Oral medications, administration

Use the oral route of administration if the patient has mild nausea with minimal or no vomiting. Seek an alternative route (e.g., transdermal, rectal suppository, or parenteral) if the patient is unable to retain oral medications due to vomiting. 

Attapulgite adsorbs excess fluid in the stool with few adverse effects. Calcium polycarbophil is a hydrophilic polyacrylic resin that also works as an adsorbent, binding about 60 times its weight in water and leading to the formation of a gel that enhances stool formation. Neither attapulgite nor polycarbophil is systemically absorbed. Both products are effective in reducing fluid in the stool but can also adsorb nutrients and other medications. Their administration should be separated from other oral medications by 2 to 3 hours. Psyllium and methylcellulose products may also be used to reduce fluid in the stool and relieve chronic diarrhea. 

Adjust the route of administration if the patient is unable to take oral medications. 

Sociocultural, illness, and biological factors affect individual attitudes towards psychotropic medications. Health beliefs or explanatory models, particularly causal attributions regarding the illness and the treatment options afforded within such models, exert a profound influence on patients attitudes and behavior regarding medications (Smith, Lin Mendoza, 1993). Such effects can be subtle and can occur during the course of treatment even if there has been initial successful negotiation about the nature of the illness and treatment. In psychiatric illness little research has been leveled at the personal meaning that patients bring to treatment practices such as electro-convulsive therapy (ECT), oral medications, and depot injections, or to the transition between different administrative routes and types of medications. 

Many drugs are administered as parenterals for speed of action because the patient is unable to take oral medication or because the drug is a macromolecule such as a protein that is unable to be orally absorbed intact due to stability and permeability issues. The U.S. Pharmacopoeia defines parenteral articles as preparations intended for injection through the skin or other external boundary tissue, rather than through the alimentary canal. They include intravenous, intramuscular, or subcutaneous injections. Intravenous injections are classified as small volume (<100 mL per container) or large volume (>100 mL per container) injections. The majority of parenteral dosage forms are supplied as ready-to-use solutions or reconstituted into solutions prior to administration. Suspension formulations may also be used,101 although their use is more limited to a subcutaneous (i.e., Novolin Penfill NOVO Nordisk) or intramuscular (i.e., Sandostatin LAR Depot Novartis) injection. Intravenous use of disperse systems is possible but limited (i.e., Doxil Injection Ortho Biotec). 

Administration - To maximize absorption and clinical benefit, patients should take ibandronate at least 60 minutes before the first food or drink (other than water) of the day or before taking any oral medication or supplementation, including calcium, antacids, or vitamins. 

Unlabeled route of administration - Sublingual clonidine, using a dosage of 0.2 to 0.4 mg/day, may be effective in hypertensive patients unable to take oral medication. The onset occurs within 30 to 60 minutes and blood pressure appears to be maintained on a twice daily regimen. 

Rectal Administer to adults during impending coma or coma stage of portal-systemic encephalopathy when the danger of aspiration exists or when endoscopic or intubation procedures interfere with oral administration. The goal of treatment is reversal of the coma stage so the patient can take oral medication. Reversal of coma may occur within 2 hours of the first enema. Start recommended oral doses before enema is stopped entirely. 

Renal homotransplantation Initial dose is usually 3 to 5 mg/kg/day, given as a single daily dose on the day of transplantation, and in a minority of cases, 1 to 3 days before transplantation. It is often initiated IV, with subsequent use of tablets (at the same dose level) after the postoperative period. Reserve IV administration for patients unable to tolerate oral medications. Maintenance levels are 1 to 3 mg/kg/day. 

Which route of administration is optimum Choosing the optimum dmg administration route takes into account the specific circumstances of each individual case. For example, can the patient tolerate oral medications, or is intravenous administration required Does the patient have venous access For how long can it be maintained Is intramuscular administration a possibility In many clinical situations, the available formulation determines the route of administration. Antibiotics are a prime example of this phenomenon ceftriaxone, for example, is available only for parenteral administration while amoxicillin is administered orally. 

The primary indication for standard i.m. administration is when a patient is too disturbed to take oral medication. Because drugs are more rapidly absorbed when given parenterally and their effect occurs about 60 minutes faster than with oral administration (i.e., 30 vs. 90 minutes), violent or otherwise dangerously disturbed patients should initially receive i.m. injections. Further, because orally administered drugs are metabolized in the gut, as well as during their first pass through the liver, less than 50% may reach the systemic circulation for ultimate availability at the intended brain sites. 

Oral ingestion of fentanyl is the most common way it is used to relieve chronic pain today. This is achieved primarily in a lollipop or lozenge that allows for a slow ingestion into the body. Most of the lollipops and lozenges are cherry flavored for children in cancer wards, this is the preferred method of administration because they seldom view the treats as medication. Rectal administration is sometimes used as well if the patient cannot receive oral medication or if they have a strong nausea reaction to the fentanyl. This method is used only as a last resort, and few patients opt for it. 

Increase the metoclopramide dose to 10 mg four times a day and consider changing to the intravenous route, particularly if Mrs CR is continuing to vomit. The administration of metoclopramide orally will be inappropriate if she is unable to retain oral medications due to sickness. 

However, it is not always so easy to get two medications, therapies, or procedures to be indistinguishable to patients, much less to all the nurses and doctors involved. For instance, one drug may require intravenous administration, while the other is an oral medication. The two drugs may have very different durations of action or very different side effects, so that both the patients and all the clinicians know which patients are on which medication. The action of the active agent may be quite obvious, and the effect of the placebo (nothing) is nothing, so that even if patients do not deduce what arm of the study they are in, the clinicians will probably catch on, and the problem of bias in the observations surfaces. 

The oral route of drug administration may be indicated for some conditions in pediatric patients, such as in dacryocystitis and orbital or preseptal cellulitis. Young patients are able to swallow liquid suspensions and solutions more easily than oral solids (e.g., tablets or capsules). Oral medications are the most reliable form of dosing and delivery and continue to be the mainstay in pediatric drug therapy. 

The oral route is typically the preferred route for medication administration to pediatric patients. Other routes may be used, if the patient cannot take a medication orally because of vomiting, being unable to swallow, or the medication is imavailable for oral use. In addition, for specific problems it may be better to deliver the medication directly to the area being treated, for example, inhalation, ophthalmic administration, or otic administration. 

Health care providers including nurses, pharmacists, and physicians should demonstrate to parents and older children how medications should be administered and offer appropriate dosing devices (oral syringe, dropper, cylindrical medication spoon, or a small-volume doser with attachable nipple) to enable parents to accurately measure liquid products. A household teaspoon or tablespoon should not be used for medication administration because they are inaccurate. Kraus and Stohlmeyer explain the use of a new oral liquid medication delivery system that can be used for infants and young children who still use a bottle for feeding. 

Vincamine is an alkaloid extracted from the plant Vinca minor. Ethyl apovincaminate is a related synthetic ethyl ester of vincaminic acid. These drugs have spasmolytic effects similar to those of reserpine, but also have metabolic effects, including, in high doses, inhibition of phosphodiesterase. Although increased cerebral blood flow has been reported after the intravenous administration of vincamine, there have been no reliable studies of blood flow after oral medication. Improvement in scores on some psychometric tests have been obtained in some patients with cerebrovascular disease, but no clear-cut practical benefit has been demonstrated. 

The fourth form, due to FV administration of talc, is usually associated with abuse of oral medications and production of vascular granulomas manifested by consolidations, large nodules, and masses. 

Route of administration - intramuscular, intravenous and topical administrations are more likely to cause hypersensitivity reactions oral medications are less likely to result in drug hypersensitivity. 

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