of administration bypass the gastrointestinal tract and are commonly used when rapid onset of action or precise drug delivery is required.

These routes include intravenous, intramuscular, subcutaneous, and intradermal injections.

In addition, topical formulations such as creams, ointments, and transdermal patches provide localized or systemic effects through skin absorption.

Proper understanding of these routes is essential to ensure medication safety, prevent administration errors, and support appropriate patient education.

Parenteral administration

is an injection or infusion by means of a needle or catheter inserted into the body.

Parenteral forms deserve special attention.

■ Complexity, widespread use, and potential for therapeutic benefit and danger

The term parenteral comes from Greek words. ■ para, meaning outside

■ enteron, meaning the intestine.

■ intravenous ■ intramuscular ■ intradermal ■ subcutaneous ■ epidural ■ intrathecal

■ ----- ■ intramuscular ■ intradermal ■ subcutaneous ■ epidural ■ intrathecal

■ intravenous ■ ----- ■ intradermal ■ subcutaneous ■ epidural ■ intrathecal

■ intravenous ■ intramuscular ■ ---- ■ subcutaneous ■ epidural ■ intrathecal

■ intravenous ■ intramuscular ■ intradermal ■ ----- ■ epidural ■ intrathecal

■ intravenous ■ intramuscular ■ intradermal ■ subcutaneous ■ ----- ■ intrathecal

■ intravenous ■ intramuscular ■ intradermal ■ subcutaneous ■ epidural ■ -----

■ Parenteral preparations must be

■ Sterile ■ Free of microorganisms.

To ensure sterility, parenterals are prepared using: ■ Aseptic techniques ----- ■ Laminar flow hoods placed in special rooms.

■ Special clothing (gowns, masks, hair net, gloves)

To ensure sterility, parenterals are prepared using: ■ Aseptic techniques ■ Special clothing (gowns, masks, hair net, gloves) -------

■ Laminar flow hoods placed in special rooms.

■ Intravenous into the vein ■ Intradermal into the dermis (skin)

The IV route is the fastest method for delivering systemic drugs.

■ Preferred administration in an emergency situation.

It can provide fluids, electrolytes, and nutrition.

■ Patients who cannot take food or have serious problems with the GI tract.

It provides higher concentration of drug to bloodstream or tissues.

■ Advantageous in serious bacterial infection

Disposable syringes and needles are used to administer drugs by injection .

Different sizes are available depending on the type of mediation and injection needed .

IV infusion provides a continuous amount of needed medication.

■ Without fluctuation in blood levels of other routes.

Infusion rate can be adjusted.

■ Provides more or less medication as the situation dictates.

Parenteral Route Characteristics

■ Has to be STERILE (bacteria free).

Parenteral Route Characteristics

pH must match body fluid’s using buffer system.

Parenteral Route Characteristics

Limited volume should be used to avoid pain and necrosis.

Parenteral Route Disadvantages Higher Cost. ------ Most difficult to remove once administered if there is an adverse or toxic reaction. Requires a needle injection. Potential for infection or clot formation.

Require skilled personnel to administer them.

Parenteral Route Disadvantages Higher Cost. Require skilled personnel to administer them. -------- Requires a needle injection. Potential for infection or clot formation.

Most difficult to remove once administered if there is an adverse or toxic reaction.

Parenteral Route Disadvantages Higher Cost. Require skilled personnel to administer them. Most difficult to remove once administered if there is an adverse or toxic reaction. Requires a needle injection. -------

Potential for infection or clot formation.

Intravenous Formulations

Administered directly into a vein.

Intravenous Formulations

Takes about 20 seconds to circulate throughout the body.

