References:
- Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 11th Edition, ISBN 9780135428733, by Audrey Berman, Shirlee J. Snyder, and Geralyn Frandsen (Ch. 35, pp. 852–854)
Pharmaceutical preparations are generally designed for one or two specific routes of administration. The route of administration should be indicated when the drug is ordered. When administering a drug, the nurse should ensure that the pharmaceutical preparation is appropriate for the route specified. The nurse often administers opioids for pain management. The routes for opioid delivery are also discussed in this chapter.
| Route | Advantages | Disadvantages |
|---|---|---|
| Oral | Usually least expensive Safe, does not break skin barrier Administration usually does not cause stress Some new oral medications are designed to rapidly dissolve on the tongue, allowing for faster absorption and action | Inappropriate for clients with nausea or vomiting Drug may have unpleasant taste or odor Inappropriate when GI tract has reduced motility Inappropriate if client 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 clients |
| Sublingual | Same as for oral, plus: Drug can be administered for local effect More potent than oral route because drug directly enters the blood and bypasses the liver | If swallowed, drug may be inactivated by gastric juice Drug must remain under tongue until dissolved and absorbed. May cause stinging or irritation of the mucous membranes Drug is rapidly absorbed into the bloodstream |
| Buccal | Same as for sublingual | Same as for sublingual |
| Rectal | Can be used when drug has objectionable taste or odor Drug released at slow, steady rate Provides a local therapeutic effect | Dose absorbed is unpredictable May be perceived as unpleasant by the client Limited use |
| Vaginal | Provides a local effect | May be messy and may soil clothes |
| Topical | Few side effects | Drug can enter body through abrasions and cause systemic effects Leaves residue on the skin that may soil clothes |
| Transdermal | Prolonged systemic effect Few side effects Avoids GI absorption problems Onset of drug action faster than oral | Rate of delivery may be variable Verify that the previous patch has been removed and disposed of appropriately to avoid overdose |
| Subcutaneous | Absorption is slower (an advantage for insulin and heparin administration) | Must involve sterile technique because breaks skin barrier More expensive than oral Can administer only small volume Some drugs can irritate tissues and cause pain Can produce anxiety Breaks skin barrier |
| Intramuscular | Can administer larger volume than subcutaneous Drug is rapidly absorbed | Can produce anxiety Breaks skin barrier |
| Intradermal | Absorption is slow (this is an advantage in testing for allergies) | Amount of drug administered must be small Breaks skin barrier |
| Intravenous | Rapid effect | Limited to highly soluble drugs Drug distribution inhibited by poor circulation |
| Inhalation | Introduces drug throughout respiratory tract Rapid localized relief Drug can be administered to unconscious client | Drug intended for localized effect can have systemic effect Of use only for the respiratory system |
Oral
Oral administration is the most common, least expensive, and most convenient route for most clients. In oral administration, the drug is swallowed. Because the skin is not broken as it is for an injection, oral administration is also a safe method. The major disadvantages can include an unpleasant taste of the drugs, irritation of the gastric mucosa, irregular absorption from the GI tract, slow absorption, and, in some cases, harm to the client’s teeth. For example, the liquid preparation of ferrous sulfate (iron) can stain the teeth.
Sublingual
In sublingual administration a drug is placed under the tongue, where it dissolves. In a relatively short time, the drug is largely absorbed into the blood vessels on the underside of the tongue. The medication should not be swallowed. Nitroglycerin is one example of a drug commonly given in this manner.
Buccal
Buccal means “pertaining to the cheek.” In buccal administration, a medication (e.g., a tablet) is held in the mouth against the mucous membranes of the cheek until the drug dissolves. The drug may act locally on the mucous membranes of the mouth or systemically when it is swallowed in the saliva.
Parenteral
The parenteral route is defined as other than through the alimentary or respiratory tract; that is, by needle. The following are some of the more common routes for parenteral administration:
- Subcutaneous (hypodermic)—into the subcutaneous tis- sue, just below the skin
- Intramuscular (IM)—into a muscle
- Intradermal (ID)—under the epidermis (into the dermis)
- Intravenous (IV)—into a vein.
Some of the less commonly used routes for parenteral administration are intra-arterial (into an artery), intracardiac (into the heart muscle), intraosseous (into a bone), intrathecal or intraspinal (into the spinal canal), intrapleural (into the pleural space), epidural (into the epidural space), and intra-articular (into a joint). Sterile equipment and sterile drug solution are essential for all parenteral therapy. The main advantage is fast absorption.
Topical
Topical applications are those applied locally to the skin or to the mucous membranes. They affect only the area to which they are applied. Topical applications include the following:
- Dermatologic preparations—applied to the skin
- Instillations and irrigations—applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina
- Inhalations—administered into the respiratory tract by a nebulizer or positive pressure breathing apparatus. Air, oxygen, and vapor are generally used to carry the drug into the lungs.