A nurse reads in a drug information guide that PO morphine has a high first-pass effect. Which of the following would the nurse expect?

The drug will be more effective when given in a nonenteral route.

The drug will be most effective when given orally

The drug is excreted by the kidneys at a slower rate than most medications

The kidney will metabolize some of the drug before it reaches the blood stream

Answer and Explanation

The Correct Answer is A

A. The drug will be more effective when given in a nonenteral route:
Morphine has a high first-pass effect when taken orally, meaning that a significant amount of the drug is metabolized in the liver before it reaches systemic circulation. This reduces the amount of active drug available in the bloodstream. To avoid this extensive metabolism, morphine is often administered through nonenteral routes, such as intravenous or subcutaneous, where it bypasses the digestive system and liver first-pass metabolism, resulting in higher systemic bioavailability and effectiveness.

B. The drug will be most effective when given orally:
Due to the high first-pass effect of oral morphine, a significant portion of the drug is metabolized by the liver before it reaches systemic circulation. This means that oral morphine is often less effective compared to other routes of administration, such as intravenous, because the bioavailability of the drug is reduced.

C. The drug is excreted by the kidneys at a slower rate than most medications:
The high first-pass effect primarily affects the drug's absorption and systemic availability rather than its excretion rate. The rate at which a drug is excreted by the kidneys is generally unrelated to its first-pass effect. Morphine’s excretion is influenced by its metabolism and clearance, but not directly by the first-pass effect.

D. The kidney will metabolize some of the drug before it reaches the bloodstream:
The first-pass effect occurs primarily in the liver, not the kidneys. It involves the metabolism of the drug by the liver before it reaches systemic circulation. Therefore, this option incorrectly attributes the first-pass effect to kidney metabolism.

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Correct Answer is ["A","F"]

Explanation

A. St. John's wort 450 mg by mouth twice daily: St. John's wort is known to be a potent inducer of cytochrome P450 enzymes and can significantly reduce the effectiveness of warfarin by increasing its metabolism. This interaction can lead to subtherapeutic levels of warfarin and an increased risk of thromboembolic events.

B. Gabapentin 400 mg by mouth twice daily: While gabapentin can interact with other medications, its interactions with warfarin or St. John's wort are generally not as significant as those between warfarin and St. John's wort.

C. Aspirin 81 mg by mouth daily: Aspirin has anticoagulant properties and can have interactions with warfarin. However, the interaction with St. John's wort is less pronounced compared to the interaction between warfarin and St. John's wort.

D. Atorvastatin 80 mg by mouth daily: Atorvastatin primarily affects lipid levels and has different metabolic pathways compared to warfarin. It does not have a strong interaction with St. John's wort.

E. Lisinopril 5 mg by mouth daily: Lisinopril is an ACE inhibitor and does not have significant interactions with St. John's wort or warfarin.

F. Warfarin 5 mg by mouth daily. Warfarin is an anticoagulant that requires careful monitoring due to its interactions with various substances that can either increase the risk of bleeding or decrease its effectiveness.

G. Ginger 5 mg by mouth daily: Ginger can affect platelet function but is not as significant in interaction with warfarin as St. John's wort.

H. Valerian 10 mg by mouth daily: Valerian may have mild interactions with central nervous system depressants but does not have significant interactions with warfarin or St. John's wort.

A. Naloxone B. Flumazenil C. Protamine D. Epinephrine

Correct Answer is A

Explanation

A) Naloxone: Naloxone is an opioid antagonist used to reverse the effects of opioid overdose, including respiratory depression. Given that the client has overdosed on morphine and is exhibiting a critically low respiratory rate of 6/min, naloxone is the appropriate medication to administer to reverse the effects of morphine and restore normal breathing.

B) Flumazenil: Flumazenil is a benzodiazepine antagonist used to reverse the effects of benzodiazepine overdose. It is not effective for opioid overdoses, such as those caused by morphine.

C) Protamine: Protamine is used to reverse the effects of heparin, an anticoagulant, and is not relevant in the context of opioid overdose. It does not address the respiratory depression caused by morphine.

D) Epinephrine: Epinephrine is used in cases of anaphylaxis or severe allergic reactions and is not appropriate for reversing opioid overdose. It would not address the respiratory depression caused by morphine overdose.

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A nurse reads in a drug information guide that PO morphine has a high first-pass effect. Which of the following would the nurse expect?

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","F"]

Explanation

A nurse is caring for a client who overdosed on morphine and has a respiratory rate of 6/min. Which medication should the nurse plan to administer?

Correct Answer is A

Explanation

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