NURS 202 Drug routes (Advantages & Disadvantages of each)

emergency meds that can be delivered through endotracheal tube:

ALE Atropine Lidocaine Epinephrine

advantages and disadvantages of rectal and vaginal routes

Advantages: 1) drugs administered through the rectal or vaginal routes don't irritate the upper Gi tract, as some oral medications do. 2) These drugs avoid destruction by digestive enzymes in the stomach and small intestine Disadvantages: 1) the rectal route is usually contraindicated when the patient has a disorder affecting the lower GI tract, such as rectal bleeding or diarrhea 2) drug absorption may be irregular or incomplete with these routes 3) the rectal route usually can't be used in an emergency 4) rectal doses of some drugs may need to be larger than oral doses 5) because rectal administration typically stimulates the vagus nerve, this route may pose risk for cardiac patients 6) drugs given rectally may irritate the rectal mucosa 7) administering a drug by the rectal or vaginal route may cause discomfort and embarrassment for the patient

buccal, sublingual, and translingual (advantages and disadvantages)

Advantages: 1) these routes can be used if the patient can take nothing by mouth, can't swallow, or is intubated. 2) These drugs have no "first-pass" effect in the liver and don't cause GI irritation. Disadvantage: Only drugs that are highly lipid-soluble may be given by these routes and they may irritate the oral mucosa

disadvantages of subcutaneous route

Disadvantages: 1) Subq may cause tissue damage 2) the subq route can't be used when the patient has occlusive vascular disease (blocking or narrowing of artery in the leg) and poor perfusion because decreased peripheral circulation delays absorption. Exceptions to this are heparin (Lovenox) and insulin. 3) the subq route can't be used when the patient's skin or underlying tissue is grossly adipose, edematous (edema), burned, hardened, swollen at common injection sites, damaged by previous injections or diseased.

Disadvantages of IM route

Disadvantages: 1) a drug delivered IM may precipitate in the muscle, thereby reducing absorption 2) the drug may not absorb properly if the patient is hypotensive or has a poor blood supply to the muscle 3) Improper technique can cause accidental injection of the drug into the patient's bloodstream, possibly causing overdose or an adverse reaction 4) the IM route may cause pain and local tissue irritation, damage bone, puncture blood vessels, injure nerves, or break down tissue, thus interfering with myoglobin 0 a marker for acute myocardial infraction

subcutaneous route

Injecting small amounts of a drug beneath the dermis and into the subcutaneous tissue, usually in the patient's upper arm, thigh, or abdomen. The drug is absorbed slowly from the subcutaneous tissue, thus prolonging its effects.

enteral administration: why absorption varies

a drug that's administered enterally -orally or by gastric tube- can undergo variable rates or absorption due to: 1) changes in the pH of the GI tract 2) changes in intestinal membrane permeability 3) fluctuations in GI motility 4) fluctuations in GI blood flow 5) food in the GI tract 6) other drugs in the GI tract.

Advantages of IV route

advantages: 1) since the drug or solution is absorbed immediately and completely, the patient's response is rapid. This makes the IV route the first choice for giving drugs during and emergency to relieve acute pain. 2) this route has no first-pass effect in the liver and avoids damage to muscle tissue caused by irritating drugs. 3) Because absorption into the bloodstream is complete and reliable, large drug doses can be delivered at a continuous rate

buccal, sublingual, and translingual

buccal (between the cheek and teeth), sublingual (under the tongue) and translingual (on the tongue) can be given to prevent their destruction or transformation in the stomach or small intestine. Drugs given by these routes act quickly because the oral mucosa's thin epithelium and abundant vasculature allow direct absorption into the bloodstream.

disadvantages of IV route

disadvantages: 1) life-threatening adverse reactions may arise if IV drugs are administered too fast, if the flow rate is not monitored carefully, or if incompatible drugs are mixed together. 2) The IV route increases the risk of complications such as extravasation, vein irritation, systemic infection, and air embolism.

Ophthalmic administration

drugs such as creams, ointments, and liquid drops that are placed in conjunctival sac or directly onto the surface of the eye. Advantages: 1) can be relieving to some patients for pain or irritation Disadvantages: 1) Be mindful not to allow the drops to drain and be absorbed systemically, causing adverse effects *type of topic route*

Respiratory route

drugs that are lipid soluble and available as gases can be administered into respiratory tree. The respiratory tree provides and extensive, highly perfused region for enhanced absorption. Smaller doses of potent drugs can be given by this route to minimize their adverse effects **Lipid soluble drugs can cross membranes quicker than water soluble drugs** Disadvantages: 1) a major disadvantage is that few drugs can be given this way 2) difficulty in administering accurate doses - or full doses, if the patient isn't cooperative 3) nausea and vomiting when certain drugs are delivered into the lungs 4) irritation of the tracheal or bronchial mucosa, causing couching or bronchospasm 5) possible infection from the equipment used to deliver drugs into the lungs

Otic administration

involves drugs placed directly into the ear used to treat infection or inflammation of the external er canal, produce local anesthesia, or soften built-up cerumen (earwax) for removal. Bring otic solutions to room temp because cold solutions can cause pain or even vertigo. *type of topic route*

oral route

oral administration is usually the safest, most convenient, and least expensive method. For that reason, most drugs are administered by this route patients who are conscious and able to swallow. Disadvantages: 1) the oral route produces variable drug absorption 2) because it moves drugs through the liver, first-pass metabolism may take place. 3) drugs can't be given orally in most emergencies because of their unpredictable and relatively slow absorption 4) oral drugs may irritate the GI tract, discolor the patient's teeth, or taste unpleasant 5) oral drugs can be accidentally aspirated if the patient has trouble swallowing or is combative

nasal administration

placing drugs directly into the patients nostrils from a dropper or as an atomized spray from a squeeze bottle or a pump device *type of topic route*

Intramuscular route

the IM route allows you to inject drugs directly into various muscle groups at varying tissue depths. You'll use this route to give aqueous suspensions and solutions in oil and to give medications that aren't available in oral form. The IM route also eliminates the need for an IV site

intravenous route

the IV route allows injection of substances directly into the blood stream through a vein. Appropriate substances include drugs, fluids, diagnostic contrast agents, and blood or blood products. Administration can range from a single dose to an ongoing infusion delivered with great precision.

Intradermal route

used mainly for diagnostic purposes when testing for allergies or TB. Because this route results in little systemic absorption, it produces mainly local effects. You must be sure not to inject the substance too deep! If you do, you'll have to reinject with a new needle

topical route

used to deliver a drug via the skin or mucous membranes. Advantages: 1) easy administration 2) dew allergic reactions 3) fewer adverse reactions than drugs administered by systemic routes Disadvantages: 1) delivering precise dose can be difficult 2) messy!

rectal and vaginal routes

you can instill suppositories, ointments, creams, or gels into the rectum or vagina to treat local irritation or infection. Some drugs applies to the mucosa of the rectum or vagina can be absorbed systemically. Drugs may also be delivered to the rectum in a medicated enema or to the vagina in a medicated douche