Professional Documents
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ROUTE OF ADMINISTRATION
II. INTERVAL OF ADMINISTRATION
III. TIME OF ADMINISTRATION
IV. DURATION OF THERAPHY
V. TECHNIQUE OF ADMINISTRATION
The reasons :
1. Most Convenience (oral)
2. To maximize concentration at the site of action
3. Minimize it else where (topical)
4. To prolong the duration of drug absorption
5. Avoid the first pass effect
6. Economical
7. Safest
Dose of
Drug
I
N
P
U
T
Drug in Blood
at site of
Absorption
D
I
S
T
R
I
B
U
T
I
O
N
Drug in General
Circulation
Drug at sites
of Action
Pharmacologic Effect
Clinical Effect
Toxicity
Efficacy
Utility
L
O
S
S
- Other route
: Transdermal
Inhalation
etc
Enteral Route
Oral route
Drug administered orally pass through various part of GIT/oral cavity
- Esophagus
- Stomach
- Duodenum
- Jejunum
- Illeum
- Collon
Small intestine : transit time 3 4 hours
Absorption is not complete by the time The drug
leave small intestine
Destruction by digestive juice/digestive enzim
Oral cavity : saliva, mucin interact with drug
Esophagus
: pH = 5 6
Tablet or capsules may lodge in this area local irritation
Drug dissolution is very little
Stomach
: The fasting pH = 2 6
In the presence of food pH = 1.5 2
Basic drug solubilized increase
Duodenum
: pH = 6 6.5
Bicarbonat neutralized the acidic chyme
The complex fluid to dissolved drugs with limited
aqueous solubility
Jejunum
Illeum
: pH = 7 (distal part 8)
Bicarbonat secretion acid drug will dissolved
Bile secretion to dissolved fats and hydrophobic drug
Collon
: pH = 5.5 7
Lumen content more viscous semisolid limited drug
absorption
Theophyllin and metoprolol absorbed
Levo dopa and lactulose metabolized by enteric bacteria
(aerobic micro organism)
Absorption of clindamycin and propanolol
Parenteral Route
Intravenous (I.V.)
- After injection distribused via the circulation to all part of body
- Aqueous solution
- Bioavailability is complete and rapid
- Drug delivery is controlled and achieved with an accuracy and
immediately
- Certain irritating solution of drug can be given
- Unfaforable reaction (high concentration of drug in plasma and
tissues)
Disadvantages : - once injected no retreat
- Drug in oily vehicle, precipitate blood constituent,
hemolized erythrocyte (should not be given)
Subcutaneous (S.C.)
- Injection under the skin
- The effect < I.V. and I.M.
Other Route
Transdermal Route
1. Mucouse membrane
- A drug applied to mucouse membranes of the conjunctive
nasopharinx, aropharinx, vagina, collon, urethra, and urinary bladder
- Primary for the local effect
- Absorption readily
2. Skin
- Few drugs readily penetrate the intact skin
- Absorption is dependent on the surface area, lipid solubility and vehicle
of the drugs
- The effect local or systemic
- Eye ; topically applied local effect
Inhalation Route
- Pulmonary absorption / respiratory tract
- Gas on volatile drugs
- Solution of drug atomized
- Avoidance of hepatic first-pass loss
BIOAVAILABILITY
ADVANTAGES
DISADVANTAGES
No first-pass effect.
Rapid absorption
Buccal or
sublingual (SL) from lipid-soluble
swallowed.
Not for most drugs or
drugs.
Rectal (PR)
Absorption may be
erratic.
Suppository may migrate
different position.
Some patient discomfort.
ROUTE
BIOAVAILABILITY
ADVANTAGES
DISADVANTAGES
Requires skill in
insertion of
infusion set.
Tissue damage at
site of
Intramuscul
ar
injection
(IM)
Easier to inject
than
intravenous
injection.
Large volumes may
be used
Parenteral
Routes
Complete (100%)
Intravenous systemic
(IV)
drug absorption.
Rate of
bioavailability
considered
instantaneous.
injection
(infiltration,
necrosis,
or sterile Abscess).
Irritating drugs may
be very painful.
Different rates of
absorption
depending upon
ROUTE
Other Routes
Transdermal.
BIOAVAILABILITY
ADVANTAGES
DISADVANTAGES
Slow absorption,
rate may vary.
Transdermal
delivery system
(patch) is easy to
use.
Used for lipidsoluble drugs with
low dose.
Some irritation by
patch of drug.
Permeability of skin
variable with condition,
anatomic site, age,and
gender.
Type of cream or
ointment base affects
drug-release and
Increased
absorption with
occlusive dressing.
absorption.
Inhalation
Rapid absorption.
Total dose
absorbed is variable.
