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. A history of hypertension is not a direct contraindication for propofol, although it should be monitored as part of overall management.
B. Benzodiazepine abuse/dependence does not contraindicate the use of propofol but may require careful assessment of sedation and anesthesia needs.
C. Propofol contains soy lecithin and egg phosphatide, making allergies to these products a significant contraindication, as they can lead to severe allergic reactions.
D. An allergy to latex is not a contraindication for propofol use but should be addressed in the overall anesthesia plan regarding equipment and supplies.
Correct Answer is A
Explanation
A. Asthma is a contraindication for cholinergic medications because these drugs can cause bronchoconstriction and may exacerbate respiratory conditions. Careful assessment is necessary before administration to ensure safety.
B. Hypertension is not a direct contraindication for cholinergic medications; they may not significantly affect blood pressure in most cases.
C. Alzheimer's disease is not a contraindication for cholinergic medications; in fact, cholinergic agents may be used to improve cognitive function in some patients with dementia.
D. Diarrhea is not a contraindication for cholinergic medications but may indicate excessive cholinergic activity; it should be monitored, but it does not prevent administration.