Considering The First Pass Effect is the metabolisation of a drug which is absorbed in the GI tract being brake down in the liver and transported to the vascular system through the vein into the body, this means 1/3 of the drug is lost in the liver and the body wont experience the full effect of the drug.

Methadone has an extensive first pass metabolism as it is a lipid soluble opioid absorbed from the GI tract, bound to albumin and other plasma proteins and to lipoproteins resulting in a higher concentration in the lung, liver and kidneys than in the blood = slow transfer between some parts of this tissue reservoir and the plasma. 

Oral methadone is the most common way of administering by using tablets, soluble tablets, and oral solutions. However, some patient may not be able to tolerate oral methadone.  

Methadone can also be given rectal (PR) to the patient as an alternative to intravenous (IV) or oral in cancer pain. Giving Methadone PR is quickly absorbed and long lasting. 

·  Distribution in fat: Evidence shows that it is highly lipophilic, so it is probably localised in the fat, and the distribution of drug in fat is very essential for highly lipid soluble drugs such as nitro-glycerine. For this reason, it becomes a factor that affect the distribution of the drug in the body. E.g. the effect of nitro-glycerine has a quick effect in the body but comes down because the drug is distributed to fat and no longer active. This is also called redistribution of drugs

· Because it undergoes an extensive first pass metabolism in the liver, therapeutic levels in the plasma are never achieved (Therapeutic range is the levels of the drug in the blood). Also, this is supported by some clinical studies done on animals such as rats.

·         Patient may no longer need the medication

·         Not taken correctly 

·         Improve medicine safety 

·         Check what you have before ordering more

·         Being reviewed regularly 

 

 

Activity 2

·         Polypharmacy is most common in elderly patient to many co-morbidities

 

·         It can also happen when patients get dependant on medication, for example, using an opioid regular for pain

 

Activity 1

Common reactions to medication include:

·         Cough

·         Nausea

·         Diarrhoea 

·         Headaches 

 

Acceptable side effects include:

·         Dizziness

·         Nausea 

·         Heartburn

·         Fatigue 

·         Constipation 

·         Bloating 

·         Stomach upset

·         Skin irritation

 

Nurses role 

 

·         Giving medication to reverse the side effect

·         Managing side effects

·         Educate the patient around what to look for if they are experiencing a side effect 

Patient vomiting 

Activity 2

·         Administer an anti-emetic if prescribed

·         Monitor and change medication if necessary

 

Activity 1

Symptoms of anaptyxis:

 

·         Difficulty breathing

·         Affects the heart rhythm or blood pressure 

 

Activity 2

Airway- persistent cough, vocal changes (hoarse voice), difficulty in swallowing, swollen tongue

Breathing- difficult or noisy breathing, wheezing (like an asthma attack)

Circulation- feeling lightheaded or faint, clammy skin, confusion, unresponsive/unconscious due to drop in blood pressure. 

Disability- impending doom, anxiety, and panic

Exposure- skin changes, rashes and swelling