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A route of drug administration is the path by which a drug or other substance

is brought into contact with the body. Drugs are introduced into the body by
several routes. When administering a drug, the nurse should ensure that the
pharmaceutical preparation is appropriate for the route specified.

Route Advantages Disadvantages


Oral · Most convenient · Inappropriate for patients
with nausea and vomiting
· Usually least expensive
· Drug may have
· Safe, does not break skin unpleasant taste or odor
barrier
· Inappropriate when
· Administration usually gastrointestinal tract has
does not cause stress reduced motility

· Inappropriate if patient
cannot swallow or is
unconscious

· Cannot be used before


certain diagnostic tests or
surgical procedures

· Drug may discolor teeth,


harm tooth enamel

· Drug may irritate gastric


mucosa

· Drug can be aspirated by


seriously ill patients
Sublingual · Same as oral route, plus · If swallowed, drug may
be inactivated by gastric
· Drug can be juice
administered for local effect
· Drug must remain under
· More potent than oral tongue until dissolved and
route because drug directly absorbed
enters the blood and
bypasses the liver · Drug is rapidly absorbed
into the bloodstream

Buccal · Same as sublingual · Same as sublingual


Rectal · Can be used when drug · Dose absorbed is
has objectionable taste or unpredictable
odor

· Drug released at slow,


steady rate
Vaginal · Provides a local · Limited use
therapeutic effect
Topical · Provides a local effect · Maybe be messy and
may soil clothes
· Few side effects
· Drug can enter body
through abrasions and
cause systemic effects
Transdermal · Prolonged systemic · Leaves residue on the
effect skin that may soil clothes

· Few side effects

· Avoids gastrointestinal
absorption problems
Subcutaneo · Onset of drug action · Must involve sterile
us faster than oral technique because breaks
skin barrier

· More expensive than oral

· Can administer only


small volume

· Slower than
intramuscular
administration

· Some drugs can irritate


tissues and cause pain

· Can produce anxiety


Intramuscul · Pain from irritating drugs · Breaks skin barrier
ar is minimized
· Can produce anxiety
· Can administer larger
volume than subcutaneous

· Drug is rapidly absorbed


Intradermal · Absorption is slow (this is · Amount of drug
an advantage in testing for administered must be small
allergies)
· Breaks skin barrier
Intravenous · Rapid effect · Limited to highly soluble
drugs

· Drug distribution
inhibited by poor circulation
Inhalation · Introduces drug · Drug intended for
throughout respiratory tract localized effect can have
systemic effect
· Rapid localized relief
· Of use only for the
· Drug can be respiratory system
administered to
unconscious client

Pharmacology Terms &


Definitions, Clinical
Conditions, and Associated anaphylactoid reaction
Signs and Symptoms
excessive allergic response
acute dystonia manifested by wheezing, chills,
generalized pruritic urticaria,
extrapyramidal symptom diaphoresis, sense of uneasiness,
manifested by abnormal posturing, agitation, flushing, palpitations,
grimacing, spastic torticollis (neck coughing, difficulty breathing, and
torsion), and oculogyric (eyeball cardiovascular collapse.
movement) crisis.
anticholinergic actions
adverse effect
inhibition of parasympathetic
unintended, unpredictable, and response manifested by dry mouth,
nontherapeutic response to drug decreased peristalsis, constipation,
action. Adverse effects occur at blurred vision, and urinary
doses used therapeutically or for retention.
prophylaxis or diagnosis. They
generally result from drug toxicity, bioavailability
idiosyncrasies, or hypersensitivity
reactions caused by the drug itself fraction of active drug that reaches
or by ingredients added during its action sites after administration
manufacture, e.g., preservatives, by any route. Following an IV dose,
dyes, or vehicles. bioavailability is 100%; however,
such factors as first-pass effect,
afterload enterohepatic cycling, and
biotransformation reduce
resistance that ventricles must bioavailability of an orally
work against to eject blood into the administered drug.
aorta during systole.
blood dyscrasia
agranulocytosis
pathological condition manifested
sudden drop in leukocyte count; by fever, sore mouth or throat,
often followed by a severe infection unexplained fatigue, easy bruising
manifested by high fever, chills, or bleeding.
prostration, and ulcerations of
mucous membrane such as in the cardiotoxicity
mouth, rectum, or vagina.
impairment of cardiac function
akathisia manifested by one or more of the
following: hypotension,
extrapyramidal symptom arrhythmias, precordial pain,
manifested by a compelling need to dyspnea, electrocardiogram (ECG)
move or pace, without specific abnormalities, cardiac dilation,
pattern, and an inability to be still. congestive failure.

