Author Question: Two nurses are discussing drugs that are affected by the first-pass effect. The nurses understand ... (Read 202 times)

crobinson2013 · **on:** Jul 23, 2018

Two nurses are discussing drugs that are affected by the first-pass effect. The nurses understand that a prime example of a drug affected by the first-pass effect is _____ given _____.

a. morphine; intravenously
b. nitroglycerin; sublingually
c. insulin; sublingually
d. nitroglycerin; orally

Question 2

A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information?

a. By reducing inflammation, this drug will slow the progression of your disease.
b. Glucocorticoids are used as adjunctive therapy during acute flare-ups.
c. Oral glucocorticoids cause less toxicity than intra-articular injections.
d. You may resume running when the pain and swelling improve.

tanna.moeller · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

D
Nitroglycerin given orally is subject to the first-pass effect because most of it is destroyed by the liver; therefore, this medication should not be given orally.
An intravenous medication cannot be subject to the first-pass effect.
Nitroglycerin given sublingually is not subject to the first-pass effect, therefore the most effective route for administration of nitroglycerin is the sublingual route.
A drug given sublingually is not subject to the first-pass effect.

DIF: Cognitive Level: Application REF: p. 39
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

Answer to Question 2

B
Glucocorticoids are used as adjunctive therapy to treat acute exacerbations of rheumatoid arthri-tis. Glucocorticoids reduce pain and inflammation but do not alter the course of the disease. Oral glucocorticoids produce side effects similar to those of all glucocorticoids, but they are absorbed more rapidly and completely than intra-articular injections. Patients should be warned against overactivity even though their pain has been reduced, because they can further injure their joints.