It is usually administered orally and rectally. External route of administration

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The drug may enter the body in various ways. Routes of drug administration are determined by speed therapeutic effect, its severity and duration. In some cases, the nature of its action, and therefore our recovery, depends on how the medicine enters the body. There are several main methods of administering drugs orally, and each of them has its pros and cons. Before you figure out which route of administration to choose, you need to know exactly what forms of medications exist.

Basic forms of drugs

Before determining the routes for introducing drugs into the body, you need to know what types of drugs exist, and there are many of them:

Solutions- This is a liquid form of the drug. They are a medicinal substance diluted in water, alcohol, glycerin or other solvent. But it is worth remembering that a high-quality and unspoiled solution should be transparent, no cloudy sediment or foreign particles. They can be used for both parenteral and enteral administration.
Decoctions and infusions- these products are prepared from plant materials. But it is worth remembering that they for a long time not stored, no more than 3 days in a cool and protected from sun rays place.
Pills- this is a solid material that is obtained by pressing. They are mainly taken orally, but external administration of drugs is also possible if they are crushed into powder.

Dragee- this is another type of product; they are created by layering the main substance onto a granule. Used for oral administration.
Capsules- the solid form of the medicine, is a tablet coated with gelatin or another substance. Most often, capsules contain medications with a bitter taste or specific odor; the shell makes it much easier to take these medications. In addition, it allows you to protect the substance from rapid destruction in the digestive tract.
Candles is a dosage form of the drug that remains solid at room temperature, but melts inside the human body. If we consider the administration of drugs, there are two types of routes for suppositories - rectal and vaginal.
Patch- This is a plastic form of the product, which softens under the influence of body temperature and easily adheres to the skin. Suitable for external use only.
Ointments- a product of viscous consistency, used mainly for external use. They must contain about 25% dry matter.

There are several ways of administering drugs; we will consider each of them in more detail.

Types of enteral administration

The enteral route of drug administration is considered one of the most convenient and safest. There are several subtypes of this route: oral, sublingual, rectal.

1. Oral administration of the drug, in other words, ingestion- this is one of the simplest methods, which is why it is most often prescribed by many doctors. Absorption of drugs delivered in this way occurs mainly by diffusion into small intestine, in rare cases - in the stomach. The effect of use is noticeable after 30-40 minutes. It is for this reason that this method is not suitable for emergency assistance. The speed and completeness of absorption depend on food intake, its composition and quantity. Thus, if you drink the medicine on an empty stomach, the absorption of weak bases improves, since the acidity in the stomach is low, but acids are better absorbed after eating. But there are also drugs, for example “Calcium chloride”, which, when entering the body after eating, can form insoluble calcium salts, which limits the possibility of their absorption into the blood.

2. Another convenient and effective enteral route of drug administration is sublingual. The medicine is placed under the tongue, thanks to the large network of capillaries in the mucous membrane, it is absorbed very quickly. The effect occurs within a few minutes. This method of administration is most often used to use Nitroglycerin for angina, Clonidine and Nifedipine to eliminate a hypertensive crisis.

3. The rectal route is not used very often. It is mainly used if the patient has gastrointestinal diseases, or if he is unconscious.

Enteral administration: advantages and disadvantages

All routes and methods of drug administration have their advantages; enteral administration also has them:

Simplicity and ease of use.
Naturalness.
Relative safety for the patient.
Does not require sterility or supervision by medical staff.
Possibility of long-term therapy.
Comfort for the patient.

But there are also disadvantages of the enteral route of drug administration:

The effect comes slowly.
Low bioavailability.
Different speed and completeness of suction.
The influence of food intake and other components on the absorption process.
Impossibility of use by patients in an unconscious state.
It is not advisable to use for patients who have pathologies of the stomach and intestines.

Types of parenteral administration of drugs

The parenteral route of drug administration involves the administration of drugs without involving digestive system. It can be divided into several types.

