Route of Admisintration

8/3/2019 Route of Admisintration

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Routes Of Adminstration

Intramuscular

Intraarterial

TransdermalTransmucosal


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An intramuscular injection is an injection givendirectly into the central area of a specificmuscle.

In this way, the blood vessels supplying thatmuscle distribute the injected medication viathe cardiovascular system.

Used for particular forms of medication, whichare administered in small amounts.

Intramuscular Route


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Purpose

Intramuscular injection is used for the delivery ofcertain drugs not recommended for other routes ofadministration, for instance intravenous, oral, orsubcutaneous.

The intramuscular route offers a faster rate ofabsorption than the subcutaneous route, andmuscle tissue can often hold a larger volume of

fluid without discomfort.


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Medication may either be absorbed fairly quicklyor more gradually, depending on the chemicalproperties of the drug


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Often given in the deltoid, vastus lateralis,

ventrogluteal and dorsogluteal muscles.


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Deltoid MuscleDeltoid muscle is the muscle forming the roundedcontour of the shoulder


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Vastus LateralisThe vastus lateralis muscle is located on the outsidethe thigh and connects buttock to the knee cap.


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VentroglutealAn anatomic area of the upper lateral thigh.


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DorsoglutealAn anatomic area just behind the hip.


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When the gluteal muscles are used,injections should be made on the upper,outer quadrant of the buttock to avoid

damaging the sciatic nerve.

Intramuscular injection is similar tosubcutaneous injection, except that

medication is delivered deeper intotissue, and a larger needle is usuallyused.


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Drugs in aqueous solution are rapidlyabsorbed. However, very slowconstant absorption can be obtainedif the drug is administered in oil orsuspended in other repositoryvehicles.


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It can be used for relatively irritantdrugs and larger volumes can beadministered.

Introduction of larger amounts ofdrugs (as much as 3 mL) intomuscles, using needle & syringe.


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Therapeutic Uses:

IM Route preferred over Oral Route when:

Cant swallow a drug

vomiting/having gastric suction

Drug Action is hampered/destroyed by GIsecretions

Quicker action needed compared to Oral route

Drug produces irritating to GIT


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IM Route preferred over SQ Routewhen:

Irritating to SQ tissues More rapid action desired

Amt. Of Drug (to be injected) is

more than what SQ tissues canabsorb


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Advantage

Less danger of causing tissue damage whenentering deep muscle

Muscle is less sensitive to irritating & viscousmedications.

A depot or sustained release effect is possible

with IM injections, e.g. procaine penicillin.


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Disadvantage

Incorrect placement of the needle may damageblood vessels or nerves and cause pain.

Trained personnel required for injections.

Absorption can be rapid from aqueous solution.Absorption is sometimes erratic, especially forpoorly soluble drugs.

The solvent maybe absorbed faster than the

drug causing precipitation of the drug at thesite of injection.

Irritiating drug may be painful.


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Examples

Diazepam

Phenytoin

Sex hormones Morphine


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Transmucosal Route


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Entering through, or across, a

mucous membrane, as theadministration of a drug via the cavitybetween the cheek and gum.


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Drug absorption through a mucosal surface isgenerally efficient because the stratumcorneum epidermidis, the major barrier to

absorption across the skin, is absent.

Mucosal surfaces are usually rich in bloodsupply, providing the means for rapid drug

transport to the systemic circulation andavoiding, in most cases, degradation by first-pass hepatic metabolism.


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The amount of drug absorbed depends on:

drug concentration

vehicle of drug delivery

mucosal contact time, venous drainage

of the mucosal tissues

degree of the drug's ionization

pH of the absorption site

size of the drug molecule relative lipid solubility.


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Nasal mucosal administration is rapid and relativelypainless.

Drugs sprayed onto the olfactory mucosa are rapidlyabsorbed by three routes (1) by the olfactoryneurons, (2) by the supporting cells and thesurrounding capillary bed, and (3) into thecerebrospinal fluid (CSF). Vasopressin and

corticosteroids were among the first drugs to beadministered by this route.


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However, the nasal mucosaalso has been usedfor the administration of sedatives andpotentnarcotics, which generally results in a rapidsystemicresponse.

It is not known if this response to sedatives

and narcotics is due to systemic absorptionfollowed by transportto the central nervoussystem, direct transport into the CSF,or

transneuronal transport.


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Limitation

In general, children object to this

mode of drug administration (75%

cry when midazolam is given)

because of the discomfort and, if thedrug is unpalatable, its unpleasanttaste in the posterior pharynx


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Oral transmucosal administration involves sublingual(under the tongue) and buccal (inside the cheek)tablets. Oral transmucosal absorption is generallyrapid because of the rich vascular supply to themucosa and the lack of a stratumcorneumepidermidis. This minimal barrier to drug transportresults in a rapid rise in blood concentrations. Theoral transmucosal route has been used for manyyears to provide rapid blood nitrate levels for thetreatment of angina pectoris


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E.g fentanyl, which is the first FDA-approvedformulation for children. Current approval is forpreoperative sedation and for painful procedures in ahospital setting.

Fentanyl has been used successfully in oncologypatients undergoing painful procedures such as bonemarrow aspiration or lumbar punctures.

Absorption of buprenorphine is better than that of

morphine, but the utility of this drug is limited by theslow onset of effect.


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Rectal Transmucosal Administration

Medications may be administered by the rectal mucosalroute for systemic effects if other more preferable routesare not available for the treatment of nausea andvomiting, sedation, control of seizures, analgesia, or

antipyresis. Rectal administrationprovides rapid absorption of many

drugs and may be an easy alternativeto the intravenousroute, having the advantage of being relativelypainless,and usually no more threatening to children than taking

a temperature. However, rectal administration of drugs should be

avoided in immunosuppressed patients in whom evenminimal traumacould lead to formation of an abscess.


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Intra Arterial

Intra-artery route is specially used whenhigh drug concentration in specific tissue isrequired than other tissue:

- diagnostic purpose and- for chemotherapy

It is little used, some examples ofintraarterial administration: a vasodilatorfor arteritis, a thrombolytic to dissolve aclot, an antineoplastic for localizedtreatment of a cancer.


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