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Drug Administration

TermDefinition
Dose or unit (unit dose)- measured amount of drug
Local effect (topical)- drug effect stays at the site of administration
Systemic effect- drug acts on many sites away from the administration site
Gastrointestinal/Enteral- applied via the digestive tract (systemic effect) oral, sublingual, buccal, and rectal
Parenteral- injectable method of application (systemic effect)
Topical/Localized- localized administration, but not applied enteral or parenteral (limited systemic effects) Vaginal, inhalation, otic, nasal, inhaled, transdermal
Topical/Localized- Ears and Eyes
Otic- Ear (auricular) Administration via otic dropper directly into the ear
Earwax buildup Carbamide peroxide drops- help soften, loosen, and remove earwax.
Ear Infection Antibiotic drops (e.g. ciprofloxacin, gentamicin, and neomycin)- used alone or in combination with corticosteroid (acetic acid) to treat ear infections.
Ear swelling, irritation, inflammation Corticosteroids (e.g. dexamethasone, fluocinolone, and hydrocortisone)- used to decrease swelling, irritation, or inflammation
Ophthalmic and Ocular- Eye
Ophthalmic administration- via eye dropper directly into the eye (eye drops).
Intravitreal administration- via a needle into the vitreous of the eye (less common)
Eye redness Vasoconstrictor to constrict or tighten small superficial blood vessels (e.g. Visine)
Eye infection/prevention of inflammation and eye infection post cataract surgery Combination of corticosteroids and antibiotics in a saline solution (e.g. TobraDex)
Conjunctivitis (pink eye)- inflammation of the conjunctiva (inner surface of the eyelids, over the forepart of the eyeball) Bacterial cause- antibiotics (e.g. bacitracin, AK-Spore). Viral cause- symptomatic treatment
Allergic symptoms (itchy, red, watery eyes) Patanol eye drops
Eye dilation Mydriacyl eye drops
Glaucoma Diamox (pill formulation)
Dental- mostly a local effect
Local anesthetics- deaden the nerves in and around the teeth and can be applied via injection, a swish, a spray, or a gel.
Types of Local anesthetics: lidocaine (Xylocaine), articaine/epinepherine (Septocaine) mepivacaine (Carbocaine) prilocaine (Citanest) bupivacaine (Marcaine)
Tooth whitening- applied directly to the teeth e.g carbamide peroxide gel (same medication applied to the ear canal for wax buildup)
Inhalation- taking in of air, or of breathing in a drug, which affects the airway and lungs directly, or is absorbed through the lungs for a systemic effect.
Example Inhalers: Albuterol- dilates the bronchi to ease breathing during an asthma attack (local effect) Tobi- inhaled drug that treats infections (systemic effect)
Nebulizer- device used to administer medications in the form of a mist that is inhaled into the lungs. It can be used in treating the symptoms of asthma.
Anesthesia- the most common medication administered via inhalation with a systemic effect to begin and to maintain a general anesthesia.
General anesthesia- is for pain control, often during surgery, chara. by unconsciousness, muscle relaxation, a total loss of sensation throughout the entire body. Administered using either a face mask or an endotracheal tube
Nitrous oxide (laughing gas)- relieves pain and causes relaxation and forgetfulness but usually without putting a patient under, often used in dental offices.
desflurane (Suprane) a potent inhalational anesthetic that is used during surgery to accomplish general anesthesia
Skin - Applying medication to a specific area of the skin, or to a wound, to anesthetize it, clean it, or otherwise aid in healing is a way to topically administer some medications.
Lotions and emollients Hydrate the skin and make it soft
Antibiotic ointments Apply to scrapes or cuts to prevent infection (e.g. Neosporin)
Astringents Draw together tissues, protect the skin, and help to stop bleeding (e.g. Calamine lotion)
Antifungals Treat athlete’s foot (e.g. miconazole) and jock itch (e.g. Lamisil)
Cleansers Cleans out wounds (e.g. Betadine)
Premedicated pads Treatment of hemorrhoids (e.g. Tucks)
Sprays To relieve pain (e.g. Dermoplast and benzocaine)
Antivirals Treat cold sores (e.g. Abreva)
Nose- using the inside of the nose as an administration route (Intranasal) to primarily treat medical problems related to the nose (e.g. nosebleeds, sinus congestion/swelling)
Examples of Nose Administration: Flonase, Nasonex, and Afrin
Systemic agent- Imitrex Nasal Spray for migraine headaches
Vaginal- generally administered topically in the form of a cream or suppository
Antifungal Suppositories- treat vaginal infections e.g. Gyne-Lotrimin, Monistat, and Vagistat
Powders, creams, sprays- treat symptoms of vaginal infection
Spermicide- cream or suppository form, inserted into the vagina to kill sperm and prevent pregnancy.
