Drug Administration Routes and Oral Medications: Advantages,

ENTERAL ADMINISTRATION ➔ Routes of drug administration: ◆ Enteral ◆ Parental ◆ Percutaneous ➔ Enteral route: drugs administered directly to GI tract by oral, rectal, or GI tube methods ➔ Oral route: ◆ Advantages: ● Safe, convenient, and economical. ● Dose forms readily available. ● Drug retrieval possible in case of error or overdose. ○ At a certain time after administration ◆ Disadvantages: ● Slowest and least dependable absorption. ● Absorption affected by food, emotions, and physical activity. ● Some drugs (e.g., insulin, gentamicin) destroyed by digestive fluids. ○ Given parenterally ● Not suitable if: ○ Drug harms or discolors teeth. ○ Patient is vomiting, has gastric/intestinal suction, risk of aspiration, or is unconscious and unable to swallow. ➔ GI Tube Method: ◆ Purpose: Bypass mouth and pharynx. ● For pt who cannot swallow or had oral surgery ◆ Advantages and Disadvantages: ● Similar to oral route. ● Consider irritation of nasal passage/throat vs.: ○ Immobility from continuous IV infusions. ○ Expense and pain from multiple injections. ● Used for long-term drug and feeding administration. ➔ Rectal Route: ◆ Advantages: ● Bypasses digestive enzymes. ● Avoids irritation of mouth, esophagus, and stomach. ● Suitable when nausea or vomiting present. ◆ Absorption Variability: ● Depends on drug product. ● Patient's ability to retain the suppository/enema. ● Presence of fecal material. ADMINISTRATION OF ORAL MEDICATIONS Dose Forms 1. Capsules ◆ Small, cylindrical, gelatin containers that hold dry powder or liquid medicinal agents; Available in a variety of sizes. ◆ Advantages: ● Convenient for drugs with unpleasant odor or taste. ● No need for coatings or additives to improve taste. ● Identifiable by color, shape, and manufacturer's symbol. ◆ Timed-Release Capsules and Tablets: ● Function: Provide gradual, continuous drug release. ● Mechanism: Granules in capsules or tablet ingredients dissolve at different rates. ● Advantages: ○ Reduces the number of doses needed per day. ○ Typically administered every 12 or 24 hours. Medication Safety Alert Timed-release capsules and tablets should not be crushed or chewed or have their contents emptied into food or liquids because this may alter the absorption rate and could result in a drug overdose or subtherapeutic activity. ➔ Lozenges ◆ Description: Flat disks containing medicinal agents. ◆ Base: Hard sugar candy or sugar with gelatinous substances. ◆ Usage: Held in the mouth to dissolve slowly.

◆ Function: Releases therapeutic ingredients gradually. ➔ Pills ◆ Description: Obsolete dose form. ◆ Current Use: Term often used to refer to tablets and capsules. ◆ Reason for Obsolescence: Replaced by capsules and compressed tablets. ➔ Tablets ◆ Description: Dried powdered drugs compressed into small disks. ◆ Ingredients: ● Binders: Adhesive substances for cohesion. ● Disintegrators: Encourage dissolution in body fluids. ● Lubricants: Aid in manufacturing. ● Fillers: Inert ingredients to make tablet size convenient. ◆ Features: ● Scored/Grooved: Allows dose division (though exact dose preferred). ● Crushing: Can be crushed for solution administration or mixed with food. ◆ Caplets: ● Description: Tablets shaped like capsules. ● Purpose: Prevents opening and contamination of contents. ● Example: Reformulated from capsules for safety (e.g., in response to the Chicago Tylenol murders). ◆ Layered Tablets: ● Description: Tablets formed in layers. ● Purpose: Allows administration of incompatible medications simultaneously. ◆ Enteric-Coated Tablets: ● Description: Special coating resists stomach acid, dissolves in intestines. ● Purpose: Protects medications destroyed by stomach acid. ◆ Orally Disintegrating Tablets (ODTs): ● Description: Rapidly dissolve (within seconds) on the tongue. ● Usage: ○ Rapid onset of action (e.g., migraines). ○ For patients with difficulty swallowing (e.g., parkinsonism, Alzheimer's, post-stroke). ○ Ensures administration for patients prone to avoiding medication (e.g., schizophrenia). ● Example: Sublingual film for rapid disintegration (e.g., Suboxone for opiate addiction). Medication Safety Alert Enteric-coated tablets must not be crushed or chewed because their active ingredients will be released prematurely and destroyed in the stomach. ➔ Elixirs: ◆ Description: Clear liquids with drugs dissolved in alcohol and water. ◆ Usage: Used when drugs cannot dissolve in water alone. ◆ Components: ● Alcohol content varies based on drug solubility. ● Water and flavoring agents often added for taste. ◆ Examples: Many cough medicines and mouthwashes. ➔ Emulsions: ◆ Description: Dispersions of small droplets of water in oil or oil in water. ◆ Emulsifying Agents: Sodium lauryl sulfate, gelatin, acacia. ◆ Purpose: ● Mask bitter tastes. ● Improve mouth and throat feel (palatability). ● Enhance drug solubility. ➔ Suspensions: ◆ Description: Liquid dose forms with solid, insoluble drug particles in a liquid base. ◆ Usage: Must be shaken well before administration for thorough mixing. ◆ Examples: ● Oral liquid antacids (e.g., Maalox, Mylanta Classic). ● Liquid antibiotics (e.g., Augmentin, EryPed).