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GAY 3

Question	Answer
Parenteral routes	of administration bypass the gastrointestinal tract and are commonly used when rapid onset of action or precise drug delivery is required.
Parenteral routes	These routes include intravenous, intramuscular, subcutaneous, and intradermal injections.
Parenteral routes	In addition, topical formulations such as creams, ointments, and transdermal patches provide localized or systemic effects through skin absorption.
Parenteral routes	Proper understanding of these routes is essential to ensure medication safety, prevent administration errors, and support appropriate patient education.
Parenteral administration	is an injection or infusion by means of a needle or catheter inserted into the body.
Parenteral forms deserve special attention.	■ Complexity, widespread use, and potential for therapeutic benefit and danger
The term parenteral comes from Greek words. ■ para, meaning outside	■ enteron, meaning the intestine.
This route of administration ---the alimentary canal.	bypasses
Injection Dependent	■ intravenous ■ intramuscular ■ intradermal ■ subcutaneous ■ epidural ■ intrathecal
intravenous	■ ----- ■ intramuscular ■ intradermal ■ subcutaneous ■ epidural ■ intrathecal
intramuscular	■ intravenous ■ ----- ■ intradermal ■ subcutaneous ■ epidural ■ intrathecal
intradermal	■ intravenous ■ intramuscular ■ ---- ■ subcutaneous ■ epidural ■ intrathecal
subcutaneous	■ intravenous ■ intramuscular ■ intradermal ■ ----- ■ epidural ■ intrathecal
epidural	■ intravenous ■ intramuscular ■ intradermal ■ subcutaneous ■ ----- ■ intrathecal
intrathecal	■ intravenous ■ intramuscular ■ intradermal ■ subcutaneous ■ epidural ■ -----
■ Parenteral preparations must be	■ Sterile ■ Free of microorganisms.
To ensure sterility, parenterals are prepared using: ----- ■ Special clothing (gowns, masks, hair net, gloves) ■ Laminar flow hoods placed in special rooms.	■ Aseptic techniques
To ensure sterility, parenterals are prepared using: ■ Aseptic techniques ----- ■ Laminar flow hoods placed in special rooms.	■ Special clothing (gowns, masks, hair net, gloves)
To ensure sterility, parenterals are prepared using: ■ Aseptic techniques ■ Special clothing (gowns, masks, hair net, gloves) -------	■ Laminar flow hoods placed in special rooms.
IV route	■ Directly into a vein
■ Prepared in hospitals and home healthcare pharmacies ■ Antibiotics ■ Chemotherapy ■ Nutrition ■ Critical care medications	Antibiotics
■ Prepared in hospitals and home healthcare pharmacies ■ Antibiotics ■ ------ ■ Nutrition ■ Critical care medications	Chemotherapy
■ Prepared in hospitals and home healthcare pharmacies ■ Antibiotics ■ Chemotherapy ■ ---- ■ Critical care medications	Nutrition
■ Prepared in hospitals and home healthcare pharmacies ■ Antibiotics ■ Chemotherapy ■ Nutrition ■ -----	Critical care medications
INTRA means INTO	■ Intravenous into the vein ■ Intradermal into the dermis (skin)
Intramuscular (IM) injections	■ Into a muscle
Subcutaneous injections	■ Under the skin
Intradermal (ID) injections	■ Into the skin
Intravenous (IV) 16–20	1–1.5˝
Intramuscular (IM) 19–22	1–1.5˝
Subcutaneous (SC) 24–27	3/8–1˝
Intradermal (ID) 25–26	3/8˝
The IV route is the fastest method for delivering systemic drugs.	■ Preferred administration in an emergency situation.
It can provide fluids, electrolytes, and nutrition.	■ Patients who cannot take food or have serious problems with the GI tract.
It provides higher concentration of drug to bloodstream or tissues.	■ Advantageous in serious bacterial infection
Disposable syringes and needles are used to administer drugs by injection .	Different sizes are available depending on the type of mediation and injection needed .
IV infusion provides a continuous amount of needed medication.	■ Without fluctuation in blood levels of other routes.
Infusion rate can be adjusted.	■ Provides more or less medication as the situation dictates.
Formulation is limited to: ■ ------ ■ suspensions, and ■ Emulsions.	■ solutions,
Formulation is limited to: ■ solutions, ■ --------- ■ Emulsions.	■ suspensions, and
Formulation is limited to: ■ solutions, ■ suspensions, and ■--------	■ Emulsions.
Parenteral Route Characteristics	■ Has to be STERILE (bacteria free).
Parenteral Route Characteristics	pH must match body fluid’s using buffer system.
Parenteral Route Characteristics	Limited volume should be used to avoid pain and necrosis.
