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 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.
Correct Answer is B
Explanation
A. Chlorpheniramine is a first-generation antihistamine and may cause sedation and other side effects due to its ability to cross the blood-brain barrier.
B. Cetirizine is a second-generation antihistamine that is less likely to cause sedation and is used to relieve symptoms of allergic rhinitis.
C. Montelukast is a leukotriene receptor antagonist, not an antihistamine, and is used for allergic rhinitis and asthma.
D. Diphenhydramine is a first-generation antihistamine known for its sedative effects and is often used for allergies but is not classified as a second-generation antihistamine.