Route of administration

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By injection
)
Oral administration of a liquid.

In pharmacology and toxicology, a route of administration is the way by which a drug, fluid, poison, or other substance is taken into the body.[1]

Routes of administration are generally classified by the location at which the substance is applied. Common examples include oral and intravenous administration. Routes can also be classified based on where the target of action is. Action may be topical (local), enteral (system-wide effect, but delivered through the gastrointestinal tract), or parenteral (systemic action, but is delivered by routes other than the GI tract). Route of administration and dosage form are aspects of drug delivery.

Classification

Routes of administration are usually classified by application location (or exposition).

The route or course the active substance takes from application location to the location where it has its target effect is usually rather a matter of pharmacokinetics (concerning the processes of uptake, distribution, and elimination of drugs). Exceptions include the transdermal or transmucosal routes, which are still commonly referred to as routes of administration.

The location of the target effect of active substances are usually rather a matter of pharmacodynamics (concerning e.g. the physiological effects of drugs[2]). An exception is topical administration, which generally means that both the application location and the effect thereof is local.[3]

pharmacodynamic effect,[3] and sometimes merely as a local application location regardless of location of the effects.[4][5]

By application location

Enteral/gastrointestinal route

Through the

topical), such as in a contrast enema
, whereby contrast media are infused into the intestines for imaging. However, for the purposes of classification based on location of effects, the term enteral is reserved for substances with systemic effects.

A medical professional injects medication into a gastric tube.

Many drugs as

duodenal feeding tube and enteral nutrition
. Enteric coated tablets are designed to dissolve in the intestine, not the stomach, because the drug present in the tablet causes irritation in the stomach.

Administering medication rectally

The

distal rectum, giving health practitioners a way to leverage the established benefits of rectal administration. The Murphy drip
is an example of rectal infusion.

Parenteral route

Needle insertion angles for 4 types of parenteral administration of medication: intramuscular, subcutaneous, intravenous, and intradermal injection.

The parenteral route is any route that is not enteral (par- + enteral).

Parenteral administration can be performed by

indwelling catheter
.

Locations of application of parenteral administration include:

  • Central nervous system:
A transdermal patch which delivers medication is applied to the skin. The patch is labelled with the time and date of administration as well as the administrator's initials.
A medical professional applies nose drops.
Intraocular administration

Topical route

The definition of the topical route of administration sometimes states that both the application location and the

pharmacodynamic effect thereof is local.[3]

In other cases, topical is defined as applied to a localized area of the body or to the surface of a body part regardless of the location of the effect.

topical administration also includes transdermal application, where the substance is administered onto the skin but is absorbed into the body to attain systemic
distribution.

If defined strictly as having local effect, the topical route of administration can also include

Choice of routes

The reason for choice of routes of drug administration are governing by various factors:

  • Physical and chemical properties of the drug. The physical properties are solid, liquid and gas. The chemical properties are solubility, stability, pH, irritancy etc.
  • Site of desired action: the action may be localised and approachable or generalised and not approachable.
  • Rate of extent of absorption of the drug from different routes.
  • Effect of digestive juices and the first pass metabolism of drugs.
  • Condition of the patient.

In acute situations, in emergency medicine and intensive care medicine, drugs are most often given intravenously. This is the most reliable route, as in acutely ill patients the absorption of substances from the tissues and from the digestive tract can often be unpredictable due to altered blood flow or bowel motility.

Convenience

Enteral routes are generally the most convenient for the patient, as no punctures or

sterile
procedures are necessary. Enteral medications are therefore often preferred in the treatment of chronic disease. However, some drugs can not be used enterally because their absorption in the digestive tract is low or unpredictable. Transdermal administration is a comfortable alternative; there are, however, only a few drug preparations that are suitable for transdermal administration.

Desired target effect

Identical drugs can produce different results depending on the route of administration. For example, some drugs are not significantly absorbed into the bloodstream from the gastrointestinal tract and their action after enteral administration is therefore different from that after parenteral administration. This can be illustrated by the action of naloxone (Narcan), an antagonist of opiates such as morphine. Naloxone counteracts opiate action in the central nervous system when given intravenously and is therefore used in the treatment of opiate overdose. The same drug, when swallowed, acts exclusively on the bowels; it is here used to treat constipation under opiate pain therapy and does not affect the pain-reducing effect of the opiate.

Oral

The oral route is generally the most convenient and costs the least.

time-release formulations, breaking the tablets or capsules can lead to more rapid delivery of the drug than intended.[25] The oral route is limited to formulations containing small molecules only while biopharmaceuticals (usually proteins) would be digested in the stomach and thereby become ineffective. Biopharmaceuticals have to be given by injection or infusion. However, recent research found various ways to improve oral bioavailability of these drugs. In particular permeation enhancers,[27] ionic liquids,[28] lipid-based nanocarriers,[29] enzyme inhibitors and microneedles[30]
have shown potential.

Oral administration is often denoted "PO" from "per os", the Latin for "by mouth".