Parenteral Route Disadvantages ----- Require skilled personnel to administer them. Most difficult to remove once administered if there is an adverse or toxic reaction. Requires a needle injection. Potential for infection or clot formation.	Higher Cost.
Parenteral Route Disadvantages Higher Cost. ------ Most difficult to remove once administered if there is an adverse or toxic reaction. Requires a needle injection. Potential for infection or clot formation.	Require skilled personnel to administer them.
Parenteral Route Disadvantages Higher Cost. Require skilled personnel to administer them. -------- Requires a needle injection. Potential for infection or clot formation.	Most difficult to remove once administered if there is an adverse or toxic reaction.
Parenteral Route Disadvantages Higher Cost. Require skilled personnel to administer them. Most difficult to remove once administered if there is an adverse or toxic reaction. ------ Potential for infection or clot formation.	Requires a needle injection.
Parenteral Route Disadvantages Higher Cost. Require skilled personnel to administer them. Most difficult to remove once administered if there is an adverse or toxic reaction. Requires a needle injection. -------	Potential for infection or clot formation.
Intravenous Formulations	Administered directly into a vein.
Intravenous Formulations	Takes about 20 seconds to circulate throughout the body.
Intravenous Formulations	Aqueous solutions are the most common formulations
Syringeability	– the ease with which a suspension can be drawn from container into a syringe.
Injectability	is the ease of flow when a suspension is injected into a patient
Intravenous (IV) injections	are injected directly into veins and are administered at a 15- to 30- degree angles.
Thrombus	is a blood clot.
Phlebitis	is an inflammation of the vein.
■ Air embolism	occurs when air is introduced into the vein.
Particulate material	can include small pieces of glass that chip from the product’s vial or rubber pieces.
Syringes	- come in a variety of sizes.
Infusion	Is the gradual intravenous injection of a volume of fluid into a patient.
Infusion	■ Usually a large volume (500 ml to 1,000 ml).
Infusion	E.g. dextrose in water 5% (D5W), 0.45% sodium chloride in water (½ NS).
Infusion	The solution bag has two ports: an administration set port and a medication port.
Infusion Pumps	Ensures consistent and controlled delivery rate.
Infusion Pumps	Patient controlled analgesia (PCA) are pumps for self administration or pain medications.
Intramuscular Injections (IM)	Care must be taken with deep ---- to avoid hitting a vein, artery, or nerve.
Intramuscular Injections (IM)	In adults, IM injections are given into upper, outer portion of the gluteus maximus.
Intramuscular Injections (IM)	For children and some adults, ------ are given into the deltoid muscles of the shoulders.
Depot	– the area in the muscle where the formation is injected during an IM injection.
Intramuscular Injections	Typical needle is 22- to 25- gauge ½- to 1-inch needle..
■ Volume limited to less than 3 mL	Intramuscular (IM) injections are administered at a 90- degree angle
For intramuscular (IM) and subcutaneous routes of administration, the injection site needs to be “prepped.”	■ using alcohol wipe. Correct syringe, needle, and technique must be used.
Rotation of injection sites with long-term use.	■ Prevents scarring and other skin changes. ■ Can influence drug absorption.
Intramuscular (IM) and subcutaneous routes of administration are convenient ways to deliver medications compared with the IV route.	■ Onset of response of the medication is slower. ■ Duration of action is much longer..
Advantages and Disadvantages of the Parenteral Route	Practical for use outside the hospital
Advantages and Disadvantages of the Parenteral Route	■ Used for drugs which are not active orally.
Subcutaneous Injections	Administer medications below the skin into the subcutaneous fat.
Subcutaneous Injections	■ Outside of the upper arm.
Subcutaneous Injections	■ Top of the thigh.
Subcutaneous Injections	■ Lower portion of each side of the abdomen.
Subcutaneous Injections	■ Not into grossly adipose, hardened, inflamed, or swollen tissue.
Subcutaneous Injections: Often have a longer onset of action and a longer duration of action.	■ Compared with IM or IV injection.
Subcutaneous Injections: ■ Given at a 45-degree angle.	■ 25- or 26-gauge needle, 3/8 to 5/8 inch length.
Subcutaneous Injections: No more then 1.5 mL should be injected into the site.	■ Avoids pressure on sensory nerves causing pain and discomfort.
