Parenteral administration injection

Parenteral administration (injection), which is the immediate option for orally undeliverable drugs, has advanced greatly in recent years for systemic and local drug delivery. " The novel drug delivery system has metamorphosed from simple polymer and antibody conjugates to sterically stabilized colloidal systems. Liposomes and nanoparticles can improve pharmacokinetic-pharmacody-... 

Parenteral drug administration means the giving of a drug by the subcutaneous (SC), intramuscular (IM), intravenous (IV), or intradermal route (Fig. 2-5). Other routes of parenteral administration that may be used by the primary care provider are intralesional (into a lesion), intra-arterial (into an artery), intracardiac (into the heart), and intra-articular (into a joint), hi some instances, intra-arterial dragp are administered by a nurse. However, administration is not by direct arterial injection but by means of a catheter that has been placed in an artery. 

PARENTERAL ADMINISTRATION. The nurse should read the manufacturer s package insert for each drug for instructions regarding reconstitution of powder for injection, storage of unused portions, life of the drug after it is reconstituted, methods of IV administration, and precautions to be taken when the drug is administered. 

PARENTERAL ADMINISTRATION. When these drag > are given intramuscularly, the nurse inspects previous injection sites for signs of pain or tenderness, redness, and swelling. Some antibiotics may cause temporary local reactions, but persistence of a localized reaction should be reported to the primary health care provider. It is important to rotate injection sites and record the site used for injection in the patient s chart. 

As pharmaceutical scientists gain experience and tackle the primary challenges of developing stable parenteral formulations of proteins, the horizons continue to expand and novel delivery systems and alternative routes of administration are being sought. The interest in protein drug delivery is reflected by the wealth of literature that covers this topic [150-154]. Typically, protein therapeutics are prepared as sterile products for parenteral administration, but in the past several years, there has been increased interest in pulmonary, oral, transdermal, and controlled-release injectable formulations and many advances have been made. Some of the more promising recent developments are summarized in this section. 

Nickel salts administered by intravenous or subcutaneous injection are comparatively toxic. For all routes of parenteral administration, the LD50 (lethal dose to 50% of the sample) range for injected nickel salts is 6 mg Ni/kg BW for dogs given nickel oxide intravenously to 600 mg Ni/kg BW for mice given nickel disodium F.DTA intraperitoneally (Nielsen 1977). 

Parenteral—administration of a substance by any other route than via the gastrointestinal tract, particularly by injection. 

The kidneys and the liver primarily take up phosphorothioated AS-ODN after parenteral administration, accumulating more than 10% each, while the rest of the organs all accumulate less than 1% of the injected dose [110,111,114,116]. It is noteworthy that renal AS-ODN tissue levels exceed that of any other organ [110,113,114], as confirmed by the tissue to plasma ratios of approximately 85 and 20 for kidney and liver, respectively [113,118]. 

Parenteral administration of Fe + salts is indicated only when adequate oral replacement is not possible. There is a risk of overdosage with iron deposition in tissues (hemosiderosis). The binding capacity of transferrin is limited and free Fe + is toxic. Therefore, Fe + complexes are employed that can donate Fe + directly to transferrin or can be phagocytosed by macrophages, enabling iron to be incorporated into ferritin stores. Possible adverse effects are, with i.m injection persistent pain at the injection site and skin discoloration with i.v. injection flushing, hypotension, anaphylactic shock. 

Parenteral suspensions (injection) Exact dose 100% compliance Suitable for unconscious patient Rapid onset, especially after intravenous administration Painful Self-administration vmusual Requires trained personnel Solutions, emulsions, implants Expensive production processes... 

The other main route used for pharmaceutical preparations is inhalation using a head only exposure system. Parenteral administration, although technically possible, is usually avoided because of the local irritant effects that can occur with repeated injection, particularly by the subcutaneous route. Topical administration is an option for materials intended for administration to the skin. 

Hydromorphone is more soluble than morphine and approximately eight times more active upon parenteral administration. High solubility permits a lower volume of injected fluid, which is important if multiple injections are needed. It begins to work faster than morphine, but lasts for a shorter amount of time. It has a high sedative effect and a lessened capability of causing euphoria. Hydromorphone is used the same way as morphine. Side effects are analogous. Synonyms for this drug are dilaudid and others. 

Inject subcutaneously or IM when possible. In older children and adults, inject IM in the upper outer quadrant of the buttocks. In infants and young children, the anterolateral aspect of the thigh or the deltoid region is preferred. When IV administration is unavoidable, inject very slowly, not exceeding 1 mg/min. Anticoagulant-induced prothrombin deficiency in adults 2.5 to 10 mg or up to 25 mg (rarely, 50 mg) initially. Determine subsequent doses by prothrombin time (PT) response or clinical condition. If in 6 to 8 hours after parenteral administration (or 12 to 48 hours after oral administration), the PT has not been shortened satisfactorily, repeat dose. If shock or excessive blood loss occurs, transfusion of blood or fresh frozen plasma may be required. 

