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. LABAs can help prevent asthma attacks, including those triggered by exercise, so this statement is accurate and does not indicate a need for further education.
B. LABAs may cause side effects like an increased heart rate, which the client correctly recognizes.
C. LABAs are not intended for immediate relief of asthma symptoms; they are for long-term control. A short-acting beta2-agonist (SABA) should be used for acute symptoms, indicating this client needs further education.
D. Over time, tolerance can develop with some medications, and this understanding is accurate, so it does not indicate a need for additional teaching.
Correct Answer is D
Explanation
A. Epinephrine is primarily used for anaphylaxis and severe asthma attacks; it is not effective in reversing opioid overdose.
B. Protamine is an antidote for heparin, not for opioid overdose.
C. Flumazenil is a benzodiazepine antagonist and is not indicated for opioid overdose; it can potentially precipitate seizures in patients with mixed drug overdoses.
D. Naloxone is an opioid antagonist specifically indicated for reversing the effects of opioid overdose, including respiratory depression, making it the appropriate choice in this scenario.