Progesterone- vaginal suppository inserted into the vagina where it is assimilated into the soft tissues and then the bloodstream, raising the level of progesterone in the body (systemic effect).
Enteral- “relating to or inside the intestines” and have an intended systemic effect
Enteral medications- medications-assimilated into the body through the gastrointestinal system, and the primary method for getting them into the body is through the mouth.
Oral administration- by mouth, then in the stomach where most pass through intestinal wall and the liver.
Gastroduodenal feeding tube - is an example of enteral administration that bypasses the mouth
Nasogastric tube (NG tube)- through the nose, down the esophagus, and into the stomach
G-tube- A gastric or a gastrostomy feeding tube is inserted via a small incision directly into the stomach. A similar tube, also inserted (usually via laparoscopy) for feeding is a percutaneous endoscopic gastrostomy (or PEG) tube
Jejunostomy tube- smaller than a gastric tube and, is inserted into the jejunum instead of the stomach
Rectal- via the rectum have a systemic effect and are generally in the form of a suppository or an enema
Suppository- sm plug or cone of med inserted in rectum, designed to melt at body temp, being absorbed into the surrounding soft mucosa. A suppository is considered enteral because they are assimilated through the digestive tract
Phenergan suppositories- treat nausea
glycerin or bisacodyl (Dulcolax)- treat constipation
Oral medications can be either solids or liquids
long acting (LA) - Entex LA a cold medicine which contains a decongestant and an expectorant
long acting (LA) - Inderal LA a beta-blocker used to help with chest pain, prevent heart attacks, or treat other circulatory system problems
sustained release (SR) - Wellbutrin SR an antidepressant. It works on the brain to treat depression
sustained release (SR) - Bontril SR an appetite suppressant
extended release (ER) - Ultram ER for pain management, especially those with moderate to severe pain that requires a long treatment period can be addictive used when around-the-clock management is required
extended release (ER) - Depakote ER This is both an anticonvulsant and a mood-stabilizing drug. It is used for treatment of bipolar disorder, epilepsy, and migraines.
controlled release (CR) - Nalex CR a cold medicine which contains the same generic medicine as Entex LA
extended release (XL) - Glucotrol XL an antidiabetic medication
Buccal- refers to the area inside the cheek. The buccal area has large area of smooth muscle that allows for sustained delivery. The drug is placed between the upper gums and the cheek for buccal enteral administration
Nicotine Gum- Delivers doses of nicotine to the blood-vessel-rich areas of the mouth EX: NicoDerm CQ, Habitrol
Testosterone- male hormone, used to treat testosterone deficiency in men. EX: Striant
Sublingual- the area under the tongue near many blood vessels
Under the tongue (permeable) capable of being penetrated, particularly by a liquid or a gas
Under the tongue (rich blood supply) means that substances can be assimilated very quickly from here
Sublingual (enteral administration) medication is placed under the tongue and is one of the fastest ways for a drug to get into the body systemically
Sublingual (parenteral adminstration) administration-bypasses the gastrointestinal system, and it is both assimilated quicker and causes fewer breakdowns or change in the chemistry of the drug itself
Sublingual Medications: buprenorphine SL nitroglycerin SL isosorbide dinitrate SL
buprenorphine SL An opioid, ironically used for treatment of opioid dependence. A pt is given sublingual doses of narcotic buprenorphine, under a brand name such as Subutex, in order to avoid severe withdrawal symptoms
nitroglycerin SL A vasodilator that relaxes blood vessels, easing the workload of the heart, often given for angina or chest pain
isosorbide dinitrate SL A vasodilator used to dilate the blood vessels, which helps to both prevent and alleviate heart pain
Parenteral - Intravenous Injections
Intravenous (IV)- injecting medication directly into a vein using a needle and syringe. The drugs bypass the gastrointestinal system, thereby avoiding both the delay of effect and the chemical alteration that can occur.
IV Syringe- contains the drug and is attached to a hollow needle, and the drug is injected directly into a vein, generally a vein in the arm
Peripheral IV line- is a catheter placed into a peripheral vein to administer meds or fluids and draw blood.
