Routes of parenteral administration

Description of various routes of parenteral administration

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2. PARENTERAL ROUTES OF DRUG ADMINISTRATION 2

3. Definition: A route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body. Guidelines – US-FDA – 6 ‘Rights’ Right Patient Right Drug Right Dose Right Time Right Route Right Documentation 3

4. Significance of Route Speed and efficacy of drug action Absorption and Bioavailability Rapid action, minimal adverse reactions, better tolerability Rapid delivery of therapeutic concentrations of drug to desired site of action 4

5. Factors affecting choice of route Drug – related Patient – related Therapeutic action desired 5

6. ROUTES Enteral e nteron – of intestine From mouth to rectum Simple, safe, no sterilization required Slow, digestive juices/enzymes, FPM, Irritants, emergencies, etc. Parenteral p ar – beyond; enteron Emergencies Rapid, No FPM, irritants, no gastric irritation Painful, invasive, asepsis, skilled personnel, more adverse events, etc. 6

7. Parenteral Route Across the body’s defence barriers Higher bioavailability Control over actual dose of drug delivered into the body Uses 7

8. Classification Systemic Introduces drug directly into the systemic circulation Local Exerts action locally at site of application before disseminating into circulation 8

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10. Intravenous Most common parenteral route Types – Bolus Push Slow Infusion final\intravenouslineinsertion.avi Central Venous Administration final\peripherallyinserted.avi 10

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12. Intravenous (contd.) Disadvantages – Adverse Drug Reactions Strict Asepsis Inadvertant administration of wrong dose/drug Irritation, thrombophlebitis , cellulitis Injury to deeper structures Air embolism, necrosis Suspensions, emulsions Skilled personnel 12

13. Intamuscular Muscle is an extremely vascular structure Aqueous, emulsions, depot preparations Sites – Adult Pediatric 13

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15. Intramuscular (contd.) Disadvantages – Slower onset Nerve Damage Large volumes Erratic absorption for some drugs Solvent Leakage - Z track technique final\ztrack.avi 15

16. Subcutaneous Beneath the skin, permeates capillary walls Injections, Implants Vaccines Insulin final\subcutaneous.avi 16

17. 45º 17

18. Implants 18

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20. Insulin Pump 20

21. Medi-Jector The Medi-Jector VISION uses pressure to create a micro-thin stream of insulin that penetrates the skin The insulin is deposited into the subcutaneous (fatty) tissue in a fraction of a second Currently FDA approved for insulin delivery 21

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23. Autoinjectors Atropine Diazepam 23

24. PenJet New no-needle way of delivering SC drugs Can deliver liquid or powdered drugs Uses compressed gas to force drug through the skin Currently used to deliver smallpox vaccine 24

25. Subcutaneous (contd.) Disadvantages – Slower onset Bruising – Rotation of site Small Volumes Irritants – sloughing, necrosis Only highly soluble drugs 25

26. Hypodermoclysis Large amounts (500-1000ml) Infants and children Rarely used nowadays 26

27. Intradermal Dermal layer of skin Very small amounts Diagnostic tests, BCG vaccine final\intradermal.avi final\ intravenouslineinsertion 1.avi 27

28. Intra-Arterial Through a catheter into Artery directly to area to be treated Intra-arterial ports Pressure – Infusion pump/pressure cuff final\intra-arterial.avi 28

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30. Intraperitoneal Into the peritoneal space Usually infusion – dialysis Risky final\dialysisf.avi 30

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32. Intra-Osseous Administration into marrow space Non-collapsible vein Pediatric – red vascular marrow EZ-IO 32

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34. Intracardiac Directly into the ventricle of the heart Exclusively in Life-threatening situations Left 4 th Intercostal – MidClavicular Line 34

35. Inhalational Directly into the respiratory tree Drugs administered in the form of – Aerosol Dry powders Nebulized solutions Gases 35

36. Inhalatonal (contd.) Local Respiratory distress Nebulized solutions or aerosols Particle Size - < 0.5 μ and >20 μ final\inhaler.avi 36

37. Inhalational (contd.) Systemic General Anaesthesia Gaseous and volatile agents 37

38. Exubera Inhaled Insulin 38

39. Intranasal Aerosols instilled in nose Massive vascular network Mucosal dystrophy Route of abuse 39

40. Optinose 40

41. Mucosal Atomization Device 41

42. Intrathecal i nto the sheath Subarachnoid or Epidural space Anaesthesia, Antibiotics 42

43. Subarachnoid Instillation of drug into CSF after puncturing the dura and arachnoid Free communication of CSF in and out the brain Only in Lumbar spaces 43

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45. Epidural In the potential space above the dura Space ends at Foramen magnum All spaces Continuous block 45

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47. Combined Spinal Epidural 47

48. Infusaid 48

49. Intra- Articular Local application for pain relief Initially local discomfort, before palliation 49 final\intra-art.avi

50. Mucosal Conjunctival Occuserts Lacriserts final\lacrisertf.avi Otic Nasal 50

51. Mucosal (contd.) Vaginal Solutions, emulsions, ointments, pessaries Urethral Endotracheal Adrenaline Atropine Diazepam Naloxone 51

52. Transdermal Sustained delivery of drugs through the skin Drug must be potent or the patch becomes too large Lower risk of side effects 52

53. Adhesive patches 53

54. Transdermal Patches 54 final\trans needle 1.avi

55. Transdermal (contd.) Rate of absorption Site Thickness & integrity of Stratum corneum Size of molecules Permeability of membrane Hydration of skin Lipid solubility Blood flow 55

56. Iontophoresis Non-invasive technique that uses a mild electric current to deliver drugs through the skin 56

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58. Phonophoresis Movement of drug molecules through the skin under the influence of ultrasound 58

59. Conclusion No single route is ideal for all medications in all circumstances 59

60. Thank You! 60