The bioavailability of oral administration is affected by the amount of drug that is absorbed across the

first-pass metabolism.[31]

Local

By delivering drugs almost directly to the site of action, the risk of systemic side effects is reduced.[25]

Skin absorption (dermal absorption), for example, is to directly deliver drug to the skin and, hopefully, to the systemic circulation.[32] However, skin irritation may result, and for some forms such as creams or lotions, the dosage is difficult to control.[26] Upon contact with the skin, the drug penetrates into the dead stratum corneum and can afterwards reach the viable epidermis, the dermis, and the blood vessels.[32]

Mouth inhalation

A dummy wears a nebulizer mask, used to administer inhaled medications.
alveolar sac (transitional respiratory zone)
  • alveolus (transitional respiratory zone)
  • [33][34][35][36][37][38][39][40]

    Inhaled medications can be absorbed quickly and act both locally and systemically.[26] Proper technique with inhaler devices is necessary to achieve the correct dose. Some medications can have an unpleasant taste or irritate the mouth.[26]

    In general, only 20–50% of the pulmonary-delivered dose rendered in powdery particles will be deposited in the lung upon mouth inhalation.[41] The remainder of 50-70% undeposited aerosolized particles are cleared out of lung as soon as exhalation.[41]

    An inhaled powdery particle that is >8 μm is structurally predisposed to depositing in the central and conducting airways (

    conducting zone) by inertial impaction.[41]

    An inhaled powdery particle that is between 3 and 8 μm in diameter tend to largely deposit in the transitional zones of the lung by sedimentation.[41]

    An inhaled powdery particle that is <3 μm in diameter is structurally predisposed to depositing primarily in the respiratory regions of the peripheral lung via diffusion.[41]

    Particles that deposit in the upper and central airways are generally absorbed systemically to great extent because they are only partially removed by mucociliary clearance, which results in orally mediated absorption when the transported mucous is swallowed, and first pass metabolism or incomplete absorption through loss at the fecal route can sometimes reduce the bioavailability.[42] This should in no way suggest to clinicians or researchers that inhaled particles are not a greater threat than swallowed particles, it merely signifies that a combination of both methods may occur with some particles, no matter the size of or lipo/hydrophilicity of the different particle surfaces.[41]

    Nasal inhalation

    Inhalation by nose of a substance is almost identical to oral inhalation, except that some of the drug is absorbed intranasally instead of in the oral cavity before entering the airways. Both methods can result in varying levels of the substance to be deposited in their respective initial cavities, and the level of mucous in either of these cavities will reflect the amount of substance swallowed. The rate of inhalation will usually determine the amount of the substance which enters the lungs. Faster inhalation results in more rapid absorption because more substance finds the lungs. Substances in a form that resists absorption in the lung will likely resist absorption in the nasal passage, and the oral cavity, and are often even more resistant to absorption after they fail absorption in the former cavities and are swallowed.

    Parenteral

    The term parenteral is from para-1 'beside' + Greek enteron 'intestine' + -al. This name is due to the fact that it encompasses a route of administration that is not intestinal. However, in common English the term has mostly been used to describe the four most well-known routes of injection.

    A peripheral IV placed on the hand.
    A medical professional performs an intradermal (ID) injection.

    The term injection encompasses

    subcutaneous (SC) and intradermal (ID) administration.[43]

    Parenteral administration generally acts more rapidly than topical or enteral administration, with onset of action often occurring in 15–30 seconds for IV, 10–20 minutes for IM and 15–30 minutes for SC.

    Disadvantages of injections include potential pain or discomfort for the patient and the requirement of trained staff using

    insulin-dependent diabetes mellitus. As the drug is delivered to the site of action extremely rapidly with IV injection, there is a risk of overdose if the dose has been calculated incorrectly, and there is an increased risk of side effects if the drug is administered too rapidly.[25]

    Intranasal

    Drug administration via the nasal cavity yields rapid drug absorption and therapeutic effects.

    Intranasal absorption features low lipophilicity, enzymatic degradation within the nasal cavity, large molecular size, and rapid mucociliary clearance from the nasal passages, which explains the low risk of systemic exposure of the administered drug absorbed via intranasal.[47]

    Involved subjects' positions.

    Sublingual

    Sublingual administration is fulfilled by placing the drug between the tongue and the lower surface of the mouth.[47] The sublingual mucosa is highly permeable and thereby provides access to the underlying expansive network composed of capillaries, leading to rapid drug absorption.[47]

    Buccal

    Buccally administered medication is achieved by placing the drug between gums and the inner lining of the cheek.[48][47] In comparison with sublingual tissue, buccal tissue is less permeable resulting in slower absorption.[47]

    Sublabial administration

    Sublabial administration

    Research

    Neural drug delivery is the next step beyond the basic addition of

    Drug delivery systems allow the rate of growth factor release to be regulated over time, which is critical for creating an environment more closely representative of in vivo development environments.[49]

