routes of administration

• Pharmaceutical preparations are generally designed for one or two specific routes of administration
• Oral administration is the most common, least expensive, and most convenient route for most clients.
• For example, the liquid preparation of ferrous sulfate (iron) can stain the teeth
• In sublingual administration a drug is placed under the tongue, where it dissolves.
• Nitroglycerin is one example of SUBLINGUAL drug
• Buccal means “pertaining to the cheek.”
• In buccal administration, a medication (e.g., a tablet) is held in the mouth against the mucous membranes of the cheek until the drug dissolves.
• The drug may act locally on the mucous membranes of the mouth or systemically when it is swallowed in the saliva.
• The parenteral route is defined as other than through the alimentary or respiratory tract; that is, by needle.
• Subcutaneous (hypodermic)—into the subcutaneous tissue, just below the skin (45 degrees )
• • Subcutaneous sites: abdomen, - thigh, - arm
• Intramuscular (IM)—into a muscle (90 degrees )
• Intramuscular sites :

  • Ventrogluteal sites
  • Vastus lateralis
  • Deltoid site
  • Rectus femoris site
• Intradermal (ID)—under the epidermis (into the dermis) (15 degrees )
• Intravenous (IV)—into a vein. (25 degrees )

  use for specimen

  - 30 minutes for reactions
• Topical applications are those applied locally to the skin or to the mucous membranes.
• ORAL

  duration of action of most opioids is approximately 4 hours, people with chronic pain have had to awaken during the night to medicate themselves for pain.

  • To avoid this problem, long-acting or sustainedrelease formulations of morphine with a duration of 8 or more hours have been developed.
• An example of a long-acting morphine is MS Contin, a controlled release tablet.
• Clients receiving long-acting morphine may also need prn “rescue” doses of immediate-release analgesics such as Actiq, the short-acting oral transmucosal fentanyl citrate (OTFC) for acute breakthrough pain.
• Another method of oral opiate delivery is high-concentration liquid morphine.

  • This formulation enables clients who can swallow only small amounts to continue taking the drug oral
• Transnasal administration has the advantage of rapid action of the medication because of direct absorption through the vascular nasal mucosa.
• A commonly used agent in transnasal is butorphanol (Stadol) for acute migraines.
• The nurse must remember that fentanyl is 100 times more potent than morphine and is ordered in micrograms (mcg) not milligrams (mg). It provides drug delivery for up to 72 hours.
• Used patches should be disposed of in a tamper-proof container.
• The transmucosal route is helpful for breakthrough pain because the oral mucosa is well vascularized, which helps with rapid absorption.
• The rectal route is particularly useful for clients who have dysphagia (difficulty swallowing) or nausea and vomiting.
• An example of rectal is the belladonna and opium suppositories, which are used to relieve moderate to severe pain caused by ureteral spasm
• continuous subcutaneous infusion (CSCI)
• CSCI involves the use of a small, light, batteryoperated pump that administers the drug through a 23- or 25-gauge butterfly needle.

  The site is rotated every 7 days and medication infusion rates are usually 3 to 5 mL per hour
• The intramuscular (IM) route should not be used for administration of analgesics.
• The intravenous route provides the most rapid onset for pain relief with few side effects
• Intraspinal infusion may be administered to clients who require pain management in a variety of practice settings (e.g., acute care, outpatient, and home care).
• The epidural space is most commonly used because the dura mater acts as a protective barrier against infection, including meningitis, and there is less risk of developing a “spinal headache.”
• Intraspinal catheters are not in constant contact with blood; thus, an infusion can be stopped and restarted later without concern that the catheter is no longer patent
• Temporary catheters, used for shortterm acute pain management, are usually placed at the lumbar or thoracic vertebral level and usually removed after 2 to 4 days.