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Retired NBME 27 Answers

nbme27/Block 4/Question#48 (reveal difficulty score)
An 84-year-old woman is brought to the ...
Decreased first-pass effect ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(19)
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Increased first-pass effect would lead to an increased conversion of morphine to its metabolites and therefore a decreased morphine concentration. Increased first-pass effect occurs in states of high hepatic blood flow.

Decreased first-pass effect would lead to a decreased conversion of morphine to its metabolites and an increased morphine concentration. Hepatic blood flow and liver size both decrease in older age and as such, oral morphine may increase in concentration because of a decreased first-pass effect.

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