A nurse is reviewing discharge instructions with a patient. The patient asks the nurse why the oral dose of the opioid is so much higher than the intravenous dose he has been receiving. The nurse's best response would be
a. "Only a maintenance dose of the medication is required. Your body already has built up the medication from its intravenous administration."
b. "The oral form of the drug passes through the liver and is then metabolized prior to obtaining the desired effect."
c. "Opiates are subject to being acid labile and destroyed in the gut, so the dose required is higher."
d. "The doses should be the same. The prescriber must think that your pain is not well controlled."
ANS: B
The oral dose is delivered enterally and is subject to the first-pass effect, therefore a higher oral dosage is required compared with the intravenous dose.
Dosing for morphine sulfate is not determined by previous intravenous usage.
Opiates are not acid labile and are not destroyed in the gut.
The intravenous dose of morphine sulfate is significantly lower than the dose for oral administration.
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