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?

A. Category A:
Medications classified as Category A are considered the safest during pregnancy. They have been well-studied in pregnant humans, and no risk to the fetus has been demonstrated. This classification means that adequate and well-controlled studies have shown no evidence of harm to the fetus in the first trimester and no risk in later trimesters.

B. Category C:
Category C medications have shown potential risks to the fetus in animal studies, and there are no well-controlled studies in humans. The benefits of the medication may outweigh the potential risks, but caution is advised. These medications are used when the potential benefits justify the potential risks to the fetus.

C. Category X:
Category X medications are contraindicated in pregnancy due to evidence of fetal abnormalities or risks that outweigh any potential benefits. These medications have demonstrated clear evidence of harm to the fetus in both human and animal studies, and their use is not recommended during pregnancy.

D. Category B:
Category B medications have shown no risk to animal fetuses, but there is a lack of adequate and well-controlled studies in pregnant humans. The absence of evidence of harm in animal studies suggests that these drugs are generally considered safe, though their effects on human fetuses are not well-documented.

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.