- Mouth
- GI tract system via mouth
- Under the tongue
- Other sites than GI tract (by injection)
* Into vena
* Into artery
* Into the heart
* Into spine
* Into bone
* Into joint
* Synovial fluid cavity
* Into skin
* Under skin
* Into muscle
- Skin surface
- Skin surface
- Conjunctiva
- Eye globe
- Nose
- Ear
- Lung
Dosage Form
Solid and Liquid dosage form
Tablet, trochition and lozenges
Solution, suspension
Ointment, Cream, Paste, Powder, Aerosol,
Lotion,Transdermal, Disc, and Solution
Attachment
Solution, Ointment, Suppositoria
Ointment
Solution, Ointment
Solution, Spray, Inhalant, Ointment
Aerosol
Solution, Ointment, Emulsified foam,
Tablet, Insert, Suppositoria, Sponge
Solution, Suppositoria
Sulfa group
Metronidazol
Erythromycin
Amoxicillin
Aspirin
b. Fast
c. Slow
d. Very slow
Base on :
1. Chemical properties of drugs
Exp : Anticholinergic drugs reduce secretion and peristaltic of intestinal.
These drugs should be taken one hour before meal.
3. Possible interaction :
Interaction between drug
Drug that interact with antacid in stomach
Exp : Amoxicillin, Ampicillin, Cloxacillin, Nitrofurantoin
Interaction Drug and Food
Drug interferred by gastric chyme
Exp : Ampicillin, Amoxicillin, Erythromycin, Lincomycin
(Should be taken during empty stomach)
5. Stomach-irritating drugs
Exp : Aminophylline, Acetyl salicilic acid, Codein, Phenylbutazon
EXAMPLE OF ADMINISTRATION TIME OF THE INTERACTIVE
DRUGS
R/
R/
= ante cibos
= past cibos
Administration times
* Exceptions:
1.
2.
Oral hypoglycemic agents and insulin (7:00 AM and/or 4:30 PM) when ordered bid.
3.
Antibiotics should be spread evenly over 24 hours. An approximate schedule to avoid meals might be 4:0
AM, 10:00 AM, 4:00 PM, and 10:00 PM.
4.
5.
: Steroid
Diureticum
Antihypertensi
- In the night
: Contraceptive agent
Hypnotic agent
- During meal
- During episode
: Antiasthmatic drug
Drug for migraine
Angina pectoris drugs
- Empty stomach
: should be enough
lower
lid
4. Press and rub the eye ointment as long as 1/4 - 1/2 inch
onto the inner side of the lid without touching it nor eye
globe.
5. Close the eye and rotate the eye globe in all direction
(possibly the vision will become slightly blurred ).
6. Cap the tube immediately without touching the tips of
cap nor tube.
of
the
drugs
as
Suppositoria
Insert
INTRAVAGINAL
MEDICATION
In general, intravaginal medication is limited to
the localized application for which ointments or
tablets are available to insert into vagina and
usually by the time of going to bed, such as
metronidazole and primaricin for vaginitis
caused by trichomonas and candida.
The drugs may be used in the form of swabbing
liquid, others in the forms of spermaticide (to kill
spermatocyte), foam tablet,and cream.
WATTER (SOLUTION)
2.
ALCOHOL (TINCTURE)
3.
POWDER
4.
5.
CREAM
6.
PASTE
7.
OINTMENT
All types
Powder, watered powder, cream
solution.
Powder, watered powder, cream
solution.
Water (solution), alcohol, cream.
Powder, water solution, alcohol,
ointment, wet powder, paste,
cream.
Watered powder (solution),
alcohol, ointment, wet powder,
cream.
All types except for eye skin.
Glass
Plastic
2. VIAL
It is made from glass with rubber cap fixed with film
metal surrounding the bottle lip, generally can be
used repetitively.
The filling of drug solution into syringe is as follows :
Solution :
Suck the air as much as needed
Make the vial rubber clean using sterilized alcohol cotton
Prick the syringe into the vial while the upside-down
position of the vial .
Press the air into the vial then directly pump-in the
solution as much as needed, the needle should be
always in the solution border.
Make the syringe free from air and clean it, wash the
hands.
HYPODERMIC EQUIPMENTS
SYRINGE is an equipment to get water or solution into
the body or body cavities.
HYPODERMIC SYRINGE is syringe to use for
subcutanous, intramuscular, and intravenous methods. It
is a sucking type and characterized by the main
components including a metal piston and a tube made
from glass with various sizes.
1. Tuberculin syringe : small size with capacity no more
than 1 ml .
0.1 - 0.001 ml.
Hypodermic Syringe : Larger size with capacity 2 - 50 ml.
DISPOSABLE SYRINGE :
HYPODERMIC NEEDLES
This needle typically is made from stainless steel,
hyperchromed steel, carbon steel, chromium,
platinum, silver or gold.
The
1.
2.
3.
Needle Size
The
1.
2.
3.
4.
