Tri Widyawati

Dep. Farmakologi & Terapeutik,

Fakultas Kedokteran

15 April 2020, Blok 7 FKG USU, Medan

 Definition
A route of administration is the
path by which a drug, fluid, poison
or other substance is brought into
contact with the body.
 Drug Administration
oral intramuscular subcutanous topical intravenous

Absorption

Tissue Site of Action

Plasma water

Metabolism

Excretion
 Classification
Routes of administration can broadly be divided
into:
• Topical: Drugs are applied topically to the
skin or mucous membranes, mainly for local
action.
• Oral: used for systemic (non-local) effect,
substance is given via the digestive tract.
• Parenteral: A drug administered parenterally
is one injected via a hollow needle into the
body at various sites and to varying depth.
• Rectal: Drugs given through the rectum by
suppositories or enema.
• Inhalation: The lungs provide an excellent
surface for absorption when the drug is
delivered in gaseous, aerosol or ultrafine solid
particle form.
 Routes of Administration
Oral Parenteral
Swallow, Sublingual, Buccal ID, Sub-Q, IM, IV

Other Topical
Epidural, Intrathecal, Skin
Intraosseous, Transdermal patch
Intraperitoneal, Intrapleural, Instillation or irrigation
Intraarterial
Inhalation Intraocular
Nasal passages, oral Insertion of disk containing
passage, ET or trach med; drops
 TOPICAL ADMINISTRATION
• PERCUTANEUS
• EYE OINTMENT AND INSTILLATION
• NASAL INSTILLATION
• EAR INSTILLATION
• VAGINAL SUPPOSITORIA AND IRRIGATION
• URETHRAL SUPPOSITORIA
 Topical route:
1. Skin
A Dermal – cream, ointment (local action)
B Transdermal- absorption of drug through skin
(i.e systemic action)
I. stable blood levels
(controlled drug delivery system)
II. No first pass metabolism
III. Drug must be potent or patch becomes too
large
Transdermal drug patches

Source: Nursing made Incredibly Easy, Vol. 5, No. 2, pg.18

8
 Topical route:
2. Mucosal membranes
• Eye drops (onto the conjunctiva)
• Ear instillations (drops)
– straighten canal
• Nasal instillations (into the nose)
– position
• Vaginal applications
– technique
• Rectal instillations
– technique
9
INFANT ADULT
NASAL DROPS
 Oral route
• By swallowing.
• It is intended for systemic effects resulting
from drug absorption through the various
epithelia and mucosa of the
gastrointestinal tract.
 Oral medications
• Systemic and local • Common dose forms
actions for oral
• Forms administration
– solids – tablets
– enteric coated – capsules
– liquids – liquids
– solutions
– suspensions
– syrups
– elixirs
19
 Advantages of Oral route
1. Convenient - portable, no pain, easy to
take.
2. Cheap - no need to sterilize, compact,
multi-dose bottles, automated machines
produce tablets in large quantities.
3. Variety - tablets, capsules, suspensions,
mixtures .
 Disadvantages of Oral route
1- Sometimes inefficient - low solubility drugs may suffer poor
availability e.g. Griseofulvin
2- First-pass effect - drugs which are extensively metabolized will be
metabolized in the liver during absorption. e.g. propranolol
3- Food - Food and G-I motility can affect drug absorption.
Often patient instructions include a direction to take with food or take
on an empty stomach.
Absorption is slower with food (milk and milk products) for
tetracyclines and penicillins, etc.
However, for propranolol bioavailability is higher after food,
and for griseofulvin absorption is higher after a fatty meal.
4- Sometimes may have adverse reactions – e.g. Antibiotics may kill
normal gut flora and allow overgrowth of fungal varieties. Thus,
antifungal agent may be included with an antibiotic.
5- Not suitable for unconscious patient - Patient must be able to
swallow solid dosage forms. Liquids may be given by tube.
6- May cause irritation to gastric mucosa, nausea and vomiting.
7- Effect too slow for emergencies.
 Oral Administration
• easy to take, safe, comfortable and economic
• slow onset of action
• absorption may be affected by food
• drugs can be destroyed by gastric secretion and
low ph
• first pass metabolism in liver
• drugs may irritate gi mucous
• can’t be given to unconscious patients
 Clinical Application
• for easier ingestion, tablet can be crushed and
mixed with a small amount of liquid or soft food
• drugs are given before, with or after meal
• for unconscious patients, drugs can be given via
NGT (naso gastric tube)
 Sublingual Administration
• drug is absorbed from oral mucous
• fast absorption & high bioavailability
• fast effect
• no first pass metabolism in liver
• drugs are not destroyed by gi secretion
• absorption do not affected by food
• distasteful
• may irritate oral mucous
 Buccal/Sublingual route
• Some drugs are taken as smaller tablets
which are held in the mouth (buccal
tablet) or under the tongue (sublingual
tablet).
• Buccal tablets are often harder tablets [4
hour disintegration time], designed to
dissolve slowly.
• e.g Nitroglycerin, as a softer sublingual
tablet [2 min disintegration time], may be
used for the rapid relief of angina.
 Clinical Application
• oral mucous should be wet to
fascilitate drugs dissolution and
absorption
• avoid drinking water after administer
the drug
• nitrate preparations are used to be
administered by this route
 Advantages of
Buccal/Sublingual route
1. Avoid hepatic first pass - The liver is by-
passed thus there is no loss of drug by first
pass effect for buccal administration.
Bioavailability is higher.
2. Rapid absorption - Because of the good blood
supply to the area, absorption is usually quite
rapid.
3. Drug stability - pH in mouth relatively neutral
(gf. stomach - acidic). Thus a drug may be
more stable.
 Disadvantages of
Buccal/Sublingual route
1. Holding the dose in the mouth is
inconvenient.
2. Small doses only can be
accommodated easily.
 Oral Medications
• NEVER crush sustained release,
controlled release or enteric coated pills.
• Capsules can not be split
• More than 3 to = dose
• Place into plastic/paper administration cup
without touching the med.
• May use pudding or applesauce for
patient’s with difficulty swallowing
• Stay with patient until all medications are
taken.
 Parenteral route
• Parenteral
• giving a substance by
any route other than
through the GI system
• Most often given by
injection (invasive
procedure)

