Chapter 9 Introduction

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Chapter 9 Administration by the Parenteral Route

Introduction • Parenteral routes – Include any route other than the gastrointestinal tract • Most common: injection • Other routes: skin, mucous membranes, eyes, ears, and respiratory tract

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Introduction (cont’d.) • Purpose of administration – Systemic effects: those affecting the body as a whole • Sublingual or buccal, transcutaneous (transdermal), inhalations, and injections – Local effects: those limited to one particular part (location) of the body • Topical medications, mucous membrane applications, and eye and ear medications

Sublingual and Buccal Administration • Sublingual administration – Medication placed under the tongue – Drug absorbed directly into the circulation – More commonly use than buccal • Buccal administration – Medication placed in the pouch between the cheek and gum at the back of the mouth

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Transcutaneous Drug Delivery System • Transcutaneous, or transdermal, systems – Medication delivered to the body by absorption through the skin – Examples: ointments and patches • Slower absorption rates • Not effective in treatment of acute angina attacks

Transcutaneous Drug Delivery System

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Transcutaneous Drug Delivery System

Inhalation Route • Frequent route of administration – Especially to those with chronic pulmonary conditions, such as asthma • Metered-dose inhalers (MDIs) and small-volume nebulizers (SVNs) • What are the advantages of this route? – Rapid action – Potent drugs may be given in small amounts – Convenience and comfort

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Inhalation Route (cont’d.) • What are the disadvantages of this route? – Requires cooperation of the patient in proper breathing techniques – Adverse side effects may result rapidly – Improper administration can lead to irritation – Patients sometimes become dependent on a small-volume nebulizer or MDI – If not cleaned properly, the small-volume nebulizer can be a source of infection

Inhalation Route (cont’d.) • Metered-dose inhaler (MDI) – Popular – Portable – Easy to use

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Inhalation Route (cont’d.)

Inhalation Route (cont’d.) • Small-volume nebulizers (SVNs) – Powered by a gas source – Essential • Use of proper breathing techniques • Proper cleaning of equipment on a daily basis

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Inhalation Route (cont’d.)

Inhalation Route (cont’d.) • Dry powdered inhalers (DPIs) – Deliver a drug in powdered form into the lung with no propellant or external power source • Advantages: small; easy to use; eliminates any timing technique problems; and can be used in very cold environments • Disadvantages: fewer drugs are available in powder form; patient must be able to generate a significant inspiratory effort

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Inhalation Route (cont’d.) David Hay Jones/ScienceDavid Hay Source

Inhalation Route (cont’d.) • Intermittent positive pressure breathing (IPPB) – Combines administration of an aerosol with a mechanical breather – Assists patients who are unable to take a deep breath on their own

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Injections • What equipment is used for injections? – Syringes: barrel, plunger, and tip – Needles: hub, shaft, and tip

Insert Figure 9-4

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Injections • Three main types of syringes – Standard – Tuberculin – Insulin

Injections

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Injections

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Injections

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Injections

Injections (cont’d.) • Drawing up medications – Refer to chapter for step-by-step instructions

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Injections (cont’d.)

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Injections (cont’d.)

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Injections (cont’d.) • Administration by injection – Intradermal injections: administered into the skin on the inner surface of the lower arm – Subcutaneous injections: administered into fatty tissues on upper outer arm, front of the thigh, abdomen, or upper back

Injections (cont’d.)

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Injections (cont’d.) – Intramuscular injections: administered deep into large muscles • Dorsogluteal • Ventrogluteal •Deltoid • Vastus lateralis • Rectus femoris

Injections (cont’d.)

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Injections (cont’d.)

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Injections (cont’d.)

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Injections (cont’d.) • Z-track method is used for injections that are irritating to the tissue – Iron dextran, hydroxyzine, or cefazolin

Injections (cont’d.)

(A)Skin and subcutaneous tissue pulled to one side and held there (B)Needle is placed in muscle (C)Z-track sealed when tissue released

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Skin Medications • Topical medications for the skin – Prescribed for a great variety of conditions – Available in a variety of forms: ointments, lotions, creams, solutions, soaks, and baths – Administration requires knowledge of condition, purpose of treatment, and strict adherence to directions as prescribed

Application to the Mucous Membranes • Medications applied to the mucous membranes – Come in a variety of forms • Suppositories, ointments, solutions, sprays, gargles, etc. – Always follow specific directions that accompany the individual medication, unless directed to do otherwise by the physician

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Eye Medications • Technique for instillation of eye medications – Refer to chapter for technique

Eye Medications

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Eye Medications