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. Hydrochlorothiazide is a thiazide diuretic that can be used for hypertension and edema but is not specifically indicated for open-angle glaucoma.
B. Furosemide is a loop diuretic used primarily for fluid overload conditions and does not have a specific role in the treatment of open-angle glaucoma.
C. Acetazolamide is a carbonic anhydrase inhibitor that reduces aqueous humor production and is specifically used to lower intraocular pressure in clients with open-angle glaucoma.
D. Spironolactone is a potassium-sparing diuretic used mainly for conditions like heart failure and hypertension, and it is not indicated for the treatment of open-angle glaucoma.