Drugs injected under the skin are not absorbed in the GI tract and are not
initially metabolized in the liver.
Parenteral medications must be sterile and must be in a liquid form – may
be diluted with sterile water or NS
 Drawbacks for Parenteral
Medication:
• Infection
• Pain
• Localized bleeding
• Nerve damage
• Sterile abscesses
• Necrotic tissue
• Once the drug is under the skin, absorption
occurs
• Administration of injectable medications prevent
injury to nerves, blood vessels, tissue and
prevent infection
 Key Terms
• Intravena • Ampule
• Intramuscular • Vial
• Subcutaneous • Viscous
• Intradermal • Wheal
• Intrathecal • Bevel
• Compatible
• Filter needle
• Gauge
 Needles
• Many lengths, diameters, gauges
• Choice depends on:
– depth needed
– viscosity of medication
– safety
– patient comfort
 Injectable Medication Containers

• Ampules—small,
glass, sealed
containers; hold
single doses
• Vials—glass/plastic
containers with metal-
enclosed rubber
seals; hold single,
multiple doses Figure 14-10. Assorted vials and ampules.
From Perry AG and Potter PA (2002). Clinical
• Prefilled syringes nursing skills and techniques (5th ed.). St. Louis,
Mosby.
 Preparing a Medication: “Vial”
• Remove metal/plastic cap
covering rubber stopper
(if first use of vial)
• Cleanse stopper with
alcohol
• Remove needle cover;
draw air amount into
syringe equal to liquid
amount to be withdrawn Vials.
From Potter PA and Perry AG (2001).
• Maintain equal pressure Fundamentals of Nursing (5th ed.). St. Louis:

within vial Mosby.

 Preparing a Medication: “Vial”

Insert needle into rubber cap; Invert vial with syringe in place
inject air into vial Ensure needle remains below
liquid surface
Reconstitution of Powder forms of Medication

• some medications come in a powder form

because they would lose their potency if mixed
to soon
• the label will tell what type of diluent and how
much is to be used
• some require sterile water vs. NS or some may
say preservative free solution (watch carefully
and when in doubt ASK)
Mixing Medications: Two Multidose Vials
• Inject air into vial A
before injecting air
into vial B
• Do not touch needle
to solution in vial A
• Hold plunger, remove
syringe from vial A
• Aspirate and insert
needed air into vial B
• Remove proper
medication amount
from vial B
 Intravascular (IV, IA):
• placing a drug directly into blood stream, may be
• Intravenous (into a vein) or
• intraarterial (into an artery).
Advantages
1- precise, accurate and immediate onset of
action, 100% bioavailability.
Disadvantages
1- risk of embolism.
2- high concentrations attained rapidly leading to
greater risk of adverse effects.
Intravascular Injection Sites
 Intra-venous injection
• desirable plasma concentration can be
achieved rapidly and accurately
• irritative and hypertonic drugs may be
given by this route
• may provide a precise and continuous
drug therapy using iv infusion
• adverse drug reaction may occur rapidly
• insoluble or oily substance may cause
embolism
• aseptic procedure may cause infection
 clinical application
• appropriate in emergency cases which
required rapid effect
• also appropriate when the medications are
too irritating to be given by other routes
(eg. cancer chemotherapy)
• establish an iv line if we are going to
administer the medication by iv route
repetitively
• always use sterile technique to prevent
infection
 Intra-arterial injection
• this route is reserved for situations
requiring localization of drug in particular
organs
• localised drug concentration, so reduces
the toxic concentration in systemic
circulation
• eg. injecting an anti neoplastic nitrogen
moustard at a tumor site
• sterile procedures are needed as well
 Intramuscular (IM)
into the skeletal muscle
Advantages
1- suitable for injection of drug in aqueous
solution (rapid action) and drug in
suspension or emulsion (sustained
release).
Disadvantages
1- Pain at injection sites for certain drugs.
Intramuscular Vastus lateralis
Injection Sites
Gluteus