Intradermal- this method is mainly used for diagnostic purposes, for example, for Burnet allergy tests or for local anesthesia.
Subcutaneously- used if you need to get maximum effect from the drug. This is achieved due to the fact that the subcutaneous fat layer is well supplied with blood vessels, and this facilitates rapid absorption.
Intramuscularly- used if subcutaneous administration causes irritation or pain, and also when the drug itself is slowly absorbed.

Intraosseous- this method is used infrequently, mainly for extensive burns and deformities of the limbs, when other options cannot be used.

If medications are to be administered, the routes through the vessels are as follows:

Intravenously- this method is used to introduce large quantity medicines and some drugs that have such a requirement for use.

Intra-arterial- used for conditions caused by shock, large loss of blood, asphyxia, injury electric shock, intoxication and infections.
IN lymphatic vessels - this method is used to ensure that the medicine does not enter the liver and kidneys, to ensure more accurate delivery to the site of the disease.

Intravascular administration of drugs is not always convenient; routes can also lead through cavities:

Pleural.
Abdominal.
Hearts.
Articular.

advantages and disadvantages

Parenteral administration has a number of advantages:

This method allows the drug to be administered bypassing the digestive tract, which is very important for patients with serious gastric pathologies.
Speed of action is necessary in emergency situations.
Maximum dosage accuracy.
The drug enters the blood unchanged.

The parenteral route of drug administration has a number of disadvantages:

The drug must be administered by a trained medical professional.
Asepsis and antiseptics are required.
It is difficult and even impossible to administer the medicine if there is bleeding or damage to the skin at the injection site.

Inhalations

The inhalation route of drug administration allows the use of aerosols, gases (volatile antiseptics) and powders in treatment. With this method of administration, drugs quickly enter inside and exert their effect. therapeutic effect. In addition, it is easy to control the concentration of the drug in the blood - stopping inhalation leads to a suspension of the drug's effect. By inhaling an aerosol, the concentration of the drug in the bronchi is very high with minimal

But it is worth remembering that no matter how effective inhalation is, it does not allow the use of irritating substances. You should also keep in mind that inhaled drugs can affect others (for example, anesthesia).

Pros and cons of inhalation administration

We continue to consider ways of administering drugs. The inhalation method also has advantages and disadvantages. Pros of inhalation:

It acts directly at the site of pathology.
The medicine easily penetrates to the site of inflammation, while bypassing the liver unchanged, which causes its high concentration in the blood.

Disadvantages of inhalation:

If bronchial patency is severely impaired, the drug does not penetrate well into the site of the disease.
The drugs may irritate the mucous membranes of the nose, mouth and throat.

The main routes of drug administration have been discussed, but there are others that can also become indispensable in some cases.

Rectal, vaginal and urethral routes of administration

If we compare the rectal route of drug administration with oral administration, we can say for sure that the effect of the first method occurs much faster. The drug is quickly absorbed into the blood without being destroyed by enzymes of the digestive tract and liver.

Suppositories, ointments, and other forms of drugs, previously ground into powder and diluted, are administered rectally into the body, while enemas are used. But it is worth remembering that a solution administered rectally will give an effect much faster than a suppository. The enema volume for adults ranges from 50 to 100 ml, and for children - from 10 to 30 ml. But this method There are also disadvantages to the introduction of drugs:

Inconvenient to use.
Particular variations in speed and overall suction pattern.

Vaginal and urethral methods allow the administration of any form of drugs. But both of these methods give best result, if they are used to treat infections in these organs or for diagnostics, for example, to administer contrast agents, such as "Yodamide", "Triombrast" and others.

Spinal and intracranial routes of administration

In very rare cases, spinal and intracranial (suboccipital, subarachnoid, subdural and others) injections are used. This is largely due to the fact that the drug should be administered using such methods only qualified specialist. Such methods require the use of only sterile, absolutely transparent true aqueous solutions with a neutral reaction. The action comes very quickly.