Caudal needle
Epidural needle
Intravenously anesthetic needle
Blood transfusion needle
Spinal needle
Biopsy needle
Cerebral angiographic needle
ROUTES OF ADMINISTRATION IN
INJECTION DRUGS
1. INTRADERMAL OR INTRACUTANEOUS
Dosage form : Solution and Suspension
Volume
Purpose
: Solution or oil
Volume
: No more than 2 ml
The injection under skin should be conducted with nonirritant drugs which are soluble either in water or oil, but the
effect is not as rapid as IM or IV method. It is easy to do by
patients themselves, such as insulin administration.
This
method
administration
is
also
of
used
heparin
in
the
and
epinephrine suspensions.
Skin has poor blood vasculature, thereby the
drugs that will be absorbed by blood vessels and
the nonsoluble drugs diffuse into lymphatic
vessels.
INJECTION TECHNIQUES
1.
2.
3. INTRAMUSCULAR INJECTION
Dosage form
or
Volume
: No more than 4 ml
In injection into muscles, the soluble drug
resorption will last within 10 - 30 minutes.
The adventages :
Easy, safer, good tolerated, rapid resorption,
and rarely develops necrosis. For very irritative
drugs, this intramuscular method is preferred
than subcutanous method.
Injection Procedure
Localize the muscle to choose:
Ventro Gluteal : thicker, no main nerve fibers and
blood vessels. Choose the upper lateral quadrant,
in Medial Gluteal, take attention on ischiadic
nerves and Superior Gluteal Artery.And patient
position should be facing laterally, facing
downward, or standing.
Vestus Lateralis :
Middle aspect of thigh :
very poor nerve fibers and blood vasculature.
Position : supine, or sitting
Volume : 2.5 - 3 ml
Deltoid muscle :
Easy, with position of facing laterally, sitting,
or standing, needs attention that the area is
very limited and the existence of large bone,
blood vessels, and nerve fibers.
Drug Volume :
No more than 2 ml.
Wash hands thoroughly
Make the patient ensure and explain the procedure
Rub disinfectant on the skin
Ask the patient to let the muscles relaxed, because if the
muscle is in contraction will the drug liquid flow into the
surrounding tissue leading to irritation and pain sensation.
6. Shoot the needle in perpendicular position (90 degrees) to
the skin surface
7. Re-suck to ensure if it shot blood vessel (if it did so, repeat
the procedure from point 4, or replace with new syringe, if
any)
8. Inject the drug by pressing the pump slowly and gradually
to diminish pain sensation
9. Remove the needle quickly
10. The injection site is press using the other hand with
sterilized cotton, fix it with plaster
11. Observe the patient's reaction, necessarily keep the patient
calm
12. Clean the hands and used equipments
1.
2.
3.
4.
5.
4.
INTRAVENOUS
ADMINISTRATION
DRUG
Materials :
Syringe filled with air-free drug liquid,
Needle of 20 gauge, long and moderate thickness
Disinfectant
Cotton, plasters, and tourniquet
Injection Procedure :
1. Wash the hands thoroughly
2. Ensure the patient and explain what will be done
3. Localize the injection site, choose forearm slightly lower from
cubital fossa. The vein lies more superficially and is not covered
and easy to legate.
4. The patient is asked to be relaxed with fisting the related hand.
5. Tourniquet is set up, then see the vein to be swollen while
giving disinfectant on to the skin area.
Injection Procedure :
6. Vein is stabilized by replacing the pressing hand to the
skin in line with the vein longitudinal axis, using the other
hand.
7. Direct cardially the needle to vein with 35 degree of angle,
shoot the needle slowly into 3-5 mm depth of vein
8. Do aspiration, if there is blood inside the syringe, it means
that the needle has aimed to the vein, instead, try again.
9. Tourniquet then is removed
10. Inject the drug slowly, observe the pain sensation, swelling
or hematoma; if the needle is still in vein, try to suck again.
11. The needle then should be removed immediately while the
injection site is press with cotton and subsequently cover
it with plaster.
12. Observe the patient's reaction, meanwhile wash your
hands and clean the used equipments
INTRAVENOUS
FLUID
ADMINISTRATION
OF
NAME
1.
2.
3.
4.
5.
6.
7.
AminoAcids (synthetic)
Aminosyn
Veinamine
Dextrose (Glucose,D5/W)
Dextrose&NaCl
Lactate's Ringer
(Harmann)
NaCl
KCl
CaCl2
Na Lactate
Pprotein (hydrolized)
Aminosol
CPH-5
Ringer's
NaCl
KCl
CaCl2
Natrium Lactate
CONCENTRATION PURPOSE
5.5-8%
8%
2.5 - 50%
5-20%
NaCl 0.11 - 1.9%
0.60%
0.03%
0.02%
0.30
5% casein&fibrin
0.86%
0.03%
0.033%
1/6M
Fluid &nutrition