DRUG’S ADMINISTRATION
2015
Anna Molnár
Route of administration
• The path by which a drug is taken into the body.
Route of administration
• Routes of administration are generally classified
by the location at which the substance is applied (
e.g. oral,intravenous …).
• Routes can also be classified based on where the
target of action is.
– topical (local),
– enteral (system-wide effect, but delivered through the
GI tract),
– parenteral (systemic action, but delivered by routes
other than the GI tract).
Route of administration
Topical
• epicutaneous (application onto the skin), e.g.
allergy testing, typical local anesthesia (LA)
• inhalational, e.g. asthma medications
• enema, e.g. contrast media for imaging of the
bowel
• eye drops (on the conjunctiva), e.g. antibiotics
• ear drops
• through mucous membranes in the body (LA)
Route of administration
Enteral
• Involves any part of the gastrointestinal and has
systemic effects:
– By mouth (orally), many drugs as tablets, capsules, or
drops
– By feeding tube ( drugs and enteral nutrition)
– Rectally :various drugs in suppository
Route of administration
Parenteral
• Subcutaneous (under the skin)
• Intra-muscular
• Intravenous (into a vein), e.g. many drugs, total
parenteral nutrition
• Intra-arterial (into an artery), e.g. thombolytic drugs for
treatment of embolism
• Intracerebroventricular (into cerebral ventricular system)
• Intrathecal (an injection into the spinal canal)
Route of administration
Parenteral (cont.)
• intraosseous infusion (into the bone
marrow) is, in effect, an indirect
intravenous access because the bone
marrow drains directly into the
venous system. This route is
occasionally used for drugs and
fluids in emergency medicine and
pediatrics when intravenous access
is difficult.
Choice of route
Depends on:
• Available forms of any given drug.
• Advantages and disadvantages of administration.
• Urgency (patient actual clinical situation)
• Patient preferences
Choice of route
advantages
• generally the most
convenient
• low cost
Oral
disadvantages
• Gastrointestinal tract
irritation
• Delayed effect
• Time-release
formulations, breaking the
tablets or capsules can
lead to more rapid
delivery of the drug than
intended.
Route of administration
Parenteral – Injection
• Encompasses intravenous (IV), intramuscular
(IM), and subcutaneous (SC) administration.
• Injections act rapidly, with onset of action
– in 15-30 seconds for IV,
– 10-20 minutes for IM,
– 15-30 minutes for SC.
Route of administration
Parenteral – Injection
• Advantages:
– 100% bioavailability,
– can be used for drugs that are poorly absorbed or
ineffective when given orally.
– Some drugs (e.g. anitpsychotics) can be administered
as long-acting intramuscular injections
– Ongoing IV infusions: deliver continuous medication
or fluids.
Route of administration
Parenteral – Injection
• Disadvantages:
– potential pain or discomfort for the patient,
– requirement of trained staff using aseptic techniques
for administration,
– risk of overdose,
– increased risk of side effects.
Uses of routes
• Topical or systemic purpose e.g. through
inhalation: inhalation of asthma drugs is targeted
at the airways (topical effect), whereas inhalation
of volatile anesthetics is targeted at the brain
(systemic effect).
• Identical drugs can produce different results
depending on the route of administration. (e.g.
Naloxon IV/ PO)..
Uses of routes
• In acute situations, in emergency medicine and
intensive care medicine, drugs are most often
given intravenously.
– reliable route, as in acutely ill patients the absorption
of substances from the tissues and from the digestive
tract can often be unpredictable due to altered blood
flow or bowel motility
The injections
General rules:
 Before injection the skin must be disinfected carefully
 The air must be removed from the syringe
 After an ampoule is opened, the drug most be utilized
in a short time
 When the drug is sucked out, the needle must not touch
the outside of the ampoule
 When the drug is sucked out, change the needle before
administration
 In case of powder vials the diluent is first added to the vial,
the vial is shaken and the solution is sucked into the
syringe
 The drug must be checked carefully before administration!
(Once you have injected a solution, it cannot be removed!)
The injections
Intracutaneous injection:
- This is administered to layers of the skin
- Aim: allergy testing, tuberculosis screening
- A tuberculin type syringe and thin needle are used
- The needle should be inserted at an angle of 10-20o
- Sites: inner forearm, posterior of upper arm
The injections
Subcutaneous injection
- This is administered into the fat or connective tissue
underlying the skin (insulin and heparin)
- Thin needle is applied
- The skin should be gently pinched into a fold to elevate the sc.
tissue. The injection should be given at an angle of 45o into
the raised skin fold
- Sites: external upper third of the upper arm, abdomen, external
medial area of the thigh
The injections
Intramuscular injection
- This is used for the injection of a larger volume (max. 5 ml)
- The needle should be inserted at an angle of 90o
- The skin should be stretched
- Sites: gluteal muscle, (borders: anterior superior iliac spine and the iliac crest)
in adults
- lateral side of the femoral muscle (above the medial third of the femur) in
children
- Contraindicated for patients treated with anticoagulants
The injections
Intravenous injection:
- Fast effect
- Use a tourniquet; the vein must be punctured at an angle of
30-45o
- Once the needle is in place, it is helpful to draw blood
- Torniquet is released and injection is given slowly
- Sites: v. mediana cubiti, v. cephalica, dorsal veins of hand, foot
Intravenous injection
Central venous catheter insertion
Medication safety and errors
• One of the recommendations to reduce
medication errors and harm is to use the
“five rights”:
1.the right patient,
2.the right drug,
3.the right dose,
4.the right route,
5.the right time.
Medication safety and errors
• When a medication error does occur during the
administration of a medication, we are quick to
blame the nurse and accuse her/him of not
completing the five rights. The five rights should
be accepted as a goal of the medication process
not the “be all and end all” of medication safety.
Adverse drug reaction
• “an appreciably harmful or unpleasant reaction,
resulting from an intervention related to the use of
a medicinal product, which predicts hazard from
future administration and warrants prevention or
specific treatment, or alteration of the dosage
regimen, or withdrawal of the product.”
Adverse drug reaction
• WHO's Adverse Reaction Terminology (with
mnemonics):
1.
2.
3.
4.
5.
6.
dose-related (Augmented),
non-dose-related (Bizarre),
dose-related and time-related (Chronic),
time-related (Delayed),
withdrawal (End of use),
and failure of therapy (Failure).
Adverse drug reaction
• Management:
– withdrawal of the drug if possible
– specific treatment of its effects.
Suspected adverse drug reactions should be
reported.
Adverse drug reaction
• Seriousness and severity (FDA)
–
–
–
–
Death
Life-threatening (e.g. anaphylactic)
Hospitalization (initial or prolonged)
Disability – change in the patient's body function/structure,
physical activities or quality of life.
– Congenital anomaly
– Requires intervention to prevent permanent impairment or
damage
Vancomycin (antibiotic)
iv to drug allergic pt
Thanks for your attention!