Transdermal therapeutic systems

IN Lately Drugs are increasingly available in new form. Transdermal therapeutic systems(TTS) is one of them. They are a soft dosage form intended for external use with a slow release of the drug. Modern TTS are films and plasters that were manufactured using cutting-edge technologies and are very convenient to use: the patch is glued to skin covering, and the film is placed behind the cheek. In this case, the main substance is absorbed into the blood through the skin or mucous membrane.

Many doctors around the world have recently been increasingly paying attention to newest ways administration of drugs. Each has advantages and disadvantages, including TTS. Let's consider the advantages:

The medicine works at an accelerated pace.
The drug enters the blood gradually without interruption, which ensures a stable level of the main substance.
Unpleasant sensations are completely excluded, this also applies to vomiting and pain from injections.
Complete absence unwanted effects from the digestive tract.
Reduced frequency of allergies.
Possibility of quickly discontinuing the drug if there are any contraindications.
Exact dosage.
Possibility of targeted delivery of medication to the desired part of the body.

Each of the described routes of drug administration has its pros and cons. But no matter how good the method, the main thing is that it must be prescribed by a doctor, and it is advisable that the most complex and rare methods of administration be carried out by a specially trained person in medical institution. Take care of yourself so that you don’t have to think about how to deliver the medicine inside the body.

The administration of drugs through the rectum (rectal) refers to the enteral route of administration. Liquid dosage forms are administered through the rectum: decoctions, solutions, mucus in the form of microenemas and soft dosage forms (suppositories). Suppositories belong to dosed dosage forms. They consist of medicinal substances and a base. The best foundation is cocoa butter (Oleum Cacao). Rectal suppositories (suppositories) are usually shaped like a cone or cylinder with a pointed end. At room temperature, suppositories have a solid consistency; at body temperature they melt and are absorbed through the hemorrhoidal veins; after absorption, the drug enters the inferior vena cava system and further, bypassing the liver, into systemic blood flow. Medicinal substances in suppositories are used mainly for local action, and less often for resorptive action.

Advantages of the rectal route of administration:

1. Possibility of use when administration through the mouth is impossible: with vomiting, difficulty swallowing, in an unconscious state of the patient, damage to the gastric mucosa.

2. Input medicinal substances resorptive action enters the bloodstream bypassing the liver, and, therefore, is not destroyed

Disadvantages of the rectal route of administration:

1. inconvenience of use (especially outside the hospital);

2. small suction surface area and short contact time medicine with the mucous membrane (it can be difficult for a child to keep the drug in the intestine);

3. irritant effect of the drug on the mucous membrane, as a result of which proctitis may occur.

4. due to the absence of enzymes in the rectum, administered medicinal substances are not broken down and medicinal substances of protein, fat and polysaccharide base cannot pass through its wall, so they can be prescribed only for local impact in the form of medicinal microenemas.

Introduction of a rectal suppository

Contraindications: individual intolerance active substance of the administered dosage form.

Equipment: suppository packaging, scissors, gloves, liquid soap or hand sanitizer, disposable towel, container for disinfection.

Algorithm of actions:

I. Preparation for the procedure

4. Separate the patient with a screen (if there are other patients in the room).

5. Help the patient lie on his side, bend his knees.

II. Executing the procedure.

7. Open the suppository shell (without removing the suppository from the shell)

8. Ask the patient to relax, spread the buttocks with one hand, and insert the suppository into the anal hole(the shell will remain in your hand).

9. Invite the patient to lie down in a position that is comfortable for him.

III. End of the procedure.

12. Remove the screen.

13. Make an appropriate entry about the procedure performed in the medical documentation.

Remember! Before administering medications into the rectum (with the exception of laxatives), the patient should be given a cleansing enema.

Possible patient problems and nursing interventions for them.

When conducting drug therapy problems may arise that are associated with the patient’s refusal to take prescribed medicines. As a rule, patients can justify their refusal by the lack of improvement in their condition. Nurse should calmly and tactfully explain the importance of regularly taking medications, the need for a continuous course of treatment and strict adherence to these conditions for recovery.