Subcutaneous Injections Insulin ● Given using 28- to 30-gauge short needles	in special syringe that measures in UNITS.
● Keep insulin	refrigerated.
Subcutaneous Injections Insulin	Check expiration dates frequently. ■ Opened vials should be discarded after one month.
A vial of insulin is agitated and warmed	by rolling between the hands and should never be shaken.
Subcutaneous Injections Insulin	● The rubber stopper should be wiped with an alcohol wipe.
● DO NOT use SQ or SC abbreviations.	■ Write out subcutaneous to minimize potential medication errors.
Intradermal Injections ■ Given into capillary-rich layer just below epidermis for:	■ local anesthesia ■ diagnostic tests ■ immunizations
Examples of ID injections include:	■ Skin test for tuberculosis (TB) ■ Allergy skin testing
■ Skin test for tuberculosis (TB)	■ Typical site is the upper forearm, below the area where IV injections are given.
■ Allergy skin testing	■ Small amounts of various allergens are administered to detect allergies. ■ Usually on the back.
Implants, or pellets, are dose forms placed under the skin by means of minor surgery	■ Used for long-term, controlled release of medications. E.g: Viadur® - Duros® - Supprelin LA®
Plasters are solid or semisolid and medicated or non- medicated preparations that adhere to the body.	■ Contain backing material such as paper, cotton, linen, silk, moleskin, or plastic.
Topical administration	is the application of a drug directly to the surface of the skin.
Topical administration	■ Nose ■ Ears ■ Vagina ■ Urethra ■ Colon ■ Lungs
Ophthalmic Medications	■ Must be at room temperature or body temperature before application. Have to be sterile. Only preparations with preservatives can be repeatedly used.
Ophthalmic Medications (The Major Problem)	■ The immediate loss of a dose by natural spillage from the eye. About 80% of a dose will be lost from the eye by overflow.
Unused ophthalmic medications should be discarded --- after the container is opened	30 days
• Manufacturer	expirations do not apply once a patient has opened the medication.
Ophthalmic Ointments Formulation	Tend to keep the drug in contact with the eye LONGER than suspension.
Ophthalmic Ointments Formulation	Most ointments are made of mineral oil and white petroleum and have a melting point close to body temperature.
Ophthalmic Ointments Formulation	Ointments cause eye blurring and should be applied at night.
Ophthalmic Administration: Before application, patient should wash hands.	■ Prevents contamination of application site.
Ophthalmic Administration: Tube or dropper should not touch the application site.	■ Medication may become contaminated.
Ophthalmic Administration	Only sterile ophthalmic solutions or suspensions should be used in the eye.
Ear drops can NEVER be used in the eye,	but eye drops CAN be used in the ear.
Ophthalmic Administration	Patient’s head should be tilted back.
After opthalmic administration, the patient should place a finger in the corner of the eye, next to the nose to close the lacrimal gently.	Prevents loss of medication through tear duct.
A major problem of ----- is the immediate loss of the dose by natural spillage from the eye.	ophthalmic administration
Problems of Opthalmic Administration	■ Rapid washing of tears. ■ Rapid turnover (the entire tear volume in the eye turns over every 2-3 minutes)
Patient should also keep the eyes closed for 1or 2 minutes after application .	Opthalmic Administration
Ophthalmic ointment tubes are typically small, holding approximately --	3.5 g tube .
Ophthalmic Administration	When multiple drops of more than one medication are to be administered, the patient should wait 5 minutes between different medications.
If an ointment and a drop are used together, the drop is used first.	■ Wait 10 minutes before applying the ointment.
Contact lenses	■ Used to deliver ophthalmic dosages.
Hydrogel contact	lenses that are placed in a solution containing a drug are sued.
Contact lenses	The lenses release the drugs when placed in the eye.
Ocular Inserts	Lenses placed in a solution containing a drug such as antibiotic and the lenses absorb the drug solution.
■ Ocusert®	is an ocular insert designed to deliver pilocarpine at a controlled rate for up to 7 days.
Nasal cavity	holds about 20 ml and has a very rich blood supply.
May reach drug concentration similar when a drug is administered as IV.	Intranasal Formulations
Nasal inhaler	is a cylindrical tube with a cup that contains fibrous material impregnated with a volatile drug.
