The nurse is preparing to administer a sublingual nitroglycerin tablet. With regard to the first-pass effect, the nurse understands that:
1. The first-pass effect will decrease the drug's effectiveness by one-third.
2. Drugs given sublingually are subject to the first-pass effect.
3. The first-pass effect will neutralize this drug's effect.
4. Drugs given sublingually bypass the first-pass effect.
Correct Answer: 4
Rationale 1: Drugs given by the buccal, sublingual, or rectal routes bypass the first-pass effect of the liver.
Rationale 2: Drugs given by the buccal, sublingual, or rectal routes bypass the first-pass effect of the liver because the venous supply of the head and lower rectum is not part of the hepatic portal system.
Rationale 3: Drugs given by the buccal, sublingual, or rectal routes bypass the first-pass effect of the liver.
Rationale 4: Drugs given by the buccal, sublingual, or rectal routes bypass the first-pass effect of the liver because the venous supply of the head and lower rectum is not part of the hepatic portal system.
Global Rationale: The venous systems serving the head and the lower rectum are not parts of the hepatic portal system. Thus, drugs that are given by the buccal, sublingual, or rectal routes bypass the first-pass effect of the liver.
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