Refusal to take medications by patients is sometimes caused by insufficient or lack of information about the drug prescribed to them. In this case it is necessary to accessible form and, within your competence, inform the patient about:

· the name of the drug prescribed to him;

· the purpose of taking this medicinal product;

· time of onset of effect (cure, pain reduction);

· rules for taking the drug;

· possible occurrence side effects;

· interaction of the drug with food, alcohol and other drugs.

If the patient does not remember the information received, it is necessary to give recommendations in writing.

The introduction of drugs into the rectum causes a feeling of embarrassment in patients due to intimate nature procedures, which may lead to refusal. The nurse must tactfully explain the need to follow the doctor’s orders and carry out this manipulation in a separate room, without attracting the attention of other patients.

Questions to consolidate knowledge:

1. Sampling of medical prescriptions.

2. Requirements for filling out the “Demand - invoice” forms

3. The procedure for obtaining medicines from the pharmacy for the department.

4. Preparation of medication logs.

5. Advantages and disadvantages of administering drugs by mouth.

6. Rules for distributing medicines to patients.

7. Rules for taking medications sublingually.

8. Advantages and disadvantages of the “rectal” route of administration.

9. Possible patient problems and nursing interventions for them.

Use of drugs externally and inhalation.

Plan:

1. Application to the skin of ointments in various ways, powders, patches, solutions, tinctures. Safety precautions when using ointments.

2. Instillation of drops and introduction of ointment into the eyes, nose, ears.

3. Inhalation method of administering drugs through the mouth and nose. Teaching the patient the technique of using metered and non-metered aerosol in an inhaler. 4. Safety precautions when using the inhaler.

Questions to test knowledge on the topic: “ Drug treatment in nursing practice"

1. Methods of external use of medicines.

2. Information necessary for the patient to participate consciously in drug therapy.

Application to the skin of ointments in various ways, powders, patches, solutions, tinctures. Safety precautions when using ointments.

External route of administration

The external route of administration is the use of medicinal substances on the skin and mucous membranes of the eyes, nose, vagina, and ears.

This route of administration is primarily intended for local action medications, since through intact skin (mainly through excretory ducts sebaceous glands And hair follicles) only fat-soluble substances are absorbed. But in some cases

drugs used transdermal , through the skin, are capable of creating subcutaneous tissue a depot that maintains a certain concentration of a substance in the blood. Especially in children of the first years of life soft skin, which has a thin stratum corneum, so the absorption of drugs through it occurs as easily as when they are taken orally. In addition, extreme caution should be taken when applying medications to damaged skin (wound, maceration in the area of diaper rash, burn). Methods for the external route of administration of various dosage forms (ointments, emulsions, solutions, mash, powders, tinctures, pastes, etc.) can be as follows:

· compresses,

· lotions,

· powders,

· lubrication,

· rubbing,

· rubbing;

· bandages on wound surface,

· instillation of drops into the eyes, ears, nose,

· putting ointments in the eyes, nose, ears.

Rubbing– administration of medicinal substances through the skin in the form of liquids or ointments. Rubbing is carried out in those areas where the skin is thinner and not covered with hair (flexor surface of the forearms, back of the thighs, side surfaces chest, belly). The skin at the site of rubbing should be clean. If the ointment does not have a strong irritating effect, you can rub it in with the pads of your gloved fingers. The required amount of ointment or liquid is applied thin layer onto the skin and rub in circular movements in one direction. For rubbing, you can also use special devices included with the ointments. A contraindication to this procedure is the presence of inflammatory changes on the skin.

In some cases, the ointment is applied to the skin, without rubbing, in a thin layer with a glass spatula or spatula and the area is kept open for 10-15 minutes. It is not recommended to do this with your hands, as some ointments are absorbed through intact skin or cause irritant effect.

Lubrication widely used mainly for skin diseases. Cotton or gauze swab moistened in the required medicinal substance and applied to the skin patient's lungs longitudinal movements (in the direction of hair growth).

Unction

Simple purpose medical services(purpose): therapeutic

Indications: as prescribed by a doctor

Contraindications: individual intolerance to the active substance of the drug, inflammatory processes skin (eczema, dermatitis).