Intranasal Formulations Applied by:	■ drops (instillation) ■ sprays ■ aerosol (spray under pressure) Used for: ■ relief of nasal congestion or allergy symptoms ■ administration of flu vaccine
Intranasal Formulation	Patient should: ■ Tilt head back. ■ Insert dropper or spray or aerosol tip into the nostril pointed toward the eyes. ■ Apply prescribed number of drops or sprays in each nostril.
Breathing should be through mouth to avoid sniffing medication into the sinuses.	Intranasal Formulation
Important not to overuse nasal decongestants.	■ Follow label instructions carefully.
Inhaled Medications	Intended to deliver drugs to the lungs.
Lungs are designed for exchange of gases from tissues into ---	bloodstream.
Inhaled Medications	■ Usual dose form is an aerosol.
“Environmental friendly”	propellants now required to replace chlorofluorocarbons (CFCs) .
Inhaled Medications	Degradation found with oral administration. ■ Minimizes potential toxicity associated with system administration.
■ Degradation	found with oral administration.
■ ----- potential toxicity associated with system administration.	Minimizes
Common examples are medication for respiratory illness including asthma, COPD, etc.	Inhaled Medications
Metered-dose inhalers (MDI)	Provide medication with compressed gas.
Metered-dose inhalers (MDI)	■ Deliver specific measured dose with each activation.
Metered-dose inhalers (MDI)	If a MDI contains a steroid, the patient should RINSE the mouth thoroughly after dose to prevent oral fungal infection.
Nebulizers	Create a mist when a stream of air flows over a liquid.
Nebulizers	■ Commonly utilized for young children or elderly patients with asthma or lung disease
A diskus	A newer dosage form to administer drug to lungs as micronized powder.
Most inhalation dosage forms are MDI aerosols that depend on the power of compressed or ----- to expel the drug from a container.	liquefied gas
Particle size	of the aerosolized medication is a critical factor with MDIs.
Spacer and adapters	■ MDI requires coordination between breathing in and activation of the aerosol.
Spacer and adapters	■ There are extension devices to assist the patient who can’t coordinate these two processes.
Aerosolized Medications	1. Shake canister well.
Aerosolized Medications	2. “Prime” by pressing down and activating a practice dose.
Aerosolized Medications	3. Insert canister into a mouthpiece or spacer to reduce the amount of drug deposited on the back of the throat.
Aerosolized Medications	4. Breathe out and hold spacer between lips making a seal.
Aerosolized Medications	5. Activate MDI and take a deep slow inhalation.
Aerosolized Medications	6. Hold breath briefly, and slowly exhale through the nose.
Transdermal Administration	Delivers drug to bloodstream via absorption through the skin via a patch or disk
Transdermal Administration	Therapeutic effects can last for 24 hours up to 1 week.
Transdermal Administration	Chemicals in the patch or disc force drug
across membranes of the skin.	Transdermal Administration
into layer where absorption into bloodstream occurs.	Transdermal Administration
Transdermal patches	should be carefully discarded after use because they could cause serious side effects if ingested by young children or pets.
More drug is ---- when the formulation is applied to a larger surface area.	absorbed
Formulations or dressings that increase the ---- of the skin generally improve absorption.	hydration
The greater the amount of ---- of the formulation, the greater the absorption.	rubbing in (inunction)
absorption	The longer the formulation remains in contact with the skin, the greater will be the absorption.
Dose forms for topical administration include:	Skin: ■ creams ■ ointments ■ lotions ■ gels ■ transdermal patches ■ disks
■ Dose forms should be applied as directed	■ to the skin. ■ lotions, creams, and gels are worked into the skin. ■ ointments are skin protectants and do not work into the skin but stay on the surface.
When using nitroglycerin ointment the patient or caregiver should wear gloves.	■ Avoids absorbing excessive amounts of drug, which could cause a headache.
When using topical corticosteroids:	● Apply sparingly to affected areas for short periods of time.
● Affected area should not be covered up with a bandage unless directed by the physician.	Occlusive dressings can significantly increase drug absorption and risk of side effects.
Overuse of potent ------ can lead to serious systemic side effects	topical corticosteroids
Otic Medications	Tilt head to side with ear facing up. ■ 2 to 5 minutes
