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You are watching: Which of the following medication routes has the slowest rate of absorption?

StatPearls . Sweetheart Island (FL): StatPearls Publishing; 2021 Jan-.


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Continuing education Activity

A medication administration route is frequently classified by the place at i beg your pardon the drug is applied, together as dental or intravenous. The selection of routes in which the medications are used depends not just on the convenience but likewise on the drug’s properties and pharmacokinetics. This activity describes medication management routes and also explains the interprofessional team"s function in improving care for patients who undergo medication administration.

Objectives:
Review just how interprofessional strategies in between healthcare team members have the right to improve determinants related to medicine route an option to boost pharmaceutical outcomes in patients.

Introduction

A medication administration route is frequently classified by the place at i beg your pardon the drug is administered, together as oral or intravenous. The an option of routes in which the medicine is offered depends not just on the convenience and compliance but also on the drug’s pharmacokinetics and also pharmacodynamic profile. Thus it is crucial to recognize the features of the assorted routes and techniques connected with them. Plenty of interprofessional health care team members are affiliated in the administration of medicines to patients.


Anatomy and also Physiology

Enteral course of Medication


Oral management of medication is a convenient, cost-effective, and also most typically used medication administration route. The main site of drug absorption is usually the tiny intestine, and the bioavailability that the medication is affected by the lot of drug took in across the intestinal epithelium. The first-pass result is an important consideration because that orally administered medications. It refers to the medicine metabolism whereby the medicine concentration is significantly diminished prior to it reaches the systemic circulation, often as result of the metabolism in ~ the liver.   

Parenteral course of Medication 


Intravenous injection is the most typical parental route of medication management and has actually the advantage of bypassing the first-pass line by the liver. Given their superficial location on the skin, peripheral veins provide easy access to the circulatory system and are frequently utilized in the parenteral management of medications. The top extremity is usually the desired site for intravenous medication together it has actually a reduced incidence of thrombophlebitis and also thrombosis than the lower limbs. The average basilic or cephalic veins of the eight or the metacarpal veins on the hand"s dorsum are generally used. In the lower extremity, the dorsal venous plexus of the foot have the right to be used.
Subcutaneous injections are another form of the parental route of medication and also are administered come the class of skin described as cutis, just listed below the dermis and also epidermis layers. Subcutaneous organization has couple of blood vessels; therefore, the drugs injected undergo absorption at a slow, sustained rate. Subcutaneous medication have the right to be administered to miscellaneous sites, consisting of the top arm"s outer area, abdomen staying clear of a 2-inch circle about the navel, the former of the thigh, top back, or the top area of the buttock behind the i know well bone.  

Other paths of Medication 


An intranasal drug path facilitates medicine absorption by passive diffusion throughout the single-layered, well-vascularized respiratory epithelium straight into the systemic circulation.
A vaginal path is an underexplored drug distribution route that is not frequently used yet has the advantages of bypassing the first-pass effect and can offer as one effective an approach for local and also systemic therapy. The venous plexuses from the vagina communicate with the vesical, uterine, and rectal venous plexuses and also drain into the inner iliac veins. The veins indigenous the middle and upper vagina drain straight into the inferior vena cava and bypass the hepatoportal system.

Indications

Enteral path of Medication


Oral drugs are convenient and are suggested for patient who have the right to ingest and tolerate one oral kind of medications. Some drugs with short half-lives are administered orally together timed-release or sustained-release forms that get absorbed over several hours.
Sublingual and buccal paths are suggested for drugs with high first-pass metabolism that should avoid clearance through the liver. For instance, nitroglycerin is cleared an ext than 90% during a single pass through the liver; therefore, the is provided as a sublingual form. The sublingual and buccal routes likewise have benefits of quick absorption, convenience, and low epidemic incidence.

Parenteral route of Medication


An intravenous route directly administers the medications to the systemic circulation. It is shown when a rapid drug impact is desired, a precise serum medicine level is needed, or as soon as drugs space unstable or poorly took in in the cradle tract. The is likewise the path utilized in patient with changed mental condition or major nausea or vomiting, can not to tolerate oral medications.  
A subcutaneous path is supplied when the drug"s molecular size is too large to it is in effectively soaked up in the intestinal street or when far better bioavailability or a quicker absorption rate is required than the dental route. It is easy to provide and needs minimal skills, so patients can regularly self-administer the medicine themselves. Typical medications administered subcutaneously incorporate insulin, heparin, and also monoclonal antibodies. 

