Medication Routes and Delivery Systems

8/11/2019 Medication Routes and Delivery Systems

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Medication Routes &Delivery Systems

Administration & Safety

Considerations


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Table of Contents

Routes of Administration .........................1

Medication Delivery Responsibilities ........2

Safety Considerations for

Medication Administration .......................3

Transdermal ............................................ 4

Oral ........................................................ 5

Sublingual/Buccal ...................................8

Pulmonary ..............................................9

Injection ................................................10

Rectal ...................................................11

Topical:

Skin, Mucous Membranes, Eyes............ 12

References............................................ 13


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1

Routes of Administration1,2

A route of drug administration is

the path by which a drug or other

substance is brought into contact with

the body. There is often a choice of the

route by which a medication may begiven. A route may be chosen

for convenience

to maximize drug concentration at

the site of action

to minimize drug absorption

elsewhere

to prolong drug absorption, or

to avoid first-pass metabolism

Different dosage forms of the

same drug may have different drug

absorption rates, times of onset, anddurations of action.

Oral (Enteral)

Enteral feeding tubes

Modified release

(continued)


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Sublingual/buccal

Pulmonary/inhalation

Injection

Rectal

Topical

Skin

Mucous membranes

Ophthalmic

Otic

Transdermal


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2

Medication DeliveryResponsibilities2,3

Concentrate fully when preparing

and administering medications

Be familiar with patients medicalcondition/history

Allergies

Acute/chronic disease states(contraindications)

Never give a medication if you havequestions or concerns about the

orderBe knowledgeable about the

medications you administer

Refer to Full Prescribing

Information and/or up-to-datedrug handbook

Consult with prescriber or

pharmacist

Only administer medications thatyou have prepared or that have

been prepared by the pharmacy

Inspect medication and packaging

Expiration dates

For compromise or tampering

Never give a drug if its normal

appearance or packaging is

altered in any way

(continued)


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DO NOT leave medications

unattended or unsecured

Gather pre- and post-administration

assessment data as appropriate for

the medication (eg, blood glucose

level, pulse rate, pain level)

Evaluate response including

effectiveness or any adverse

reactions

Respond promptly and

appropriately to adverse reactions,

interactions, and complications

Document immediately all actions

related to the patients drug therapy


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3

Safety Considerationsfor MedicationAdministration2,4

Factors, often referred to as rights,

should be addressed before, during,

and after medication administration to

help promote safety.

RIGHT PATIENT:

Verify by checking ID bracelet androom number

RIGHT DRUG:

Compare the name of drug onrecord with the drug on hand

Know general purpose/action,dosage, and route of drug

Compare drug order with druglabel:

At time of initial contact Before preparing the drug

Just before administering the drug

RIGHT DOSE:Compare ordered dose with the

dose on hand

(continued)


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When dispensing an unfamiliar

drug or in doubt about a dosage,

check the prescribed dose against

the range specified in a reliable

reference, such as the drugs Full

Prescribing Information (package

insert) or an up-to-date drug

handbook

RIGHT TIME:

Administer drugs at times specific to

medication

Consider factors that can affecttiming of administration, such as

meals and other drugs

Before administering a prn

medication, check to ensure:

No one else has administered it

Specified time interval has passed

RIGHT ROUTE:

Verify labeling of drug to ensure it

matches prescribed route

Never substitute one administration

route for another without an order

Administer drugs at appropriate site

Assess ability to swallow before

giving oral medsDo not crush or mix in other

substance before consultation with

prescriber or pharmacist


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4

Transdermal1,5,6

TRANSDERMAL SYSTEMS ARE

DESIGNED TO:

Apply to the skin for the purpose of

delivering drugs to the local site or

into systemic circulation

ADMINISTRATION CONSIDERATIONS 7,8

System adhesion to skin is

important for proper drug delivery

Remove system from protective

pouch and remove protective liner

Place transdermal system on

appropriate body location per FullPrescribing Information

Document the medication

administration and location of

patch per facility policyConfirm previous transdermal

system was removed

Follow disposal procedures per Full

Prescribing Information and facilitypolicies

(continued)


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SAFETY CONSIDERATIONS2,8

Do not use oils, lotions, alcohol, or

other agents that might irritate or

damage the skin siteConfirm that skin is intact, non-

irradiated, and not irritated

Avoid hairy areas if possible; clip (do

not shave) excessive hairDo not expose the application site to

direct external heat source, such as

heating pads


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5

Oral1,2

Absorption pattern

Absorbed by the gastrointestinal

(GI) tract

Oral ingestion is the most common

route of administration

May also include administration of

medication via feeding tube

Variety of formulations

Includes tablets, capsules,

chewables, liquids

ADMINISTRATION AND SAFETYCONSIDERATIONS

Confirm that patient can swallow

and remain uprightConfirm specific recommendations

with the Full Prescribing Information

Food and other drugs in the

digestive tract may affect howmuch of and how fast the drug is

absorbed

Most tablets and capsules should

be swallowed whole with an

adequate amount of water

Some medications may not be

crushed or chewed

Liquids may require special

storage precautions to maximizedrug stability


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6

Oral: Enteral FeedingTubes9


Administer each medication

separately

Use liquid dosage forms whenavailable and appropriate

Solid dosage forms may be

used in some situations; consult

the Full Prescribing Informationto determine feasibility of

administering medications via

enteral tube

Do not add medication directly to anenteral feeding formula

Prior to medication administration,

stop the tube feedings


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7

Oral: Modified-ReleaseDelivery System1,2

SR, ER, or CR formulations areexamples of modified-release

dosage formulations

Sustained release (SR)

Extended release (ER or XR)

