Question

While reviewing discharge instructions, a patient asks the nurse why the oral dose of the opioid is so much higher than the IV dose was. Select the nurse's best response.

Select one:
a. "When patients go home, they need higher doses of medication."
b. "The oral form of the drug passes through the liver, and a lot is metabolized before it can achieve the effect."
c. "When the physician converted the dosages, there was an error in calculation."
d. "The doses should be the same. The physician must think that your pain is not well controlled."

Answer 1

The nurse would explain that the oral form of the drug is metabolized by the liver, resulting in a lower effective dose compared to intravenous administration.

Step-by-step explanation:

The nurse's best response would be option b. "The oral form of the drug passes through the liver, and a lot is metabolized before it can achieve the effect." When drugs are administered orally, they are absorbed in the gastrointestinal (GI) tract and pass through the liver before they enter the bloodstream. The liver metabolizes a significant portion of the drug, which reduces the amount available to produce the desired effect. This is known as the first-pass effect. On the other hand, when drugs are administered intravenously, they bypass the GI tract and the liver, resulting in higher plasma levels compared to oral administration.

The difference in dosing routes takes into account several factors including bioavailability, metabolism, and potential side effects. For example, whereas intravenous administration leads to high plasma levels of the drug rapidly, oral administration peaks more slowly, as seen in plasma concentration graphs. Furthermore, in healthcare, the management of opioid drugs is critical due to their high potential for addiction and the ongoing opioid crisis.