Other paths of Medication


An intranasal course of medication can be utilized in administering sleep decongestants because that cold or allergy treatment. Various other uses encompass desmopressin because that the treatment of diabetes insipidus or intranasal calcitonin because that the therapy of osteoporosis. One inhaled medicine route deserve to be used to provide albuterol or corticosteroids such as fluticasone and also to provide inhaled anesthetics come patients.

Contraindications

Each medication administration route has distinct contraindications, and also the health care team members need to recognize them. An oral medication course is contraindicated because that patients who cannot tolerate dental drugs, such together those that have transformed mental condition or have actually nausea or vomiting that hinder them indigenous safely ingesting the drug orally. A rectal route is contraindicated in patient with energetic rectal bleeding or diarrhea or after ~ a recent rectal or bowel surgery. One intramuscular course is contraindicated in an active infection or inflammation in ~ the website of medicine administration, myopathies, muscular atrophy, thrombocytopenia, or coagulopathy.

A subcutaneous path of medicine is contraindicated in an actively infectious or inflamed site. Sheep that need to be injected more than 1.5 mL at once must be avoided. Subcutaneous injection volumes bigger than 2 mL are linked with disadvantage effects, including pain and leakage at the injection site.<8> one intranasal medication is contraindicated in patients through nasal trauma, anatomic obstruction, presence of a international body, or copious mucous or bleeding. Similarly, one inhaled medicine is contraindicated in patients v airflow obstruction.


Equipment

The tools required relies on the route chosen for medication administration. In general, devices needed for the parenteral route may incorporate gauze, dry noodle swab, nitrile gloves, chlorhexidine or alcohol-based antiseptic agent, tourniquet, accordingly gauged intravenous catheter, syringe, normal saline flush, and also a bandage. A neighborhood anesthetic agent may be used for bigger cannulas or to minimize discomfort in part patients, such together pediatric patients. A lubricant deserve to be made use of in rectal or vaginal management of medicine to reduce friction and also discomfort.


Personnel

One personnel is usually enough for all routes of medicine administration. Still, extr assistance may be helpful if the patience is unable to remain in an optimal place or when administering come children.


Preparation

The “five rights” space emphasized because that the preparation of medication administration: right patient, right drug, appropriate dose, right site, and right timing.<9> it is essential to explain to patients exactly how the medication will be administered, attain consent for steps when suggested (e.g., central venous catheter), and assist prepare patients before they obtain their medication. The site of application of the medication have to be chosen based upon its adequacy and also indications. The brand on the medication have to be checked for the name, dose, and also approved consumption route.


Technique

Techniques connected in each path of medication management are different, and some of the necessary points room summarized together follows:

Intravenous Route

A tourniquet may be supplied over the website intended because that the intravenous medication to make the vein an ext visible and easier come access. However, once used, the tourniquet have to be removed prior to injecting the medicine to protect against extravasation. In main lines or peripherally inserted central catheter (PICC) lines for the medication administration, ultrasound guidance is often used.<10>  

Intramuscular Route

Intramuscular injection must be excellent at a perpendicular angle together it has been shown to be the many effective method for patience comfort, safety, and medication efficacy.<11> Skin traction and also deep press to the muscle can help decrease patients" pain and discomfort.<12> as soon as injecting to the dorsogluteal site, aspirating for a couple of seconds is recommended, offered its proximity come the gluteal artery.<13>

Subcutaneous Route

A subcutaneous route calls for minimal an abilities and training, and patients have the right to often quickly learn to inject drugs to themselves. The is recommended that rather of utilizing the very same site, patients rotate the web page of injection to protect against complications such together lipohypertrophy the can cause incomplete medicine absorption.<14> The injection is generally at an edge if using a needle/syringe or at a perpendicular edge if utilizing an injector pen.

Rectal Route

It is recommended to have actually the patient lie onto the left side v the right knee bent in the direction of the chest as this position allows the medicine to flow into the rectum and also subsequently come the sigmoid colon through gravity. Separate the buttocks through the non-dominant gloved hand and also gently insert the medicine 2 to 4 cm right into the rectum using a leading hand"s gloved index finger. A lubricant may be offered for the patient’s comfort. If administering a laxative suppository, the patient will need a bedpan or commode or be put close come the toilet. It is recommended the the patient stays on the side for 5 to 10 minutes uneven otherwise mentioned by the medication’s directions.<15>    

Vaginal Route

Position the patience onto their earlier with legs bent and feet resting flat on the bed. A lubricant deserve to be provided to minimize friction against the quality mucosa together the medication is administered. Gently different labial folds with the non-dominant gloved hand while through the leading gloved index finger, insert the lubricated suppository to about 8-10 cm follow me the posterior vaginal wall.

