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?

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.

A. Transdermal patch:
A transdermal patch provides a slow, continuous release of medication over a period of time. While it is useful for long-term management of conditions, it does not provide the rapid onset needed for acute situations. The medication gradually enters the bloodstream through the skin, making it less effective for immediate relief.

B. Topical ointment:
Topical ointments are applied to the skin and are absorbed locally at the site of application. They are not designed for rapid systemic absorption and typically have a slower onset compared to other routes like sublingual or intravenous.

C. Suspended-release:
Suspended-release formulations are designed for controlled, extended-release of medication over time. These are not intended for rapid onset but rather for maintaining therapeutic levels of the medication over an extended period. They are suitable for long-term treatment rather than immediate relief.

D. Sublingual:
Sublingual administration (under the tongue) provides the most rapid onset for nitroglycerin. This route allows the medication to be absorbed directly into the bloodstream through the mucous membranes in the mouth, bypassing the gastrointestinal tract and first-pass metabolism in the liver. This results in a quick therapeutic effect, which is crucial for managing acute angina attacks.