintic medication specifically used to treat pinworm infections by inhibiting the metabolism of the parasite, making it the appropriate choice for this client.