PRESENTED BY-VINU VARGHESE KIRIYANTHAN2ND YEAR BSc.
Definition:A route of administration is the path by which a drug,fluid, poison or other substance is brought intocontact with the body.
Medications are available in a variety of forms andpreparations The form of the medication will determine itsroute of administration Composition of medicine is designed to enhanceits absorption & metabolism Many medications are available in several forms
• Check the “10 rights”• Standard Precautions: Wash your hands!• Double-check if unsure about anything• Check for drug allergies• Prepare drugs for one patient at a time• Check three times
• Check expiration dates• Check the patient’s identification• Give medications on time• Explain medications to the patient• Open the medications at the bedside• Document the medications given before going to the nextpatient
• A drug’s route of administration affects the rate andextent of absorption of that drug• Route can be broadly divided into:– Enteral (GI tract)– Parenteral– Topical
• It is the most common oldest and safe route• Drug is absorbed into the systemic circulation throughthe oral or gastric mucosa, the small intestine, orrectum– Oral– Sublingual– Buccal– Rectal
ADVANTAGES Safest route Most convenient Self administrable Non invasive route
DISADVANTAGES Slow onset Some may be irritant and unpalatable Some may not absorb Irritation may induce vomiting Irregularities in absorption Cannot gave to unconscious patients Some may undergo extensive first pass effect in liver
- The first pass effect is the term used for the hepaticmetabolism of a pharmacological agent when it isabsorbed from the gut and delivered to the liver via theportal circulation.- The greater the first pass effect, the lower thebioavailability of the drug(the rate and extent of thedrug reaching systemic circulation).
- By swallowing.- It is intended for systemic effects resulting from drug absorptionthrough the various epithelia and mucosa of the gastrointestinaltract.
These are tablets coated with substance like celluloseacetate, phthalate, gluten etc. which are not digestedby the gastric acid but get disintegrated in the alkalinejuices of the intestine
Some drugs are taken as smaller tablets which areheld in the mouth (buccal tablet) or under thetongue (sublingual tablet). Buccal tablets are often harder tablets [4 hourdisintegration time], designed to dissolve slowly. E.g Nitroglycerin, as a softer sublingual tablet [2min disintegration time], may be used for therapid relief of angina.
Route of administration other than the enteral routeare known as parenteral route. Drugs are directly delivered into tissue fluid or blood. It includes:injectionsinhalationstransdermal routetransmucosal route
ADVANTAGES Action is rapid Administered even in unconscious patients Gastric irritant can be given parenterally Used in patients who are unable to swallow
DISADVANTAGES Asepsis must be maintained Injection may be painful more expensive, less safe and inconvenient Injury to nerve may occur
• Intradermal• Subcutaneous• Intramuscular• Intravenous• Intraperitoneal• Intrathecal• Intraarticular• Intra arterial• Intra medullary
• Intradermal into the dermal layer of the skin• Subcutaneous into the subcutaneous layer of the skin• Intramuscular into the muscle• Intravenous (fastest delivery into the bloodcirculation) into the vein• Intraperitoneal into the peritoneum
• Intrathecal into the subarachnoid space (used foranesthesia)• Intraarticular into a joint Intra arterial into arteries Intra medullary into bone marrow
Drug is injected into the layers of skin by;• Raising a bleb. Eg, BCG vaccine test for allergy• by multiplying punctures of epidermis through a dropof drug, eg, smallpox vaccineonly a small dose can be administered and itmay be painful
Drug can be administered subcutaneously as ;1, dermojet2, pellet implantation3, sialistic implants
Injecting medication into large skeletal muscledeltoid, gluteus or rectus femoris
SITES OF INTRAMUSCULAR INJECTIONS– Ventrogluteal site (preferred)– Vastus lateralis site– Dorsogluteal site– Deltoid site
Advantagessuitable for injection of drug in aqueous solution(rapid action) and drug in suspension or emulsion(sustained release).DisadvantagesPain at injection sites for certain drugs.
- Placing a drug directly into blood stream.- -May be - Intravenous (into a vein)- intraarterial (into an artery).
DRUGS CAN BE GIVEN IV AS;1, bolus2, slowly3, slow infusion…
Advantagesprecise, accurate and immediate onset of action,100% bioavailability.Disadvantagesrisk of embolism.high concentrations attained rapidly leading togreater risk of adverse effects.
ADMINISRATION OF IV FLUIDS Maintain strict asepsis Port of iv line flushed with saline before infusion Watch for sign of extravascation Make sure that there are no air bubbles Carry a sterile container to place components while ivcannulisation
(infusion or injection into the peritoneum) e.g.peritoneal dialysis in case of renal insuffeciency
Drug injected into the spinal canal) is mostcommonly used for spinal anesthesia .
Drugs injected directly into joint for treating arthritis& other diseases of joint
Highly lipid solubledrug can be applied overskin for slow andprolonged absorptionEg, nitroglycerineointment in anginapectoris• Administeringmedications to the skin– Lotions, creams,ointments, powders– Transdermal patches
Used for gaseous and volatile agents and aerosols..AdvantagesA- Large surface areaB- thin membranes separatealveoli from circulationC- high blood flow-As result of that a rapid onsetof action due to rapid access tocirculation
.Disadvantages1- Most addictive route ofadministration because it hitsthe brain so quickly.2- Difficulties in regulating theexact amount of dosage.3- Sometimes patient havingdifficulties in givingthemselves a drug by inhaler
• RECTAL DRUGS• Most commonly by suppository or enema.Advantages By-pass liver - Some of the veins draining the rectumlead directly to the general circulation, thus by-passingthe liver. Reduced first-pass effect. Useful - This route may be most useful for patientsunable to take drugs orally (unconscious patients) orwith younger children. if patient is nauseous orvomiting
• RECTAL DRUGS• Most commonly bysuppository or enema.DisadvantagesErratic absorption -Absorption is often incompleteand erratic.Not well accepted
Ensure that correct drug is administered by right routeand in the right dose History of allergy should be taken particularly beforeparenteral administration of drugs Monitor the adverse effects Drugs should be kept in a safe place Check the prescription, drug label and the patientsname before the administration of drugs