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Medication/ Medication Administration Part 2

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Lecture Objective Describe the various techniques of drug administration.

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Definition: A route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body.

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ROUTES OF DRUG ADMINISTRATION ENTERAL ROUTE PARENTERAL ROUTE TOPICAL ROUTE INHALATION ROUTE

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ENTERALORALRECTALBUCCALSUBLINGUAL

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Administration of oral medication Definition: Drugs given by the oral or gastric route are absorbed into the bloodstream through the gastric or intestinal mucosa. Usually the patient swallows the drug. Forms of oral medications: Tablets. Capsules. Liquid drugs like syrup Also available as powder, granules or oil.

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ORAL Advantages Convenient - can be self- administered, pain free, easy to take Absorption - takes place along the whole length of the GI tract Cheap - compared to most other parenteral routes

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ORAL Disadvantages Sometimes inefficient - only part of the drug may be absorbed First-pass effect - drugs absorbed orally are initially transported to the liver via the portal vein irritation to gastric mucosa - nausea and vomiting

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ORAL Disadvantages cont. destruction of drugs by gastric acid and digestive juices effect too slow for emergencies unpleasant taste of some drugs unable to use in unconscious patient

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SUBLINGUAL ROUTE Sublingual administration is where the dosage form is placed under the tongue rapidly absorbed by sublingual mucosa

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SUBLINGUAL ROUTE ADVANTAGES Economical Quick termination First-Pass avoided Drug absorption is quick DISADVANTAGES Unpalatable & bitter drugs Irritation of oral mucosa Large quantities not given Few drugs are absorbed 12

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BUCCAL ROUTE Buccal administration is where the dosage form is placed between gums and inner lining of the cheek (buccal pouch) absorbed by buccal mucosa

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BUCCAL ROUTE ADVANTAGES Avoid first pass effect Rapid absorption Drug stability DISADVANTAGES Inconvenience advantages lost if swallowed Small dose limit - unpleasant taste of some drugs

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RECTAL ROUTE ADVANTAGES USED IN CHILDREN LITTLE OR NO FIRST PASS EFFECT USED IN VOMITING/UNCONSCIOUS HIGHER CONCENTRATIONS RAPIDLY ACHIEVED DISADVANTAGES INCONVENIENT IRRITATION OR INFLAMMATION OF RECTAL MUCOSA CAN OCCUR Erratic absorption 15

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RECTAL DRUGS: Most commonly by suppository or enema. Con

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Giving Medication Through an NG Tube Holding the nasogastric (NG) tube at a level some what above the patient's nose, pour the diluted medication into the syringe barrel. Hold the at a slight angle and add more medication before the syringe empties. rise the tube slightly higher to increase the flow rate.

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Continue Giving Medication Through an NG Tube Give medications separately and flush with water between each drug. After you've delivered the whole dose, position the patient on her/ his side, head slightly elevated.

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SYSTEMIC-PARENTERAL Parenteral administration is injection or infusion by means of a needle or catheter inserted into the body The term parenteral comes from Greek words para, meaning outside enteron, meaning the intestine This route of administration bypasses the alimentary canal

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ADVANTAGES Action is rapid Administered even in unconscious patients Gastric irritant can be avoided parenterally Used in patients who are unable to swallow Parenteral Route (cont)

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DISADVANTAGES Asepsis must be maintained Injection may be painful more expensive, less safe and inconvenient Injury to nerve may occur Parenteral Route (cont)

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Injections Intradermal Subcutaneous Intramuscular Intravenous Intraperitoneal Intrathecal Intraarticular Intra arterial Intra medullary

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Injections 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 blood circulation) into the vein Intraperitoneal into the peritoneum

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Injections Intrathecal into the subarachnoid space (used for anesthesia) Intraarticular into a joint Intra arterial into arteries Intra medullary into bone marrow

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Kinds of Parenteral Drug Containers Glass ampules Single and multidose vials syringes Intravenous medication fluids

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Ampules Vials Ampules and Vials

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Syringes and Needles SyringeHypodermic needle

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Intradermal Injection

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Intradermal Administration Used for diagnostic purposes such as (tuberculin test, to determine sensitivity to various substances) Site: inner forearm (may use back and upper chest) drug is given within skin layers (dermis) Painful Volume: 0. 1-0.5 ml Equipment: (1ml, 25-27g, or inch needle). Administration angle: 10-15

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Subcutaneous Injection

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Subcutaneous Administration Administered into subcutaneous tissue that lies between the skin and the muscle. Common subcutaneous injections are heparin, insulin and certain immunization. Volume: no more than 1ml Equipment: Insulin syringe (25-30g, to inch needle). Administration Angle: 45 or 90

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SITES OF SUBCUTANEOUS INJECTION Upper ventral or dorsogluteal Anterior aspect of thigh Abdomen and upper back Outer aspect of the upper arm Subcutaneous injections

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Intramuscular Injection

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Intramuscular Administration Administered into a muscle or muscle group Volume: no more than 5ml into single site for an adult with will developed muscles. Equipment: 1-5 ml syringe, needle (18-23 g, to 3 inch needle). Administration angle: 90

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Intramuscular SITES OF INTRAMUSCULAR INJECTIONS Ventrogluteal site Vastus lateralis site Dorsogluteal site(should not to be used for children younger than 3 years) Deltoid site

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36 Intramuscular Injection Sites Photo Source: Lippincott, Williams & Wilkins, Connection, Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp

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Intramuscular Advantages suitable for injection of drug in aqueous solution (rapid action) and drug in suspension or emulsion (sustained release). Disadvantages Pain at injection sites for certain drugs.

