The nurse is preparing to administer 10 a.m. medications to a group of clients on a medical–surgical unit. Which medications will bypass the first-pass effect of the liver?
Standard Text: Select all that apply.
1. Topical nitroglycerin
2. Sublingual nitroglycerin
3. Rectal diazepam
4. Buccal nitroglycerin
5. IV diazepam
Correct Answer: 2,3,4
Rationale 1: Medications that are given topically do not bypass the first-pass effect of the liver.
Rationale 2: Medications that are given sublingually bypass the first-pass effect on the liver.
Rationale 3: Medications that are given rectally bypass the first-pass effect of the liver.
Rationale 4: Medications that are given buccally bypass the first-pass effect on the liver.
Rationale 5: Medications that are given intravenously do not bypass the first-pass effect of the liver.
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. Although a drug will still eventually reach the liver by the IM, IV and subcutaneous routes, it will have an opportunity to also reach its target tissue.
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