➔ Syrups: ◆ Description: Medicinal agents dissolved in a concentrated solution of sugar (usually sucrose) and water. ◆ Purpose: Effectively mask the bitter taste of drugs. ◆ Usage: Common in pediatric preparations due to sweeter flavor. Equipment ➔ Unit Dose or Single Dose: ◆ Description: Single dose of medication in one package. ◆ Labeling: Includes generic and brand names, manufacturer, lot number, expiration date. ◆ Additional Information: Patient's name and bar code for administration and inventory control. ➔ Soufflé Cup: ◆ Description: Small paper cup. ◆ Usage: Transports solid medication forms (capsules, tablets) to prevent contamination. ➔ Medicine Cup: ◆ ◆ Description: Plastic container with scales (metric, household). ◆ Usage: ● Measure liquid medications. ● Ensure proper scale is used. ● Place on a hard surface and read at eye level. ◆ Accuracy: Inaccurate for doses less than 1 teaspoon. ● Use a syringe for smaller volumes. ● Use a tuberculin syringe for volumes less than 1 mL. ➔ Medicine Dropper: ◆ Usage: Administer eye drops, ear drops, and occasionally pediatric medications. ◆ Considerations: ● Use the dropper supplied by the manufacturer. ● Familiarize with barrel calibrations. ● Avoid tipping upside down to prevent medication loss. ● Do not transfer medication to another container. ➔ Teaspoon: ◆ Usage: Measure doses of most liquid medications. ◆ Hospital Conversion: 1 teaspoon = 5 mL (read on the metric scale of the medicine cup). ◆ Home Use: ● Recommend oral syringe. ● Baking teaspoon as an accurate measuring device if syringe unavailable. ➔ Oral Syringe: ◆ Description: Plastic syringe for measuring liquid medications. ◆ Sizes: Measures volumes from 0.1 to 15 mL. ◆ Design: Needle does not fit on the tip. ➔ Nipple: ◆ Usage: Administer oral medications to infants using an infant feeding nipple. ADMINISTRATION OF SOLID-FORM ORAL MEDICATIONS Procedure Protocol ● Definition: Set of nursing interventions for medication administration. ● Steps: 1. Assemble Equipment: ● Gather necessary tools and perform hand hygiene. 2. Seven Rights: ● Ensure adherence to the seven rights of medication preparation and administration: ○ Right Patient ○ Right Drug ○ Right Indication ○ Right Route ○ Right Dose ○ Right Time Commonly Used Measurements Equivalents Household Metric 2 Tbsp 30 mL 1 Tbsp 15 mL 2 tsp 10 mL 1 tsp 5 mL

○ Right Documentation 3. Provide Privacy and Explanation: ● Ensure patient privacy. ● Explain the procedure and what the patient can expect. 4. Premedication Assessment: ● Conduct an assessment before administering any enteral medication. ● Refer to individual drug monographs for specific information. UNIT-DOSE SYSTEM ➔ Premedication Assessment: Refer to individual drug monographs for details. Equipment: ◆ Medication cart ◆ Medication profile Technique 1. Procedure Protocol: Follow the previously described procedure protocol. 2. Read Medication Profile: ● Check prescribed drugs and administration times. 3. Obtain Medication: ● Retrieve medication from the patient’s assigned drawer in the medication cart. 4. Compare Labels: ● Verify the label on the unit-dose package against the medication profile. ● Check expiration date on all medication labels. 5. Check Doses: ● Verify the number of doses remaining in the drawer. ● Investigate if the number of doses is inconsistent. 6. Recheck Seven Rights: ● Verify the seven rights of medication administration against the medication profile and unit-dose package. 7. Patient Interaction: ● Proceed to the patient's bedside. ● Check the patient’s identification bracelet against the medication profile. ● Verify patient’s identity by asking for their name and birth date or two other identifiers. ● Explain the drugs being given, stating their names and providing education. ● Check pertinent patient monitoring parameters (e.g., apical pulse, respiratory rate). 8. Hand Medication: ● Allow the patient to read the package label. 9. Facilitate Swallowing: ● Offer a sip of water. ● Retrieve the unit-dose package, open it, and place contents in the patient’s hand or a medication cup. 10. Hand Hygiene: ● Perform hand hygiene after administering medication. COMPUTER-CONTROLLED DISPENSING SYSTEM ➔ Premedication Assessment: Refer to individual drug monographs for details. Equipment: ◆ Computer-controlled dispensing system ◆ Medication profile Technique 1. Procedure Protocol: ● Follow the previously described procedure protocol. 2. Read Medication Profile: ● Check prescribed drugs and administration times. 3. Access Dispensing System: ● Use security access code and password to access the system. 4. Select Patient: ● Choose the patient's name from the list of patients on the unit. 5. Review On-Screen Profile: ● Select the medications to be administered. 6. Check Orders: ● Verify all aspects of the on-screen order against the medication profile. 7. Verify Labels: ● Check the label on the unit-dose package against the medication profile. ● Confirm expiration dates on all medication labels. 8. Recheck Seven Rights: