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. Paroxetine is an SSRI antidepressant used for depression and anxiety disorders, not for Parkinson's Disease.
B. Lisinopril is an ACE inhibitor primarily used for hypertension and heart failure, and it does not address symptoms of Parkinson's Disease.
C. Risperidone is an atypical antipsychotic that may be used in some cases for behavioral symptoms but is not a primary treatment for Parkinson's Disease.
D. Levodopa (Inbrija) is a medication specifically indicated for the management of Parkinson's Disease, as it helps to replenish dopamine levels, alleviating motor symptoms associated with the disease.
Correct Answer is B
Explanation
A. Diarrhea is not a direct risk of stopping TPN abruptly.
B. Abruptly stopping TPN can cause hypoglycemia because the high glucose content in TPN leads to increased insulin production. Without the continuous glucose infusion, blood sugar levels can drop rapidly.
C. Hypovolemia is not a common outcome from stopping TPN suddenly.
D. Erythema at the site is unrelated to the cessation of TPN and more commonly related to local site reactions or infection.