Sublingual medications

Sublingual medications are administered under the tongue. Buccal medications are administered between the cheek and the gum. Both routes absorb medication quickly into the circulatory system because there is a vast network of capillaries beneath the thin layer of epithelium tissue in those areas. 

Medication can be administered sublingually to nonresponsive patients. There is minimal change of aspiration because sublingual medication is absorbed quickly. 

Sublingual medication such as nitroglycerin can be administered to a non-responsive patient. Sublingual medication dissolves quickly with minimal chance of aspiration. 

Which intervention should the nurse implement when administering sublingual medication ... 

Wear gloves when administering sublingual medication. 

Many technicians may not be famihar with terms such as sublingual (under the tongue), buccal (between the cheek and gingiva), otic, and so on. A clear description of each of these nontraditional routes (i.e., other than gavage routes) should be discussed with technicians, and instructions may also be written down and given to them. Demonstrations are often useftd to illustrate selected techniques of administration (e.g., to use an inhaler or nebulizer). Some chemicals must be placed by technicians into body orifices (e.g., medicated intrauterine devices such as Proges-terset). 

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. 

Self-medication of a MAOI-induced hypertensive crisis is controversial. In a hypertensive crisis the lack of access to medical services may lead to even greater complications. A small dose of medication taken as part of a larger plan to blunt the rise in blood pressure may prevent serious complications. However, headache is common, has multiple causes, and patients may not accurately identify a headache due to hypertension without a blood pressure check. In addition, selfadministration of nifedipine, especially sublingually, may result in needless and perhaps dangerous drops in blood pressure. 

Because faster onset of action is associated with higher potential for abuse, abuse-liability assessment should include consideration of whether a formulation can be altered to increase the speed of onset. There are numerous examples of abuse of a medication by a route other than that intended by the manufacturer. The sustained-release oral form of oxycodone, designed to deliver an initial rapid dose followed by slow release, has been widely abused by chewing the tablet, thus releasing the entire content of the tablet at once.65 There is also evidence for intravenous use of sublingual buprenorphine tablets.66 Transdermal systems developed to deliver medication slowly for extended periods of time have been prime targets for misuse,67 as discussed below in the case study of fentanyl. 

Specific immunotherapy is a very powerful tool which is currently underutilized in the treatment of allergies. Sublingual immunotherapy (SLIT) has many advantages over subcutaneous immunotherapy (SCIT), and has been well proven to work for many pollens and dust mites. Multiple studies have shown SLIT improves symptoms and reduces the reliance on medications. Sublingual treatment has been studied in Europe and is endorsed by the World Health Organization Committee on Immunotherapy as a viable alternative to SCIT. 

In 1990, effectiveness was well documented by Tari et al. [7] using sublingual dust mite antigens for 12-18 months. Allergic rhinitis and asthma symptoms improved in the children treated. There was a significant decrease in symptoms as well as medication use. In 1994, after 24 months of treatment, the same researchers found a decrease of specific IgE antibodies to dust mites [36],... 

European baseline SCIT dosage is lower than the US (this may account for some of the variability and higher ratios). SLIT/SCIT ratio = Sublingual immunotherapy monthly maintenance dose/subcutaneous monthly maintenance dose IR = index of reactivity N/A = not available ssx = symptom scores NC = no change meds = medication use ID = intradermal NS = not significant. 

This double-blind, placebo-controlled study included 58 children aged between 5 and 12 years 30 received sublingual desensitization and 28 a placebo for 18 months. The criteria for inclusion were rhinitis and asthma having progressed for at least 3 years. The criteria used to assess efficacy were based on the results of skin tests, symptom and medication scores, nasal inspiratory peak flow, nasal challenge test, nonspecific methacholine bronchial challenge test, assay of IgG (G1 and G4) specific to mites and the levels of T cells CD4 and CD8. 

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