1. ROUTE OF DRUG
ADMINISTRATION
Julaeha, M.P.H., Apt

2. Routes of Drug Administration
Important
Info
The route of administration (ROA) that is chosen may have a profound effect upon the speed and efficiency with which the drug acts

3. The possible routes of drug entry into the body may be divided into two classes:
Parenteral
Enteral

4. Routes of Administration

5. Parenteral Routes
Intravascular (IV, IA)- placing a drug directly into the blood stream
Intramuscular (IM) - drug injected into skeletal muscle
Subcutaneous - Absorption of drugs from the subcutaneous tissues

8. I. PARENTERAL A. Intravenous B. Intra-arterial C. Intramuscular
Injection sites for IM administration
From: Fundamentals of Nursing, 4th edition, Lippincoitt, Williams & Wilkins

9. Intravascular Absorption phase is bypassed (100% bioavailability)
1.precise, accurate and almost immediate onset of action,
2. large quantities can be given, fairly pain free
3. greater risk of adverse effects
a. high concentration attained rapidly
b. risk of embolism (penyumbatan pembuluh darah)

10. Intramuscular very rapid absorption of drugs in aqueous solution
Repository (tempat penyimpanan) and slow release preparations
pain at injection sites for certain drugs
Z-track method for IM injections

11. Subcutaneous slow and constant absorption
Sites for SC injection
slow and constant absorption
absorption is limited by blood flow, affected if circulatory problems exist
concurrent (bersamaan) administration of vasoconstrictor will slow absorption

12. Aradigm Intraject® NFI device in protein delivery
Reproduced from:

13. Enteral Routes Enteral - drug placed directly in the GI tract:
sublingual - placed under the tongue
oral - swallowing (p.o., per os)
rectum - Absorption through the rectum

14. 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

15. 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
destruction of drugs by gastric acid and digestive juices
effect too slow for emergencies
unpleasant taste of some drugs
unable to use in unconscious (tidak sadar) patient

17. Sublingual/Buccal
Some drugs are taken as smaller tablets which are held in the mouth or under the tongue.
Advantages
rapid absorption
drug stability
avoid first-pass effect
Disadvantages
inconvenient
small doses
unpleasant taste of some drugs

18. Isosorbide concentrations after a 5 mg oral or sublingual dose.
Data from: Assinder et al. J Pharm Sci 66:775, 1977.

19. Rectal unconscious patients and children
if patient is nauseous or vomiting
easy to terminate exposure
absorption may be variable
good for drugs affecting the bowel (bag paling bawah) such as laxatives
irritating drugs contraindicated

20. avoid first-pass effect
RECTAL ROUTE
Local action
e.g. rectal route is used primarily for the treatment constipation
Systemic action
Advantage
avoid first-pass effect

21. VAGINAL ROUTE
local action
systemic action
Marketed preparations include several feminine hygeine preparations, contraceptives, and labor inducing drugs.
Advantage
avoid first-pass effect
Disadvantage
The thickness of the vaginal epithelium and the blood circulation in this region changes with menstrual cycle and age, and the drug absorption also changes accordingly.

22. Dosage forms suitable for vaginal route
tablet
suppository
ointment
gel
solution
emulsion foam

23. Pharmacologic Agents Administered
III. PULMONARY
Pharmacologic Agents Administered
via Inhalation
For Systemic Effects
pentamidine
halothane
ergotamine
methoxyflurane
enflurane
isoflurane
nitrous oxide
For Local Effect
beclomethasone
terbutaline
cromolyn
metaproterenol
albuterol
pirbuterol

24. Inhalation/Pulmonary
gaseous and volatile agents and aerosols
rapid onset of action due to rapid access to circulation
large surface area
thin membranes separates alveoli from circulation
high blood flow
Particles larger than 20 micron and the particles impact in the mouth and throat. Smaller than 0.5 micron and they aren't retained.

25. Forms of pulmonary delivery
Metered dose inhaler
Dry powder inhalers
Nebulizer

26. Metered Dose Inhaler (MDI)
Metered-dose inhalers (MDI) provide medication with compressed gas
deliver specific measured dose with each activation
typical MDI

27. Techniques for use of MDI devices:
Use of space or
holding chamber
Placement of
inhaler in mouth
(not for use with
steroids)
Two finger width
from mouth
Patient must coordinate inhalation and actuation of device

28. Dry Powder Inhalers (DPI)
Breath activated
Micronized drug particles blended with an excipient (e.g., glucose or lactose)
Physical properties of drug and excipient critical (i.e., particle size, shape, surface morphology, etc)

29. Diskus

30. Nebulizer
Device produces small droplets from a suspension or solution through an air jet or ultrasonic atomization (quieter, but more expensive)

31. Topical
Mucosal membranes (eye drops, antiseptic, sunscreen, callous removal, nasal, etc.)
Skin
a. Dermal - rubbing in of oil or ointment (local action)
b. Transdermal - absorption of drug through skin (systemic action)
i. stable blood levels
ii. no first pass metabolism
iii. drug must be potent or patch becomes to large

32. The skin is generally described in terms of three tissue layers:
stratum corneum
epidermis
dermis
subcutaneous fatty tissue

33. Dosage forms suitable for skin/transdermal route.
cream and ointment
transdermal patch
e.g. scopolamine trsansdermal patch

34. Factors that influence percutaneous absorption
Site of application
Condition of skin
Hydration of skin
Temperature
Vehicle

35. B. Ocular local action systemic action
The cornea of the eye has one of the highest nerve
densities in the human body, as a result patients
perceive pain and discomfort even at low thresholds
of stimulation.
From: Fundamentals of Nursing, 4th edition, Lippincoitt, Williams & Wilkins

36. Types of Ophthalmic Preparations
Solutions
Suspensions
Ointments
Inserts
Intraocular solutions

37. Factors that influence ocular drug retention
Technique of application

38. Factors that influence ocular drug retention
Technique of application
Drop size (volume)
Formulation (tonicity, viscosity)
pH of solution

39. Route for administration
-Time until effect-
intravenous seconds
intraosseous seconds
endotracheal 2-3 minutes
inhalation 2-3 minutes
sublingual 3-5 minutes
intramuscular minutes
subcutaneous minutes
rectal 5-30 minutes
ingestion minutes
transdermal (topical) variable (minutes to hours)

40. $65.55
Which route is best?
$143.11
$143.11
$41.71

41. Makaciiii