Parenteral administration of digoxin should be used only when the need for rapid digitalization is urgent or when the drug cannot be taken orally. IM injection can lead to severe pain at the injection site, thus IV administration is preferred. If the drug must be administered by the IM route, inject it deep into the muscle followed by massage. Do not inject more than 500 meg (2 ml) into a single site. 

Pharmacology Bretylium tosylate inhibits norepinephrine release by depressing adrenergic nerve terminal excitability, inducing a chemical sympathectomy-like state. Bretylium blocks the release of norepinephrine in response to neuron stimulation. Peripheral adrenergic blockade causes orthostatic hypotension but has less effect on supine blood pressure. It has a positive inotropic effect on the myocardium. Pharmacokinetics Peak plasma concentration and peak hypotensive effects are seen within 1 hour of IM administration. However, suppression of premature ventricular beats is not maximal until 6 to 9 hours after dosing, when mean plasma concentration declines to less than 50% of peak level. Antifibrillatory effects occur within minutes of an IV injection. Suppression of ventricular tachycardia and other ventricular arrhythmias develops more slowly, usually 20 minutes to 2 hours after parenteral administration. 

IDDM is caused by T cell-mediated autoimmune destruction of the insulin-producing P-pancreatic islet cells in genetically predisposed individuals. This is probably due to the expression of a super antigen on the surface of the jS cells in such individuals, although the molecular detail of what extent factors trigger onset of the jS cell destruction remain to be elucidated. IDDM may, however, be controlled by parenteral administration of exogenous insulin preparations, usually by regular s.c. injection. 

Estrogens are administered orally, parenterally by injection or as subcutaneous implants, transdermally and topically. After oral administration a considerable first pass effect, both in the intestinal mucosa and in the liver, takes place with large interindividual variability. Estrogens are hydroxylated and conjugated in the liver and excreted mainly in the bile. The conjugates can be hydrolyzed in the intestine to active compounds that are reabsorbed again. Their hepatic oxidative metabolism is increased by enzyme inducers and the enterohepatic circulation may be decreased by some antibiotics which disturb the intestinal bacterial flora. 

Advantages of the intramuscular and subcutaneous routes include an increased reliability and precision in the drug blood level Anally achieved and reasonably rapid absorption and onset of drug action. There are, however, serious disadvantages as well. Pain, tenderness, local tissue necrosis (primarily with highly alkaline injections), microbial contamination, and nerve damage may be associated with these forms of parenteral administration. 

Glucocorticoids are available in a wide range of preparations, so that they can be administered parenterally, orally, topically, or by inhalation. Obviously the oral route is preferred for prolonged therapy. However, parenteral administration is required in certain circumstances. Intramuscular injection of a water-soluble ester (phosphate or succinate) formed by esterification of the C21 steroid alcohol produces peak plasma steroid levels within 1 hour. Such preparations are useful in emergencies. By contrast, acetate and tertiary butylacetate esters must be injected locally as suspensions and are slowly absorbed from the injection site, which prolongs their effectiveness to approximately 8 hours. 

Parenteral administration This route is applicable for drugs which are inactivated by gastrointestinal tract or absorption is poor when given orally or there is a urgency for fast response in small dose. Intramuscular, intravenous, or subcutaneous routes are commonly used. The intravenous injection (in aqueous solution) is introduced directly into the vein by which a rapid response is produced. The subcutaneous injection are given through the layer of skin, while intramuscular injection, introduced through the skin layer deep into the muscle. The nature of intramuscular injection may be in aqueous or oily solution/suspension form. The aqueous solution will be rapidly absorbed as compared to oily solution or suspension. So, the rate of absorption is dependent on the nature of the preparation. 

The parenteral administration can cause local pain at the site of injection. The other adverse effects include headache, fever, flushing, palpitation, dyspnoea, chest pain, metallic taste and even disorientation and temporary loss of taste. 

Some of the dosage formulations available for protein pharmaceuticals are listed in Table 5.7. An examination of Table 5.7 reveals that no protein drug up until this time has been formulated for oral administration. Most protein drugs are administered by means of injection (parenteral administration). Parenteral administration includes intravenous, intra-arterial, intracardiac, intraspinal or intrathecal, intramuscular, intrasynovial, intracuta-neous or intradermal, subcutaneous injections, and injection directly into a dermal lesion (e.g., a wart). The parenteral route of administration requires a much higher standard of purity and sterility than oral administration. It also may require trained... 

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