    See also

    References

    1. ^ TheFreeDictionary.com > route of administration Archived 2011-06-12 at the Wayback Machine Citing: Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. 2005, Elsevier.
    2. from the original on 2022-08-18. Retrieved 2023-12-09.
    3. ^ a b c "topical". Merriam-Webster dictionary. Archived from the original on 2017-07-30. Retrieved 2017-07-30.
    4. ^ a b thefreedictionary.com > topical Archived 2010-12-05 at the Wayback Machine Citing: The American Heritage Dictionary of the English Language, Fourth Edition, 2000
    5. ^ a b "topical". dictionary.com. Archived from the original on 2017-07-30. Retrieved 2017-07-30.
    6. ^ a b c "Oklahoma Administrative Code and Register > 195:20-1-3.1. Pediatric conscious sedation utilizing enteral methods (oral, rectal, sublingual)". Archived from the original on 2011-07-22. Retrieved 2009-01-18.
    7. S2CID 30569818
      .
    8. .
    9. .
    10. .
    11. .
    12. .
    13. .
    14. ^ [1] Archived 2013-01-26 at the Wayback Machine Nee, Douglas, Pharm D, MS. "Rectal Administration of Medications at the End of Life". HPNA Teleconference, December 6, 2006, accessed November 2013.
    15. ^ "Use of Rectal Meds for Palliative Care Patients. End of Life / Palliative Education Resource Center, Medical College of Wisconsin". mcw.edu. Archived from the original on 2 June 2014. Retrieved 14 April 2018.
    16. ^ "injection". Cambridge dictionary. Archived from the original on 2017-07-30. Retrieved 2017-07-30.
    17. ^ "MDMA (ecstasy) metabolites and neurotoxicity: No occurrence of MDMA neurotoxicity from metabolites when injected directly into brain, study shows". Neurotransmitter.net. Archived from the original on 2010-08-07. Retrieved 2010-08-19.
    18. PMID 2418156.{{cite journal}}: CS1 maint: multiple names: authors list (link
      )
    19. .
    20. ^ "Acute Decreases in Cerebrospinal Fluid Glutathione Levels after Intracerebroventricular Morphine for Cancer Pain". Anesthesia-analgesia.org. 1999-06-22. Archived from the original on 2006-01-06. Retrieved 2010-08-19.
    21. ^ "Crystal Meth: The Effects". Fenway Community Health. Fenway Health. Archived from the original on 10 December 2010.
    22. ISBN 978-0-07-148127-4.{{cite book}}: CS1 maint: multiple names: authors list (link
      )
    23. PMID 28288349. Archived from the original on 2020-04-23. Retrieved 2020-03-23.{{cite journal}}: CS1 maint: multiple names: authors list (link
      )
    24. ^ "Vancocin". The American Society of Health-System Pharmacists. Archived from the original on September 6, 2015. Retrieved Sep 4, 2015.
    25. ^ a b c d e f "The Administration of Medicines". Nursing Practice Clinical Zones: Prescribing. NursingTimes.net. 2007. Archived from the original on January 2, 2020. Retrieved April 2, 2013.
    26. ^ a b c d "DDS Medication Administration Recertification Manual" (PDF). DDS Recertification Review Manual. State of Connecticut Department of Developmental Services. 2006. Archived (PDF) from the original on May 14, 2013. Retrieved April 2, 2013.
    27. S2CID 214618193
      .
    28. .
    29. .
    30. .
    31. .
    32. ^ .
    33. .
    34. ^ "Lungs - Anatomy of the Respiratory System". archive.is. 2020-03-29. Archived from the original on 2020-03-29. Retrieved 2020-03-29.
    35. ^ "Major Zones & Divisions". GetBodySmart. 2017-10-30. Retrieved 2020-03-29.
    36. ^ "Diagram for conducting zone". Archived from the original on 2020-03-29. Retrieved 2020-03-29.
    37. ^ "Diagram for respiratory zone". Archived from the original on 2020-03-29. Retrieved 2020-03-29.
    38. ^ "Diagram for upper respiratory tract". Archived from the original on 2020-03-29. Retrieved 2020-03-29.
    39. ^ "Diagram for lower respiratory tract". Archived from the original on 2020-03-29. Retrieved 2020-03-29.
    40. ^ "Diagram for majour zones of respiratory system". Archived from the original on 2020-03-29. Retrieved 2020-03-29.
    41. ^ .
    42. .
    43. ^ "List of Error-Prone Abbreviations" (PDF). Institute For Safe Medication Practices. Archived (PDF) from the original on 22 February 2016. Retrieved 14 April 2018.
    44. ^ "Routes for Drug Administration" (PDF). Emergency Treatment Guidelines Appendix. Manitoba Health. 2003. Archived from the original (PDF) on October 1, 2013. Retrieved April 2, 2013.
    45. ^ Stahl SM, Stahl's Essential Psychopharmacology: Neuroscientific basis and practical applications, New York: Cambridge University Press, 2008
    46. ^ Smeltzer SC Bare BG, Textbook of Medical-Surgical Nursing, 9th ed, Philadelphia: Lippincott, 2000.
    47. ^
      S2CID 39802797
      .
    48. ^ LE.JENNIFER (2020-03-27). "Drug Absorption - Clinical Pharmacology". MSD Manual Professional Edition. Archived from the original on 2019-10-31. Retrieved 2020-03-28.
    49. ^ Lavik, E. and R. Langer, Tissue engineering; current state and perspectives. Applied Microbiology Biotechnology, 2004. 65: p. 1–8

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