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 A
Explanation
A. Oxymetazoline should not be used for more than 3 days because prolonged use can lead to rebound congestion.
B. Oxymetazoline typically does not cause drowsiness, so taking it at bedtime is not necessary.
C. Oxymetazoline has a rapid onset and should not take a week to show effects.
D. Oxymetazoline is a nasal decongestant and is not used for asthma management.
Correct Answer is C
Explanation
A. Morphine is a category C medication, which means it may be used if the benefits outweigh the risks; it is not contraindicated in pregnancy.
B. Famotidine (Pepcid) is also a category B medication and is generally considered safe to use during pregnancy.
C. Misoprostol (Cytotec) is classified as category X due to its association with causing uterine contractions and the potential for fetal harm; thus, it should be avoided during pregnancy.
D. Ibuprofen (Advil) is a category C medication, and while it is not typically recommended in the third trimester, it is not classified as category X.