Equipment: jar (tube) with ointment, device for rubbing ointment, gloves, liquid soap or hand sanitizer, disposable towel, container for disinfection.

Algorithm of actions:

I. Preparation for the procedure

2. Obtain the patient’s consent to perform the procedure.

6. Wash your hands and put on gloves.

7. Examine the area of skin for rubbing the ointment.

II. Execution of the procedure.

8. Apply the required amount of ointment to special device; If it is not available, rub in the ointment only while wearing gloves.

9. Rub the ointment with light circular movements on the area of the body determined by the doctor until the ointment disappears (in some cases there are precise instructions on when to stop rubbing).

10. Cover the patient warmly if required by the instructions.

11. Ask the patient how he is feeling

III. End of the procedure.

12. Remove gloves, wash hands.

13. Remove the screen.

Attention! Do not rub the ointment on the patient with unprotected hands - this is unsafe for your health.

Ointments can also be used in the form of ointment dressings. To sterile gauze bandage apply required amount ointments and apply to the damaged area of skin, then secure with a bandage. The patient is warned how long he should wear the bandage.

Applying an ointment bandage

Purpose of a simple medical service (goal): therapeutic

Indications: bedsores, infiltrates, wounds.

Contraindications: individual intolerance to the active substance of the drug, bleeding from the wound.

Equipment: a jar of ointment, a sterile spatula, sterile gauze pads and cotton wool, wax paper, scissors, sterile gloves, liquid soap or hand sanitizer, a disposable towel, a container for disinfection.

Algorithm of actions:

I. Preparation for the procedure

1. Introduce yourself to the patient, explain the purpose and course of the upcoming procedure

2. Obtain the patient’s consent to perform the procedure.

4. Help the patient take a comfortable (necessary) position.

5. Wash your hands and put on sterile gloves.

II. Execution of the procedure.

6. Apply the required amount of ointment to a sterile napkin using a sterile spatula.

7. Place a napkin with ointment on the patient’s skin, wax paper and a small layer of cotton wool on top of the napkin.

8. Secure the napkin with ointment and cotton wool with a gauze or tubular bandage.

9. Ask the patient about his well-being and whether he experiences any discomfort due to the applied bandage.

10. Warn the patient about how long he should wear the bandage.

III. End of the procedure.

11.Remove gloves, wash hands.

12.Make an appropriate entry about the procedure performed in the medical documentation.

Attention! Use the instructions that came with the ointment.

Application of powder

Powders or dusting with powdered medicinal substances (talc) are used to dry the skin during diaper rash and sweating. The surface on which the powder is applied must be clean.

Purpose of a simple medical service (goal): therapeutic

Indications: skin diaper rash, treatment of wounds and skin diseases.

Contraindications: individual intolerance to the active substance of the drug, bleeding from the wound.

Equipment: powder, sterile wipes, gloves, soap or hand sanitizer, disposable towel, container for disinfection.

Algorithm of actions:

I. Preparation for the procedure

1. Introduce yourself to the patient, explain the purpose and course of the upcoming procedure

2. Obtain the patient’s consent to perform the procedure.

4. Ask the patient whether he needs to be screened off during the procedure (if he is not alone in the room).

5. Help the patient take a comfortable (necessary) position.

6. Wash your hands and put on gloves.

II. Execution of the procedure.

7. Carefully wash and dry the area to which the medicinal product will be applied with a gauze napkin using blotting movements.

8. Match the eye holes on the lid of the drug bottle with the holes on the bottle.

9. Turn the container with the powder upside down and, using shaking movements, evenly apply the powder to the desired surface to “powder” the skin.

III. End of the procedure.

10. Remove gloves, wash hands

11. Remove the screen.

Putting drops into the nose

Purpose of a simple medical service (goal): therapeutic

Equipment: bottle of medicine, pipette, gloves, liquid soap or hand sanitizer, disposable towel, container for disinfection.

