A nurse is providing education about the various routes of ...

[formula1]

A nurse is providing education about the various routes of nitroglycerin (NTG). The nurse correctly states that sublingual NTG can be used in lower dosages than drugs given by other routes, because it
 
  a. is not directly absorbed into the bloodstream.
  b. bypasses the liver.
  c. is 100 times more potent.
  d. is acid labile.

Question 2

Prior to discharge, the nurse is reviewing the medications of a patient with diabetes. The nurse realizes that he will be going home on colesevelam, a bile acid sequestrant, and insulin.
 
  What patient education should the nurse provide in the discharge teaching for this patient?
  a. The patient needs to monitor his blood sugar carefully, because colesevelam can cause hypoglycemia.
  b. The patient needs to monitor his blood sugar carefully, because colesevelam can cause hyperglycemia.
  c. The patient needs to take his insulin at least 3 hours before the colesevelam.
  d. The patient needs to use an oral antidiabetic agent or agents, not insulin, with colesevelam.

[joshraies]

Answer to Question 1

ANS: B
Sublingual (SL) medications are not subject to the first-pass effect of the liver. Oral (PO) nitroglycerin, on the other hand, undergoes rapid inactivation by hepatic enzymes.
SL nitroglycerin is directly absorbed into the bloodstream.
SL nitroglycerin is not 100 times higher than the PO dose; however, it is immediately available to the system, because it is not broken down by the liver.
SL nitroglycerin is not acid labile; it is not even exposed to the gut.

Answer to Question 2

ANS: A
Colesevelam can help control hyperglycemia in patients with diabetes, therefore hypoglycemia is a possible risk.
Hyperglycemia is not a risk for patients with diabetes who take colesevelam.
Insulin and colesevelam do not interact, therefore the insulin can be taken at the patient's preferred time or times.
Either insulin or oral antidiabetic agents can be taken with colesevelam.

[formula1]

TYSM

[rleezy04]

Excellent