analeptic cholinergic response

restorative medication that stimulation of the parasympathetic


enhances excitation of the CNS response manifested by
without affecting inhibitory lacrimation, diaphoresis, salivation,
impulses. abdominal cramps, diarrhea,
nausea, and vomiting.
circulatory overload tissue turgor, sunken eyes,
furrowed tongue, low blood
excessive vascular volume pressure, diminished or irregular
manifested by increased central pulse, muscle or abdominal
venous pressure (CVP), elevated cramps, thick secretions, hard
blood pressure, tachycardia, feces and impaction, scant urinary
distended neck veins, peripheral output, urine specific gravity above
edema, dyspnea, cough, and 1.030, an elevated hemoglobin.
pulmonary rales.
disulfiram-type reaction
CNS stimulation
Antabuse-type reaction manifested
excitement of the CNS manifested by facial flushing, pounding
by hyperactivity, excitement, headache, sweating, slurred
nervousness, insomnia, and speech, abdominal cramps, nausea,
tachycardia. vomiting, tachycardia, fever,
palpitations, drop in blood
CNS toxicity pressure, dyspnea, and sense of
chest constriction. Symptoms may
last up to 24 hours.
impairment of CNS function
manifested by ataxia, tremor,
incoordination, paresthesias, enzyme induction
numbness, impairment of pain or
touch sensation, drowsiness, stimulation of microsomal enzymes
confusion, headache, anxiety, by a drug resulting in its
tremors, and behavior changes. accelerated metabolism and
decreased activity. If reactive
congestive heart failure (CHF) intermediates are formed, drug-
mediated toxicity may be
exacerbated.
impaired pumping ability of the
heart manifested by paroxysmal
nocturnal dyspnea, cough, fatigue first-pass effect
or dyspnea on exertion,
tachycardia, peripheral or reduced bioavailability of an orally
pulmonary edema, and weight administered drug due to
gain. metabolism in GI epithelial cells
and liver or to biliary excretion.
Cushing’s syndrome Effect may be avoided by use of
sublingual tablets or rectal
suppositories.
fatty swellings in the interscapular
area (buffalo hump) and in the
facial area (moon face), distension fixed drug eruption
of the abdomen, ecchymoses
following even minor trauma, drug-induced circumscribed skin
impotence, amenorrhea, high blood lesion that persists or recurs in the
pressure, general weakness, loss of same site. Residual pigmentation
muscle mass, osteoporosis, and may remain following drug
psychosis. withdrawal.

dehydration half-life (t½)

decreased intracellular or time required for concentration of a


extracellular fluid manifested by drug in the body to decrease by
elevated temperature, dry skin and 50%. Half-life also represents the
mucous membranes, decrease time necessary to reach steady
state or to decline from steady polyphagia, lethargy, and
state after a change (i.e., starting drowsiness.
or stopping) in the dosing regimen.
Half-life may be affected by a hyperkalemia
disease state and age of the drug
user. excessive potassium in blood,
which may produce lifethreatening
heat stroke cardiac arrhythmias, including
bradycardia and heart block,
a life-threatening condition unusual fatigue, weakness or
manifested by absence of heaviness of limbs, general muscle
sweating; red, dry, hot skin; dilated weakness, muscle cramps,
pupils; dyspnea; full bounding paresthesias, flaccid paralysis of
pulse; temperature above 40° C extremities, shortness of breath,
(105° F); and mental confusion. nervousness, confusion, diarrhea,
and GI distress.
hepatic toxicity
hypermagnesemia
impairment of liver function
manifested by jaundice, dark urine, excessive magnesium in blood,
pruritus, lightcolored stools, which may produce cathartic effect,
eosinophilia, itchy skin or rash, and profound thirst, flushing, sedation,
persistently high elevations of confusion, depressed deep tendon
alanine amino-transferase (ALT) reflexes (DTRs), muscle weakness,
and aspartate aminotransferase hypotension, and depressed
(AST). respirations.

hyperammonemia hypernatremia

elevated level of ammonia or excessive sodium in blood, which


ammonium in the blood manifested may produce confusion,
by lethargy, decreased appetite, neuromuscular excitability, muscle
vomiting, asterixis (flapping weakness, seizures, thirst, dry and
tremor), weak pulse, irritability, flushed skin, dry mucous
decreased responsiveness, and membranes, pyrexia, agitation, and
seizures. oliguria or anuria.

