2.3 Drug Administration Routes, Preparation, and Administration

Drug administration routes are crucial in determining how medications work in the body. From oral pills to intravenous injections, each method has unique advantages and considerations. Understanding these routes helps healthcare providers choose the most effective way to deliver medications for optimal patient outcomes.

Proper technique is essential for safe and effective drug administration. Whether it's giving an injection, applying a topical cream, or using an inhaler, following correct procedures ensures patients receive the right dose and experience minimal discomfort. Nurses play a key role in administering medications and educating patients about their treatments.

Drug Administration Routes

Drug administration routes

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• Oral administration convenient non-invasive cost-effective suitable for self-administration
  • Slower onset of action compared to parenteral routes
  • Potential for first-pass metabolism reduces bioavailability of certain medications (propranolol, lidocaine)
  • May be affected by food or other medications altering absorption (tetracyclines, bisphosphonates)
• Parenteral administration bypasses gastrointestinal tract delivers medication directly into body tissues or circulation
  • Subcutaneous (SC) injection into fatty tissue beneath skin suitable for small volumes non-irritating medications (insulin, heparin)
  • Intramuscular (IM) injection into muscle tissue faster absorption than SC route accommodates larger volumes oil-based medications (vaccines, antibiotics)
  • Intravenous (IV) direct injection into vein fastest onset of action precise dosing titration risks include infection phlebitis extravasation
• Topical administration applies medication directly to skin or mucous membranes for localized effect minimal systemic absorption
  • Examples include creams ointments patches (transdermal fentanyl) eye drops (antibiotics, glaucoma medications)
• Inhalation administration delivers medication directly to lungs via inhalation rapid onset of action targets respiratory system
  • Examples include metered-dose inhalers (albuterol) nebulizers (ipratropium) dry powder inhalers (fluticasone)
• Various dosage forms affect absorption and administration route choice

Sites for parenteral therapy

• Subcutaneous (SC) injection sites outer aspect of upper arm anterior abdomen upper back anterior thigh
• Intramuscular (IM) injection sites deltoid muscle (upper arm) ventrogluteal site (hip) vastus lateralis (lateral thigh) dorsogluteal site (buttocks) less preferred due to risk of sciatic nerve injury
• Factors affecting site selection
  • Absorption rate muscle tissue has more blood supply than subcutaneous tissue leading to faster absorption
  • Patient comfort rotate injection sites to minimize discomfort tissue damage
  • Medication properties certain medications may require specific administration routes (insulin typically given SC)
  • Patient's age mobility body composition consider ease of access amount of subcutaneous or muscle tissue available

Plan for effective drug administration

• Patient assessment review medication order verify patient identity assess allergies contraindications vital signs evaluate appropriateness of medication dose route timing
• Medication preparation gather necessary supplies equipment perform hand hygiene use personal protective equipment (PPE) follow aseptic technique double-check medication label dose expiration date
• Post-administration monitoring assess patient's response to medication monitor for adverse reactions or side effects document administration including time dose route relevant observations
• Provide patient education on medication purpose, expected effects, and potential side effects

Techniques for medication delivery

• Oral administration ensure upright position offer water or liquids to aid swallowing observe to confirm medication swallowed
• Parenteral administration
  1. Subcutaneous intramuscular injections use new sterile needle syringe clean injection site with alcohol swab using circular motion stretch or pinch skin insert needle at 90-degree angle (SC) or appropriate angle (IM) aspirate to check for blood return (IM only) inject medication slowly steadily apply gentle pressure with gauze after removing needle
  2. Intravenous administration use aseptic technique when preparing administering IV medications assess IV site for patency signs of infiltration phlebitis use appropriate equipment (pumps tubing filters) flush IV line with saline before and after medication administration
• Topical administration wear gloves to prevent contamination protect healthcare provider apply medication evenly to affected area following package instructions cover with dressing if needed
• Inhalation administration ensure upright position instruct patient to exhale fully before inhaling place inhaler mouthpiece in mouth seal lips coordinate actuation with inhalation hold breath for 5-10 seconds after inhalation rinse mouth with water after using corticosteroid inhalers to prevent oral thrush (candidiasis)

Medication Safety and Pharmacokinetics

• Understanding pharmacokinetics helps predict drug behavior and optimize dosing
• Be aware of potential drug interactions that may affect efficacy or safety
• Implement strategies to prevent medication errors, such as double-checking orders and using barcode scanning
• Monitor for adverse effects and report them promptly to ensure patient safety