Central IV line (or central venous line)- Placed into a large vein, the superior or inferior vena cava, or even within the atrium of the heart itself.
Mediation via central line ... is added to a large, rapidly flowing vein; the medication burns less when added to the line. Some medications, like vancomycin, are caustic and can cause phlebitis.
PICC (peripherally injected central catheter) line- used when a patient will require intravenous access for a long time period; inserted through a vein in the arm and threaded upwards until it is in the superior vena cava or right atrium.
Total parental nutrition (TPN)- typically administered via a central line, which delivers 100 % of the patient’s nutrition via an IV line eliminating the need for both eating and digesting.
TPN (total parental nutrition) is necessary when ... a pt has undergone major surgery and their digestive system can't properly function, or when a patient is in a coma or unconscious and requires nutrition
Parenteral – Intravenous Injections: Intravenous (IV)- IV Syringe- Peripheral IV line- Central IV line (or central venous line)- PICC (peripherally injected central catheter) line- Total parental nutrition (TPN)- Intramuscular (IM) Subcutaneous (SQ) Spinal
Methods of Infusion: intravenous drip bolus piggyback
intravenous drip This is the continuous infusion of fluid (which can be accomplished with or without medication) through any of the IV access devices and administered slowly over time.
bolus The administration of medication in a single, large dose. The drug is administered all at once.
piggyback Intermittent infusion. This typically involves a smaller IV bag added into the existing IV line to administer doses of medication.
Intramuscular (IM)- a long needle with a large diameter to get through all the layers on top of your muscle because the needle reaches all the way inside a muscle to deliver its contents. EX: hips, gluteals, lg muscle of legs
Types of Intramuscular Drugs: vaccine antibiotics follicle-stimulating hormones, hCG as protocol for in vitro fertilization
Subcutaneous (subcu, subq, SQ)- a short, small diameter needle is used to inject medication through the skin, specifically the layer of fat directly under the skin.
Types of Subcutaneous Drugs: insulin (insulin-dependent diabetics- systemic effect) Novocain (dental procedures-local effect)
Spinal- The spinal administration route is accomplished with a needle injected directly into the spinal canal. This can achieve a different result dependent upon where in the spinal canal it is inserted.
Types of Spinal Administration: Spinal block Epidural Intrathecal Instillation
Spinal block delivered directly into the spinal fluid and is a one-time injection. This can be used for pain control during and after a caesarean.
Epidural into the epidural space surrounding the spine
Intrathecal Instillation introduced into or occurring in the space under the arachnoid membrane of the brain or spinal cord. Methotrexate is often used for cancer chemotherapy and injected into the spinal canal.
Drug Action - Absorption Drug active ingredients dissolved and released into bloodstream
Drug Action - Distribution Drug active ingredients circulated to various structures/tissues of the body
Drug Action - Metabolism Chemical alteration of the drug to perform its therapeutic function in the body
Drug Action - Elimination Removal/excretion of the drug
Absorption- the active ingredients of a drug preparation are dissolved and released into the bloodstream
Absorption rate- is the key to determining the amount of drug needed, the timing of the doses, and the way the drug is administered
Amoxicillin absorption is increased when... taken with antacids
Cipro is not absorbed well when taking with foods... containing a lot of calcium, magnesium, or iron (e.g. antacids, vitamins, or dairy products).
Absorption term - Half-Life the time the total amount of drug diminishes by one half
Absorption term - Loading Dose a large dose given rapidly at the beginning of treatment to reach therapeutic level quickly
Distribution- Transportation of a drug via the bloodstream to other body tissue (travel the bloodstream or target a specific organ)
Liver- the first organ the drug encounters
First change- active form and then inactive form for elimination
Secondary activity- may lead to a new treatment or to unwanted side effects
Factors impacting rate of drug distribution: Proteins Fluid retention Obesity Disease states (like if the pt has CKD, this will effect it) Age
Metabolism- how well your body breaks down the drug, called metabolized or chemically changed, so it can perform its therapeutic function
Factors impacting rate of metabolism Age Liver and Kidney function Drugs Foods
Elimination- how the drug is eliminated from the body Urine (most drugs) Feces
Potency- a drug’s strength and typically used to compare drugs within a class or group that work by the same mechanism
Efficacy- the degree to which a drug can produce a certain effect. Efficacy also means the degree to which a drug is able to induce an effect
Dilaudid (hydromorphone) is more potent than... Morphine
Created by: wallace263