Cotton swabs placed in the ear after administration of drops will prevent excess medication from dripping out of the ear.	Swabs will not reduce drug absorption.
Cotton swabs placed in the ear after administration of drops will prevent excess medication from dripping out of the ear.	Patients under 3 should have lobes pulled down and back.
Cotton swabs placed in the ear after administration of drops will prevent excess medication from dripping out of the ear.	Patients over 3 should have lobes pulled up and back.
Otic Medications: ■ Must be at room temperature or body temperature.	■ Heated drops may cause rupturing of the eardrum. ■ Cold drops can cause vertigo and discomfort.
Otic Medications: Old medication should be removed	along with any drainage before applying fresh medication
■ Alcohol causes pain and burning sensation.	■ Should not be used if the patient has a ruptured tympanic membrane (eardrum).
Toxic Shock Syndrome (TSS)	●A rare and potentially fatal disease that results from a severe bacterial infection of the blood.
Toxic Shock Syndrome (TSS)	n women, it can be caused when bacteria natural to the vagina move into the bloodstream. Though primarily associated with the use of super absorbency tampons, it has also been associated with various vaginal dosage forms.
Toxic Shock Syndrome (TSS)	a high fever, nausea, skin rash, faintness, and muscle ache. It is treated with antibiotics and other medicines.
The Vaginal Ring	A hormone based IUD, but is used in one month cycles.
The Vaginal Ring	The ring is inserted in the vagina for 3 weeks, removed for 7 days, and then reinserted.
The Vaginal Ring	■ NuvaRing® is an example of such a device.
Intrauterine Devices (IUDs)	■ Devices placed in the uterus.
Intrauterine Devices (IUDs)	Have a lower rate of vaginal expulsion due to their similarity to the uterine shape.
Intrauterine Devices (IUDs)	They also have higher surface areas of copper and are effective at a rate of greater than 99%.
Intrauterine Devices (IUDs)	ParaGard® is an IUD that has been shown to be effective for up to 12 years.
Intrauterine Devices (IUDs)	Mirena® is another category of IUDs that is based on the release of the hormone progesterone
Vaginal tablets	also called inserts, they are inserted in the same manner as vaginal suppositories.
Vaginal tablets	Patients should be instructed to dip the tablet into water before insertion. ■
Vaginal tablets	Patients may want to wear a sanitary napkin to protect nightwear and bed linens.
Ointments, Creams, and Aerosol Foams	Contain antibiotics, estrogenic hormonal substances, or contraceptive agents.
Ointments, Creams, and Aerosol Foams	Creams and foams are placed in a special applicator tube, and the tube is then inserted high in the vaginal tract.
Vaginal Medications	1. Begin with an empty bladder and washed hands.
Vaginal Medications	2. Open the container and place dose in applicator.
Vaginal Medications	3. Lubricate applicator with water-soluble lubricant if not pre-lubricated.
Vaginal Medications	4. Lie down, spread the legs, open the labia with one hand, and insert the applicator about two inches into the vagina with the other hand.
Vaginal Medications	5. Release labia; use free hand to push applicator plunger.
Vaginal Medications	6. Withdraw the applicator and wash the hands.
The ---- of administration is application of drug via cream or insertion of tablet into the vagina.	vaginal route
The vaginal route is preferred for:	cleansing ■ contraception ■ treatment of infections Major
disadvantages of vaginal formulations	■ inconvenience ■ “messiness”
Dermal Formulations Advantages	Local therapeutic effects.
Dermal Formulations Advantages	Lower risk of side effects.
Dermal Formulations Advantages	Not well absorbed into the deeper layers of the skin or mucous membrane.
Dermal Formulations Advantages	■ Offers steady level of drug in the system.
Transdermal Patches	Site of administration must be rotated and relatively hair free.
Transdermal Patches	Should not be placed over a large area of scar tissue.
Transdermal Patches	Some are replaced every day, others maintain their effect for 3 to 7 days. ■
Transdermal Patches	Some patients should remove nitroglycerin patch at bedtime to prevent development of drug tolerance where the body requires higher doses of drug to produce the same therapeutic effect.
Transdermal Patches	Some testosterone patches are applied to the skin of the scrotum.

Created by: Russells3709

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