Controlled release (CR)

Delayed release

Extended-release pharmaceuticalpreparations are designed to

produce slow, uniform absorption of

a drug for an extended period of time

Modified-release preparations areoffered for medications in all major

drug categories

Absorption pattern will vary based

on preparation used

Verify drug information in Full

Prescribing Information

(continued)


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ADMINISTRATION ANDSAFETY CONSIDERATIONS

Tablets usually should not be split

Some capsules may be opened,but contents may not be crushed

or chewed. Verify in Full Prescribing

Information

With few exceptions, modified-release preparations should be

swallowed whole, preferably with a

glass of water

Damage to the extended-releasepreparation can result in unintended

rapid release which can lead to

serious side effects


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8

Sublingual/Buccal2,7

ABSORPTION PATTERN

Drug is absorbed across theepithelial lining of the mouth

May provide a rapid onset of action

ADMINISTRATION AND SAFETYCONSIDERATIONS7

Medication should generally not be

administered if the gums or mucous

membranes have open sores orirritations

Have the patient sit to prevent

accidental aspiration of the

medicationShould not be used if the patient is

unconscious or uncooperative

The patient should not eat or

drink, chew or swallow until themedication has been absorbed


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9

Pulmonary1,2,8

ABSORPTION PATTERN

Medications are inhaled as gas,droplets, or aerosolized powder2

Large lung surface area allows

for rapid absorption and local

application of the drug at the desiredsite of action1


Place patient in a comfortable,

upright position

Use nebulizers to confirm that a

steady mist is flowing, and fit themask or application device correctly

on the patient

Canister devices:Hold device 1 to

2 inches from the patients mouth.

Educate the patient to breathe in

deeply while drug is administered

Consult Full Prescribing Information

for additional information


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10

Injection1,2,4

ROUTES OFADMINISTRATION

Intravenous (IV)

Subcutaneous

Intramuscular (IM)

Epidural

Intra-arterial

Intrathecal

ABSORPTION PATTERN

Generally fast

Generally more predictable than with

enteral administration


Asepsis must be maintained

Closely monitor for response and/or

reactionFor continuous and intermittent IV

administration, venous access must

be maintained

Rotation of injection sites is requiredSafely dispose of contaminated

needles

Refer to Full Prescribing Information

for specific administration andsafety recommendations


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11

Rectal2

ABSORPTION PATTERN

Drug is readily absorbed into thewall of the rectum for systemic or

local effect

FORMULATIONS INCLUDE ENEMAS

(LIQUID/SOLUTIONS), SUPPOSITORIES,CREAMS, AND OINTMENTS

Suppositories soften, melt, or

dissolve, releasing the active

medication


Remove outer wrapper prior toadministration

Introduce suppository, catheter, or

applicator gently to avoid tearing or

bleeding of the tissue


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12

Topical: Skin, MucousMembranes, Eyes2,4

ABSORPTION PATTERN Targeted drug action is the skin

surface or area of medication

administration

TOPICAL FORMULATIONS AREDESIGNED TO:

Target drug action to the surface

(systemic effect not desired)

Be administered to the skin, otic,

ophthalmic, or mucous membranes

Mucous membranes may include

the conjunctiva, nasal passages,

oropharynx, vagina, colon,

urethra, and urinary bladder

ADMINISTRATION AND SAFETY

CONSIDERATIONSWear gloves and use aseptic

technique to minimize

contamination of medication and

possibility of infection

When applying medication to theskin, clean the skin and assess for

breaks or skin damage

Administer medication as directedby Full Prescribing Information


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REFERENCES

1. BuxtonIL. Pharmacokinetics and

pharmacodynamics: the dynamics of drug

absorption, distribution, action, and elimination. In:

Brunton LL, Lazo JS, Parker KL, eds. Goodman &

Gilmans The Pharmacological Basis of

Therapeutics, 11thed. http://www.accessmedicine.

com/content.aspx?aID=935800.

2. Jonesand Bartlett Learning.2011 Nurses Drug

Handbook, 10thed. Sudbury, MA: Jones and

Bartlett Publishers; 2011.

3.Medicationadministration. Nurses Notes TheBlack Book website. http://nurseskit.blogspot.

com/2009/02/medication-administration.html.

Accessed August 4, 2010.

4. Administrationof Medication. In: Krapp K, ed.Encyclopedia of Nursing & Allied Health. eNotes.

com. http://www.enotes.com/nursing-

encyclopedia/administration-medication.

Accessed July 8, 2010.

5. SchulmeisterL. Stuck on you: Transdermal drug

patches. Nursing Made Incredibly Easy!2007:5 (2):17-19.

6. WokovichAM, Prodduturi S, Doub WH,

Hussain AS, Buhse LF. Transdermal drug

delivery system (TDDS) adhesion as a critical

safety, efficacy and quality attribute. Eur J Pharm

Biopharm. 2006; 64:1-8.

9. BankheadR, Boullata J, Brantley S, et al. A.S.P.E.N.Enteral Nutrition Practicem Recommendations.

JPEN J Parenter Enteral Nutr 2009; 33:122-167.

7. MartelliME. Sublingual and buccal medication

administration. Gale Encyclopedia of Nursing and

Allied Health. Healthline.com. http://www.healthline.

com/galecontent/sublingual-and-buccal-medication-

administration. Accessed July 26, 2010.8. Aerosoldrug administration. In: Krapp K, ed.

Encyclopedia of Nursing & Allied Health. eNotes.

com. http://www.enotes.com/nursing-encyclopedia/

aerosol-drug-administration. Accessed July 12,

2010.

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Medication Routes and Delivery Systems