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Deltoid Injection Site

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Intramuscular Administration Vastus Lateralis

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Intramuscular Administration VentroGluteal

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Intramuscular Administration DorsoGluteal Most dangerous site because of sciatic nerve location

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Z-track IM Administration Method used to prevent seepage of medication into the needle track and to reduce pain and discomfort. e.g; Iron Used to trap medication in muscle and prevent tracking of solution through tissues. Equipment: needle at least 1.5 in

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43 Intramuscular Administration Pull skin away from site to displace tissue Inject medication Dont massage after injection Photo Source: Lippincott, Williams & Wilkins, Connection, Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp Z-Track For solutions irritating to the tissues.

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Z-Track

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Pediatric IM Injection Thigh is preferred site in pediatric Especially used in infants and young toddlers Large muscle mass No proximal nerves or blood vessels Limited subcutaneous fat layer More developed muscle than other sites Can accommodate larger volumes than other pediatric injection sites

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When to Aspirate (IM & SC injection) The reason for aspiration before injection a medication is to ensure that the needle is not in a blood vessel. If blood appears in the syringe, withdraw the needle, discard the syringe, and prepare a new injection.

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When Not To Aspirate When administering SC heparin/ insulin, it is recommended that you do NOT aspirate. Because of the anticoagulant properties of heparin, aspiration could damage surrounding tissue and cause bleeding and bursting. Insulin needle is so small.

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48 Intravenous Administration (IV) Involves injection of drugs directly into bloodstream Drugs act rapidly DRUGS CAN BE GIVEN IV AS; 1, bolus 2, infusion (intermittent or continuous infusions)

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49 Intravenous Administration (continued) Disadvantages: Time and skill required for venapuncture Difficulty in maintaining an IV line Greater potential for adverse reactions Possible complications of IV therapy,e.g. Infiltration, Phlebitis, Cellulitis, Septicemia, Pulmonary edema and air embolism-

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Con

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51 Intravenous devices e.g. - Piggyback (IVPB). - Volume control administration set. - Mini- infusion pump.

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Intravenous Mini- infusion pump

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Main Veins of the Arm

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Topical Routes of Administration Topical administration is the application of a drug directly to the body site. Action: local or systemic. Includes administration of drugs to any mucous membrane eye vagina nose urethra ears colon lungs

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Topical Dosage Forms Dose forms for topical administration include: Skin: creams ointments lotions gels transdermal patches disks Eye or ear: solutions suspensions ointments Nose and lungs: sprays and powders

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This involves applying to the skin disk or patch that contains medication intended for daily use or for longer intervals. Transdermal patches are commonly used to deliver hormones and narcotic analgesics. Transdermal Route

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absorption of drug through skin (systemic action) i. stable blood levels ii. no first pass metabolism

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EAR (OTIC) INSTILLATION Definition: Instill liquid medication into external auditory canal for such therapeutic effects.Purpose: To treat infection and inflammation. To soften cerumen for removal. To produce local anesthesia. To aid in removal of foreign body trapped in the ear.

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Positioning The Client For Eardrop Instillation Before instilling eardrops, have the client lie on his or her side. Then straighten the ear canal to help the medication reach the eardrum. For adult, gently pull the auricle up and back. For young child and infant, gently pull down and back

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ADMINISTERING OPHTHALMIC MEDICATIONS Definition: Medications are instilled in mucous membranes of eye for various therapeutic effects. Purpose: To treat infection. To treat infection. To relieve inflammation. To relieve inflammation. To treat eye disorders such as glaucoma. To treat eye disorders such as glaucoma. To diagnose such as foreign bodies and corneal abrasions. To diagnose such as foreign bodies and corneal abrasions.

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Instill eye drops 1. Rt. = O.D.,Lt. = O.S. and both = O.U.

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Administering Medications by Inhalation Advantages A- Large surface area B- thin membranes separate alveoli from circulation C- high blood flow - As result of that a rapid onset of action due to rapid access to circulation

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. Inhalation route Disadvantages 1- Most addictive route of administration because it hits the brain so quickly. 2- Difficulties in regulating the exact amount of dosage. 3- Sometimes patients having difficulties in giving themselves a drug by inhaler.

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Con Drugs for inhalation may be administered by: a nebulizer. Metered-dose inhaler.

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Small volume nebulizer

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Nebulizer with attached face mask, bag- valve mask, and endotracheal tube

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