Route of administration

• Routes of Medication Administration

  • Oral and Topical
• Oral Administration


  • Convenient
  • Comfortable
  • Economical
  • Easy to administer
  • Often produce local or systemic effects
  • Rarely cause anxiety for patient
• Oral Administration

  • Oral route is avoided when patients has alterations in gastrointestinal function, reduced GI motility, surgical resection of the GI tract
  • Oral administration is contraindicated in patients who are unable to swallow
  • Oral administration is contraindicated in patients who are unconscious, confused
  • Oral medications sometimes irritate lining of GI tract, discolor teeth or have unpleasant taste
  • Gastric secretions destroy some medications
• Sublingual Route


  Medications are placed under the tongue
• Buccal Route


  Involves placing the solid medication in the mouth against the mucous membranes of the cheek until it dissolves
• Oral Drug Forms


  • Capsules
  • Lozenges
  • Pills
  • Syrups
  • Tablets
  • Elixirs
  • Emulsions
  • Suspensions
• Oral Route - Equipment

  • Medicine Pot - allow a dosage form to be taken from its original container for immediate administration to a patient
  • Tablet Splitter - increase the accuracy of tablet splitting
  • Tablet Crusher - can be used when a patient has swallowing difficulties and no alternative dosage form exists
  • Oral Syringe - if a syringe is needed to measure and administer an oral dose, an oral syringe that cannot be attached to intravenous catheters or ports should be used

  
• Oral Route - Nursing Responsibilities

  • Allow patient to self-administer medications if possible
  • Know signs of dysphagia (difficulty swallowing): cough, change invoice tone or quality after swallowing, delayed swallowing
  • Position the patient in an upright seated position at a 90-degree angle
  • Administer pills one at a time, ensuring that each medication is properly swallowed before next one is introduced
  • Refer to a medication reference to identify medications that are safe to crush
• Topical Administration


  Medications are applied to the skin
• Topical Administration


  • Local Effect
  • Painless
  • Limited side effects
• Topical Administration


  • Patients with skin abrasions are at risk for rapid medication absorption and systemic effects
  • Medications are absorbed through skin slowly
• Topical Drug Forms

  • Ointment
  • Liniment
  • Lotion
  • Paste
  • Transdermal disk or patch
• Topical Route - Nursing Responsibilities


  • The condition of the affected site should be assessed for altered skin integrity
  • The affected area must be washed and dried before applying the topical medicines where appropriate, unless the prescription directs otherwise
  • Expose the area that requires the lotion and where necessary cover the patient with a towel or sheet
  • If the medication is to be rubbed into the skin, the preparation should be placed on a sterile topical swab
  • Educate the patient to inform the nurse if there is any itching, skin colour change or signs of a rash following application
• Transdermal Administration


  A transdermal patch contains a certain amount of drug and delivers it in a quantity which is sufficient to cause the desired pharmacological effect when it crosses the skin and into the systemic system
• Transdermal Administration


  • Prolonged systemic effects
  • Medication leaves oily or pasty substance on skin and sometimes soils clothing
• Types of Transdermal Patches

  • Simply designed patches which consist of a drug-containing adhesive and a backing material
  • Layered patches consist of a drug-containing matrix, an adhesive layer and a backing layer
• Sterile topical swab


  A swab used to apply medication topically in a sterile manner
• Topical administration


  Application of a medication directly to the affected area of the skin
• Transdermal


  Administration of a medication through the skin and into the systemic circulation
• Advantages of transdermal administration

  • Prolonged systemic effects
• Disadvantages of transdermal administration

  • Medication leaves oily or pasty substance on skin and sometimes soils clothing
• Transdermal patch


  Contains a certain amount of drug and delivers it in a quantity which is sufficient to cause the desired pharmacological effect when it crosses the skin and into the systemic system
• Drugs that can be delivered via transdermal system

  • Fentanyl
  • Hyoscine
  • Nicotine
  • Oestradiol
• Types of transdermal patches

  • Simple patches (drug-containing adhesive and backing material)
  • Layered or matrix patches (drug-containing matrix, adhesive layer, backing material)
  • Reservoir patches (enclosed reservoir of drug, membrane layer, adhesive layer, backing material)
• Nursing responsibilities for transdermal patches

  1. Assess condition of affected site for altered skin integrity

  2. Wash and dry affected area before applying patch

  3. Apply patch to hairless areas of skin (upper chest, upper arms, upper back)

  4. Avoid distal areas of extremities

  5. Do not trim or cut patches

  6. Properly dispose of used patches

  7. Remove any drug residue before applying new patch
• Oral, buccal, sublingual
• Advantages:


  • Convenient • Comfortable • Economical • Easy to administer • Often produce local or systemic effects • Rarely cause anxiety for patient
• Oral route is avoided when patients has alterations in gastrointestinal function, reduced GI motility , surgical resection of the GI tract


  Disadvantage
• Oral administration is contraindicated in patients who are unable to swallow

  Disadvantage
• Oral administration is contraindicated in patients who are unconscious, confused

  Disadvantage
• Oral medications sometimes irritate lining of GI tract, discolor teeth or have unpleasant taste

  Disadvantage
• Gastric secretions destroy some medications


  Disadvantage
• Medications are given by mouth and swallowed with fluid.

  Oral Route
• Oral medications have a slower onset of action and a more prolonged effect than parenteral medications.

  Oral route
• the easiest and the most commonly used route of medication administration.

  Oral Route
• Medications are placed under the tongue

  Sublingual route
• Instruct patients not to swallow a medication given by the sublingual route or drink anything until the medication is completely dissolved to ensure that the medication will have the desired effect.

  Sublingual route
• Involves placing the solid medication in the mouth against the mucous membranes of the cheek until it dissolves

  Buccal route
• Teach patients to alternate cheeks with each subsequent dose to avoid mucosal irritation.

  Buccal route
• Do not chew. Do not swallow

  Buccal route