Enteral - Oral/By Mouth (PO)

• Very convenient for the pt

• One of the safer ways to deliver medication because there is time to react if the wrong dose is taken

• Acts systemically or locally in the GI tract

• They take longer to work (30 min - 1 hr)

• Drugs are not as effective orally due to the acidic environment of the stomach

Enteral - Sublingual (SL) and Buccal (BUC)

• Sublingual - under the tongue

• Buccal - between the check and gum

• Readily absorbed into the bloodstream through the oral mucosa, bypasses the long route through the GI tract

• Accelerates the drug action to just a few minutes

• Not as available

• Nitroglycerin for chest pain relief (most common drug given this route)

Enteral - Gastrostomy Tube (GT) and Nasogastric Tube (NGT)

• Gastrostomy Tube - tube inserted into the abdomen that delivers nutrition directly to the stomach

• Nasogastric Tube (NGT) - tube inserted into the nose, down the esophagus, and into the stomach to deliver nutrition to or remove contents of the stomach

• Medications can be specifically prepared to be administered to pts through these tubes

Enteral - Rectal, Per Rectum (PR)

• Can be suppositories, rectal suspensions, creams, or ointments

• Acts locally or systemically

• Good alternative for pts with nausea and vomiting

• Can be used to deliver medication or clear the intestines of feces

• Absorption may be unpredictable depending on retention time

• Pts are often not comfortable with this route

Parenteral

• Comes from Greek meaning “outside of intestine” so used to describe drugs not given through the GI tract

• Intravenous (IV) - one route of parenteral administration into a vein

• Intravenous Piggyback (IVPB) - administration of medication that is diluted in a small volume of IV solution through an established primary infusion line

• Other routes of parenteral administration include injection into various sites

• Intramuscular (IM) - injection into the muscke

• Subcutaneous (SUBCUT) - injection into the subcutaneous tissue

• Intradermal (ID) - injection into the dermis

• Rapid onset of action, much quicker than oral

• Great for emergencies, or if unconscious, combative, or unable to swallow

• Risk of infection due to invasive nature, much more expensive due to preparation and administration by trained personnel, little to no time to react if wrong dose is given or if allergic reaction occurs

Topical (TOP)

• Comes in different preparations - creams, lotions, patches

• Can be used for local or systemic effect

• Drugs can enter the skin through sweat glands, hair follicles, pores, and ultimately end up in the bloodstream

• Ease of application

• Patches can increase compliance because they are worn all day

• Cause skin irritation

Eye, Ear, Nose

• Effective at specific site rather than systemic

• Eye - Ophthalmic

  • Always sterile - do not touch bottle to eye

  • Dosing often very frequent due to blinking

  • May interfere with vision

• Ear - Otic

  • Are not always sterile

• Nose - Intranasal

Inhalants (INH)

• Mostly used to treat lung diseases

• Variety includes Nebulizer Solutions, Metered Dose Inhalers (MDI), and Dry Powder Inhalers

• Hand held inhalers are portable/convenient and increase pt compliance

• If not used correctly, little med. will reach the lungs