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 B
Explanation
A. Daily weight monitoring is not specifically indicated for doxazosin, and significant weight loss is typically not a primary concern with this medication.
B. Doxazosin can cause first-dose hypotension, leading to dizziness; thus, the client should be advised to lie down after the initial dose to minimize this risk.
C. Increasing potassium intake is not necessary with doxazosin; there are no direct interactions that would warrant dietary changes regarding potassium.
D. Impaired taste is not a commonly reported side effect of doxazosin; this statement is misleading and not relevant to the medication's profile.
Correct Answer is C
Explanation
A. Asking what the usual pill looks like may not provide clarity and does not address the client's concern directly.
B. While the statement is accurate, it does not provide the client with reassurance or address the reason for the difference in appearance.
C. This response acknowledges the client's concern, offers an explanation about variations in medication appearance due to different manufacturers, and reassures the client that it is the same medication prescribed.
D. Suggesting that the pill is from a different lot number does not address the fact that variations in appearance can occur due to different manufacturers, which is more common and relevant to the situation.