Inhaled Route

Each inhaler has actually its instructions indigenous the manufacturer. For metered-dose inhalers, several of the vital techniques include: shake the inhaler vigorously for a few seconds prior to each puff; inhale with the mouth, no the nose once breathing in the medication; keep the tongue under the mouthpiece to stop blocking the mouthpiece; take it a slow-moving deep breath as the medication canister is pressed and also hold the breath for 5 to 10 seconds and then exhale. Cleaning the inhaler routinely is recommended to stop a buildup of medications. Spacers or chambers can help patients breathe the aerosol and aid decrease the deposition of the medicine in the mouth or throat.


Complications

The clinical personnel should recognize the potential symptom of each path of medicine administration. The parenteral course can cause pain or discomfort in the area of application, bleeding, bruising, infection, or inflammation. Infiltration is a typical complication that the intravenous route by which the intravenous fluid or medicine enters the neighboring tissue and also not the vein. It is not considered severe unless the infiltrated medication is a compound that may damages the bordering tissue, such together a chemotherapeutic agent or a vesicant, in which case the complication is termed extravasation, and this may lead to tissue necrosis. Although the intravenous route has the advantage of swiftly delivering drugs to patients, this may reason nonspecific serious cardiopulmonary effects, and also the health care personnel should closely monitor the patients.

For intramuscular injections, there are site-specific complications to be aware of. In deltoid muscle injection, an unintended injury come radial and axillary nerves v resultant paralysis or neuropathy may not constantly resolve.<16> As disputed previously, the dorsogluteal site injection tote an raised risk of sciatic nerve injury, and therefore the ventrogluteal website is more recommended.<3> Complications associated with the subcutaneous path are much more medication-specific. Because that instance, in subcutaneous insulin, lipohypertrophy or lipoatrophy have the right to develop, resulting in slower or incomplete insulin absorb at the injection site.<17> Therefore, using different injection web page is recommended to patients.

In the intranasal route, interseptal nasal perforation had been reported in some patients, specifically those using intranasal steroids for a prolonged period.<18> Rebound congestion in patients on chronic sleep decongestants is seen as the sinusoid vasculatures perform not respond as well to the adrenergic drug with lengthy use and an outcome in a hyperemic, congested mucosa. Complications connected with inhaled medications are likewise often medication-specific. Because that instance, inhaled corticosteroids can cause local deposition that leads come thrush or dysphonia, and also sometimes cough, neck irritation, and contact hypersensitivity additionally have to be reported.<19>


Clinical Significance

Administering medicine is the hallmark of dealing with patients in different healthcare settings. The interprofessional health care team members require to understand the distinct properties of each route of medication administration. Learning contraindications and potential symptom can help avoid unnecessary threats in patients, while understanding indications can aid choose the ideal medication delivery route.


Enhancing healthcare Team Outcomes

Each route of medication administration has that is unique qualities that should be thought about by the healthcare team when caring because that patients. Certain techniques, together as central venous catheter placement and also PICC lines, require more advanced an abilities and training, and it is vital to communicate and also plan on exactly how the procedure will proceed. The healthcare members affiliated in patient care should likewise be conscious of and proactively monitor because that potential immediate and also delayed medication management complications. Informing patients well around the process and involving them in the decision-making procedure whenever suitable can improve the all at once healthcare outcome. Because that instance, in the rectal or vaginal route, patients may prefer to self-administer the drugs. Medical care personnel need to be aware of potential personal or social barriers to these medication routes.<7>


Nursing, allied Health, and Interprofessional Team Interventions

Minimizing pains or discomfort linked with medication administration can assist improve patient experience and health outcomes. Utilizing regional anesthetics when ideal for the parenteral path or utilizing lubricants in the rectovaginal medication route can be helpful.


Nursing, ally Health, and also Interprofessional Team Monitoring

Being conscious of and also monitoring because that potential immediate and also delayed symptom upon medication administration is essential. For example, in the main venous catheter, adverse effects such together bleeding, hematoma, thrombosis, or infection need to be monitored closely.

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<20> Also, nursing staff should help maintain the area the the venous catheter sterile, inspect for its usability regularly, and also communicate with other medical care team members as soon as there space issues.


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