Deltoid
 Intra-muscular injection
• medications that irritate subcutaneous
tissue (eg. penicillin) may safely be given
by this route
• absorption rate is greater than
subcutaneous injection
• larger volume of fluid may be given
• frequently used sites are dorsogluteal,
ventrogluteal, vastus lateralis, rectus
femoris, deltoid and triceps muscles
• only healthy muscles should be used for
injection
Z – TRACT INJECTION
 ID Injection Sites
• Forearm, upper back, upper dorsal aspect of
arm, upper chest
• Avoid scarred, blemished, hairy areas
• Slowly inject medication until wheal forms on
skin
 Intra-cutaneous injection
• drug is injected into the dermal layer just
beneath the epidermis
• only small amount of liquid is used (0,1 ml)
• this method is indicated frequently for
allergy skin tests, tuberkulin tests and
vaccinations
• common sites for injection are inner lower
arm, upper chest and the back beneath
the scapulae
 Subcutaneously:
• 45-degree angle
• adipose tissue
• tissue does not have as
many blood vessels as
muscle so medication is
absorbed slower
• 2 mL max.
• common sites: posterior
arm, abdomen and
anterior aspects of the
thigh
 subcutaneous injection
• drugs injected at subcutaneus layer
• slow absorption
• combination with vasocontrictor agents
may decrease absorption rate
• avoid irritative drugs
 Clinical Application
• hormones ( eg. implant), local
anaesthetic, heparin and insuline are
used to be administered by this route
• in repeated injections, the site of
injection need to be varied in order to
minimize tissue damage, aid
absorption and avoid discomfort
 Other Parenteral Routes
C- Subcutaneous (under the skin), e.g. insulin.

D- Intradermal, (into the skin itself) is used for

skin testing some allergens.

E- Intrathecal (into the spinal canal) is most

commonly used for spinal anesthesia .

F- Intraperitoneal, (infusion or injection into the

peritoneum) e.g. peritoneal dialysis in case of
renal insuffeciency.
 intrathecal injection
• drugs injected to subarachnoid space
• in order to achieve rapid effect to
cerebrospinal axis
• used in treatment of cns infections and
spinal anesthesia
 intraperitoneal injection
• rare, more often used for laboratory animal
• large surface area, rapid absorption
• high infection risk (peritonitis) and
peritoneal adhesions
• used for dialysis method
 Rectal route:
• Most commonly by suppository or enema.
Advantages
1- By-pass liver - Some of the veins draining the rectum
lead directly to the general circulation, thus by-passing
the liver. Reduced first-pass effect.
2- Useful - This route may be most useful for patients
unable to take drugs orally
– (unconscious patients) or with younger children.
– if patient is nauseous or vomiting
Disadvantages
1- Erratic absorption - Absorption is often incomplete and
erratic.
2- Not well accepted.
 Rectal Administration
• less first pass metabolism in liver
• can be given to unconscious or vomiting
patients
• advantageous when the medication has
an objectionable taste or odor
• avoid irritation to upper gi tract
• drug absorption is not complete
• several drugs may irritate rectal mucous
 clinical application
• rectal suppositories are given to provide a
local effect (eg. laxative, antihemorrhoid)
or systemic effect (eg. analgesia ,
antibiotic)
• when inserting suppositories, the patients
position are left lateral
• after inserting suppositories, press the
patients buttocks together for a few
seconds
Rectal Suppositoria
Inhalation route
• used for gaseous and volatile agents and aerosols.
• solids and liquids are excluded if larger than 20 micron.
à the particles impact in the mouth and throat.
• Smaller than 0.5 micron , they aren't retained.
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.
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 patient having difficulties in giving themselves a drug by
inhaler.
 INHALATION
• Intended to local effect at respiratory tract but
systemic absorption via alveoli may occur
• THE MEDICATION IS USED TO TREAT
RESPIRATORY PROBLEM (eg. Asthma
bronchiale, copd)
• Common medications used are
bronchodilators and steroids
KEBANGGAAN INDONESIA UNTUK DUNIA