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.)

Nitroglycerin 10mg Sublingual Tablet

Morphine 2mg IV (Intravenously)

Famotidine 10mg Tablet

Nitroglycerin 4mg Sublingual Tablet

Acetaminophen 325mg Capsule

Diphenhydramine (Benadryl) 25mg Tablet

Answer and Explanation

Correct Answer : C,E,F

A. Nitroglycerin 10mg Sublingual Tablet:
Nitroglycerin taken sublingually (under the tongue) bypasses the gastrointestinal tract and the liver’s first-pass metabolism. It is designed to act quickly and directly enter the bloodstream through the mucous membranes, avoiding significant first-pass effect.

B. Morphine 2mg IV (Intravenously):
Morphine administered intravenously bypasses the gastrointestinal tract and liver, thus avoiding the first-pass effect entirely. The drug directly enters systemic circulation, providing immediate effect.

C. Famotidine 10mg Tablet:
Famotidine, when taken orally, undergoes significant first-pass metabolism. This means that a portion of the drug is metabolized by the liver before it reaches systemic circulation, affecting its bioavailability.

D. Nitroglycerin 4mg Sublingual Tablet:
Similar to the 10mg sublingual tablet, nitroglycerin administered sublingually bypasses the first-pass effect. The medication enters the bloodstream directly through the mucous membranes in the mouth.

E. Acetaminophen 325mg Capsule:
Acetaminophen, when taken orally, undergoes first-pass metabolism. A significant portion of the drug is metabolized in the liver before reaching systemic circulation, which can impact its overall effectiveness.

F. Diphenhydramine (Benadryl) 25mg Tablet:
Diphenhydramine, taken orally, is also affected by the first-pass effect. As with other oral medications, a part of the drug is metabolized by the liver before reaching systemic circulation, which can affect its efficacy and bioavailability.

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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.

Correct Answer is ["13.3"]

Explanation

Let's calculate the dosage step-by-step:

1. Determine the total daily dosage:
20 mg/dose x 4 doses/day = 80 mg/day

2. Calculate the volume needed for one dose:
20 mg / 1.5 mg/mL = 13.33 mL

3. Round to the nearest tenth:
13.33 L ≈ 13.3 mL

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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.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for an older adult client. The nurse should recognize that which of the following considerations apply to older adults and pharmacology? (Select all that apply).

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

Explanation

The healthcare provider orders Ceftriaxone 20 mg IV every 6 hours. The instructions say to reconstitute 10 mg of Ceftriaxone with 6.5 ml of normal saline for a final concentration of 5 mg/ml. How many mL would the nurse administer? (Round to the nearest tenth)

Correct Answer is ["13.3"]

Explanation

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