hypercalcemia hypersensitivity reactions

elevated serum calcium manifested excessive and abnormal sensitivity


by deep bone and flank pain, renal to given agent manifested by
calculi, anorexia, nausea, vomiting, urticaria, pruritus, wheezing,
thirst, constipation, muscle edema, redness, and anaphylaxis.
hypotonicity, pathologic fracture,
bradycardia, lethargy, and hyperthyroidism
psychosis.
excessive secretion by the thyroid
hyperglycemia glands, which increases basal
metabolic rate, resulting in warm,
elevated blood glucose manifested flushed, moist skin; tachycardia,
by flushed, dry skin, low blood exophthalmos; infrequent lid
pressure and elevated pulse, blinking; lid edema; weight loss
tachypnea, Kussmaul’s despite increased appetite;
respirations, polyuria, polydipsia; frequent urination; menstrual
irregularity; breathlessness;
hypoventilation; congestive heart vomiting, cardiac arrhythmias, and
failure; excessive sweating. neuromuscular symptoms (tetany,
positive Chvostek’s and
hyperuricemia Trousseau’s signs, seizures,
tremors, ataxia, vertigo,
excessive uric acid in blood, nystagmus, muscular
resulting in pain in flank; stomach, fasciculations).
or joints, and changes in intake and
output ratio and pattern. hypophosphatemia

hypocalcemia abnormally low level of phosphates


in blood, resulting in muscle
abnormally low calcium level in weakness, anorexia, malaise,
blood, which may result in absent deep tendon reflexes, bone
depression; psychosis; pain, paresthesias, tremors,
hyperreflexia; diarrhea; cardiac negative calcium balance,
arrhythmias; hypotension; muscle osteomalacia, osteoporosis.
spasms; paresthesias of feet,
fingers, tongue; positive Chvostek’s hypothyroidism
sign. Severe deficiency (tetany)
may result in carpopedal spasms, condition caused by thyroid
spasms of face muscle, hormone deficiency that lowers
laryngospasm, and generalized basal metabolic rate and may
convulsions. result in periorbital edema,
lethargy, puffy hands and feet,
hypoglycemia cool, pale skin, vertigo, nocturnal
cramps, decreased GI motility,
abnormally low glucose level in the constipation, hypotension, slow
blood, which may result in acute pulse, depressed muscular activity,
fatigue, restlessness, malaise, and enlarged thyroid gland.
marked irritability and weakness,
cold sweats, excessive hunger, hypoxia
headache, dizziness, confusion,
slurred speech, loss of insufficient oxygenation in the
consciousness, and death. blood manifested by dyspnea,
tachypnea, headache, restlessness,
hypokalemia cyanosis, tachycardia,
dysrhythmias, confusion,
abnormally low level of potassium decreased level of consciousness,
in blood, which may result in and euphoria or delirium.
malaise, fatigue, paresthesias,
depressed reflexes, muscle international normalizing ratio
weakness and cramps, rapid,
irregular pulse, arrhythmias, measurement that normalizes for
hypotension, vomiting, paralytic the differences obtained from
ileus, mental confusion, depression, various laboratory readings in the
delayed thought process, value for thromboplastin blood
abdominal distension, polyuria, level.
shallow breathing, and shortness of
breath. leukopenia

hypomagnesemia abnormal decrease in number of


white blood cells, usually below
abnormally low level of magnesium 5000 per cubic millimeter, resulting
in blood, resulting in nausea,
in fever, chills, sore mouth or brown urine (myoglobinuria) or
throat, and unexplained fatigue. oliguria.

