1. Medication/ Medication Administration
Part 2

2. Routes of drug
administration

3. Lecture Objective
Describe the various techniques of drug administration.

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

5. ROUTES OF DRUG ADMINISTRATION
ENTERAL
PARENTERAL
TOPICAL
INHALATION ROUTE

6. ENTERAL
ORAL
RECTAL
BUCCAL
SUBLINGUAL

7. 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.

8. 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

9. 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

10. 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

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

12. SUBLINGUAL ROUTE ADVANTAGES DISADVANTAGES 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

13. 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

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

15. 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

16. Con…
RECTAL DRUGS:
Most commonly by suppository or enema.

17. 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.

18. 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.

19. 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

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

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

22. Injections Intradermal Subcutaneous Intramuscular Intravenous
Intraperitoneal
Intrathecal
Intraarticular
Intra arterial
Intra medullary
Parenteral (or injectable) routes include:
Intravenous – into the vein
Intramuscular – into the muscle
Subcutaneous – into the subcutaneous layer of the skin
Intradermal – into the dermal layer of the skin
Intrathecal – into the subarachnoid space (used for anesthesia)
Intraarticular – into a joint

23. 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
Parenteral (or injectable) routes include:
Intravenous – into the vein
Intramuscular – into the muscle
Subcutaneous – into the subcutaneous layer of the skin
Intradermal – into the dermal layer of the skin
Intrathecal – into the subarachnoid space (used for anesthesia)
Intraarticular – into a joint

24. Injections
Intrathecal into the subarachnoid space (used for anesthesia)
Intraarticular into a joint
Intra arterial into arteries
Intra medullary into bone marrow
Parenteral (or injectable) routes include:
Intravenous – into the vein
Intramuscular – into the muscle
Subcutaneous – into the subcutaneous layer of the skin
Intradermal – into the dermal layer of the skin
Intrathecal – into the subarachnoid space (used for anesthesia)
Intraarticular – into a joint

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

26. Ampules and Vials
Vials
Ampules

27. Syringes and Needles
Syringe
Hypodermic needle

28. Intradermal Injection

29. 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: ml
Equipment: (1ml, 25-27g, ⅝ or ½ inch needle).
Administration angle: °
Forearm: one hand’s breath above wrist

30. Subcutaneous Injection

31. 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, ½ to⅝ inch needle).
Administration Angle: 45° or 90 °
45---pinch an inch
pinch two inches

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

33. Intramuscular Injection

34. 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, ⅝ to 3 inch needle).
Administration angle: 90°

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

36. Intramuscular Injection Sites
Photo Source: Lippincott, Williams & Wilkins, Connection,
Image Bank,

37. 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.

38. Deltoid Injection Site

39. Intramuscular Administration Vastus Lateralis

40. Intramuscular Administration VentroGluteal

41. Intramuscular Administration DorsoGluteal
Most dangerous site because of sciatic nerve location

42. 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

43. Intramuscular Administration
Z-Track
For solutions irritating
to the tissues.
Pull skin away from site to displace tissue
Inject medication
Don’t massage after injection
Photo Source: Lippincott, Williams & Wilkins, Connection, Image Bank,

44. Z-Track

45. 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

46. 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.

47. 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.

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)

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-

50. Con…

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

52. Intravenous
Mini- infusion pump

53. Main Veins of the Arm

54. 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

55. Topical Dosage Forms Eye or ear: solutions suspensions ointments
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

56. Transdermal Route
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.

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

58. 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.

59. 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

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

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

62. 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

63. 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. .

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

65. Small volume nebulizer

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

67. Thank You