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":{"answers":"C"},"B":{"answers":"D"},"C":{"answers":"A"},"D":{"answers":"B"}}

Explanation

Naloxone is an opioid antagonist and is used to reverse opioid overdoses.

Flumazenil is a benzodiazepine antagonist and can reverse the effects of benzodiazepines.

Glucagon can be used to treat beta-blocker overdose by increasing heart rate and blood pressure.

Acetylcysteine acts as an antidote for acetaminophen toxicity by replenishing glutathione levels to enhance non-toxic metabolism of acetaminophen.

A. Parenteral medications are avoided due to fragility of veins. B. Older adults are at risk for drug toxicity due to accumulation in the body. C. The elderly population is susceptible to polypharmacy D. Medication metabolism tends to be faster in older adults. E. Older adults have delayed absorption. F. Older adults may require larger doses of medications.

Correct Answer is ["B","C","E"]

Explanation

A) Parenteral medications are avoided due to fragility of veins: While it is true that older adults may have fragile veins, this does not mean that parenteral medications are universally avoided. Parenteral medications are still used based on clinical needs, though careful consideration is given to the condition of the veins.

B) Older adults are at risk for drug toxicity due to accumulation in the body: This is correct. As people age, their liver and kidney functions often decline, leading to decreased metabolism and excretion of drugs. This can result in drug accumulation and an increased risk of toxicity.

C) The elderly population is susceptible to polypharmacy: This is correct. Older adults often take multiple medications for various chronic conditions, increasing the risk of drug interactions, side effects, and complications. Polypharmacy is a common issue in this population.

D) Medication metabolism tends to be faster in older adults: This is incorrect. Medication metabolism generally slows down in older adults due to decreased liver function. Slower metabolism can lead to drug accumulation and increased risk of adverse effects.

E) Older adults have delayed absorption: This is correct. Although the rate of absorption may not be significantly affected, the overall absorption can be altered due to changes in gastrointestinal function and blood flow in older adults.

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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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Explanation

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