liver toxicity nephrotoxicity

manifested by anorexia, nausea, impairment of the nephrons of the


fatigue, lethargy, itching, jaundice, kidney manifested by one or more
abdominal pain, dark-colored urine, of the following: oliguria, urinary
and flu-like symptoms. frequency, hematuria, cloudy urine,
rising BUN and serum creatinine,
metabolic acidosis fever, graft tenderness or
enlargement.
decrease in pH value of the
extracellular fluid caused by either neuroleptic malignant
an increase in hydrogen ions or a syndrome (NMS)
decrease in bicarbonate ions. It
may result in one or more of the potentially fatal complication
following: lethargy, headache, associated with antipsychotic drugs
weakness, abdominal pain, nausea, manifested by hyperpyrexia,
vomiting, dyspnea, hyperpnea altered mental status, muscle
progressing to Kussmaul breathing, rigidity, irregular pulse, fluctuating
dehydration, thirst, weakness, BP, diaphoresis, and tachycardia.
flushed face, full bounding pulse,
progressive drowsiness, mental orphan drug
confusion, combativeness.
(as defined by the Orphan Drug
metabolic alkalosis Act, an amendment of the Federal
Food, Drug, and Cosmetic Act
increase in pH value of the which took effect in January 1983):
extracellular fluid caused by either drug or biological product used in
a loss of acid from the body (e.g., the treatment, diagnosis, or
through vomiting) or an increased prevention of a rare disease. A rare
level of bicarbonate ions (e.g., disease or condition is one that
through ingestion of sodium affects fewer than 200,000 persons
bicarbonate). It may result in in the United States, or affects
muscle weakness, irritability, more than 200,000 persons but for
confusion, muscle twitching, slow which there is no reasonable
and shallow respirations, and expectation that drug research and
convulsive seizures. development costs can be
recovered from sales within the
microsomal enzymes United States.

drug-metabolizing enzymes located ototoxicity


in the endoplasmic reticulum of the
liver and other tissues chiefly impairment of the ear manifested
responsible for oxidative drug by one or more of the following:
metabolism, e.g., cytochrome headache, dizziness or vertigo,
P450. nausea and vomiting with motion,
ataxia, nystagmus.
myopathy
prodrug
any disease or abnormal condition
of striated muscles manifested by inactive drug form that becomes
muscle weakness, myalgia, pharmacologically active through
diaphoresis, fever, and reddish- biotransformation.
protein binding hyperreflexia, diaphoresis,
shivering, and tremor.
reversible interaction between
protein and drug resulting in a Somogyi effect
drug-protein complex (bound drug)
which is in equilibrium with free rebound phenomenon clinically
(active) drug in plasma and tissues. manifested by fasting
Since only free drug can diffuse to hyperglycemia and worsening of
action sites, factors that influence diabetic control due to
drug-binding (e.g., displacement of unnecessarily large p.m. insulin
bound drug by another drug, or doses. Hormonal response to
decreased albumin concentration) unrecognized hypoglycemia (i.e.,
may potentiate pharmacological release of epinephrine, glucagon,
effect. growth hormone, cortisol) causes
insensitivity to insulin. Increasing
pseudomembranous the amount of insulin required to
enterocolitis treat the hyperglycemia intensifies
the hypoglycemia.
life-threatening superinfection
characterized by severe diarrhea superinfection
and fever.
new infection by an organism
pseudoparkinsonism different from the initial infection
being treated by antimicrobial
extrapyramidal symptom therapy manifested by one or more
manifested by slowing of volitional of the following: black, hairy
movement (akinesia), mask facies, tongue; glossitis, stomatitis; anal
rigidity and tremor at rest itching; loose, foul-smelling stools;
(especially of upper extremities); vaginal itching or discharge;
and pill rolling motion. sudden fever; cough.

pulmonary edema tachyphylaxis

excessive fluid in the lung tissue rapid decrease in response to a


manifestied by one or more of the drug after administration of a few
following: shortness of breath, doses. Initial drug response cannot
cyanosis, persistent productive be restored by an increase in dose.
cough (frothy sputum may be blood
tinged), expiratory rales, tardive dyskinesia
restlessness, anxiety, increased
heart rate, sense of chest pressure. extrapyramidal symptom
manifested by involuntary
renal insufficiency rhythmic, bizarre movements of
face, jaw, mouth, tongue, and
reduced capacity of the kidney to sometimes extremities.
perform its functions as manifested
by one or more of the following: vasovagal symptoms
dysuria, oliguria, hematuria,
swelling of lower legs and feet. transient vascular and neurogenic
reaction marked by pallor, nausea,
serotonin syndrome vomiting, bradycardia, and rapid
fall in arterial blood pressure.
manifested by restlessness,
myoclonus, mental status changes,
water intoxication (dilutional
hyponatremia)

less than normal concentration of


sodium in the blood resulting from
excess extracellular and
intracellular fluid and producing
one or more of the following:
lethargy, confusion, headache,
decreased skin turgor, tremors,
convulsions, coma, anorexia,
nausea, vomiting, diarrhea, sternal
fingerprinting, weight gain, edema,
full bounding pulse, jugular vein
distension, rales, signs and
symptoms of pulmonary edema.