Algorithm of actions:

I. Preparation for the procedure

1. Introduce yourself to the patient, explain the purpose and course of the upcoming procedure.

2. Obtain the patient’s consent to perform the procedure.

5. Prepare a pipette.

II. Execution of the procedure.

6. Ask the patient to sit down, slightly throw back his head and tilt it to the side (when instilling in the left nostril - to the left, in the right - to the right).

7. Pipette the medicine.

8. Lift the tip of your nose with your left hand and drop 3-4 drops into the nasal passage (do not insert the pipette deep into the nose).

9. Ask the patient to press the wing of the nose against the septum with his fingers and make light circular movements.

10. Place drops in the same way into the second nostril.

11. Ask the patient how he is feeling.

III. End of the procedure.

12. Place the pipette in the waste container

13. Remove gloves, wash hands.

14. Make an appropriate entry about the procedure performed in the medical documentation.

Remember! A dropper mounted in the stopper of the bottle is used individually for each patient.

When instilling oil solutions, it is necessary to ask the patient to lie down with his head slightly tilted back. After administration, he should be able to taste the drops as the drops should hit the back of the throat.

Injection of ointment into the nose

Indications: diseases of the nasal mucosa.

Contraindications: individual intolerance.

Equipment: sterile cotton pads, a bottle (tube) with ointment, a glass rod, gloves, liquid soap or hand sanitizer, a disposable towel, a container for disinfection.

Algorithm of actions:

I. Preparation for the procedure

1. Introduce yourself to the patient, explain the purpose and course of the upcoming procedure.

2. Obtain the patient’s consent to perform the procedure.

4. Wash your hands and put on gloves.

II. Executing the procedure

5. Ask the patient to sit down and tilt his head back slightly.

6. Squeeze 0.5 - 0.7 cm of ointment onto a cotton pad (if the ointment is in a bottle, use a glass rod.

7. Insert the turunda with rotational movements into the lower nasal passage.

8. Remove the turunda and place it in a container for used material.

9. Repeat the same steps when introducing the ointment into the second half of the nose.

10. Ask the patient how he is feeling.

III. End of the procedure.

11. Remove gloves, wash hands.

12. Make an appropriate entry about the procedure performed in the medical documentation.

Putting drops into the eyes

Purpose of a simple medical service (purpose:) therapeutic

Indications: eye diseases.

Contraindications: individual intolerance.

Equipment: medicinal solution pipette, bottle with drops, sterile cotton balls, liquid soap or hand sanitizer, disposable towel, liquid soap or hand sanitizer, disposable towel, disinfection container.

Algorithm of actions:

I.Preparation for the procedure

1. Introduce yourself to the patient, explain the purpose and course of the upcoming procedure.

2. Obtain the patient’s consent to perform the procedure.

4. Wash your hands and put on gloves.

5. Give the patient two balls: in left hand- for the left eye, to the right - for the right.

II. Execution of the procedure.

6. Ask the patient to sit or lie on his back.

7. Pipette the required number of drops and take a gauze ball in your left hand.

8. Ask the patient to tilt his head back slightly and look up.

9. Pull back the lower eyelid with a gauze ball.

10. Place 2-3 drops into the lower conjunctival fold (do not place the pipette close to the conjunctiva).

11. Ask the patient to close his eyes.

12. Blot the leaked drops at the inner corner of the eyes.

13. Repeat the same steps when instilling in the other eye.

14. Ask the patient how he is feeling. Make sure that the patient does not experience discomfort after the procedure.

II. End of the procedure.

15. Place the pipette in the waste container .

16. Take off gloves and wash your hands.

17. Make an appropriate entry about the procedure performed in the medical documentation.

Attention! The number of pipettes depends on the amount of drugs administered to the patient. Each drug requires a separate pipette.

Note. Pipettes must be cleaned, disinfected and sterilized.

Views: 131305 | Added: March 24, 2013

All routes of drug administration into the body can be divided into enteral and parenteral. Enteral routes of administration ( enteros- intestines) ensure the introduction of the drug into the body through the mucous membranes of the gastrointestinal tract. Enteral routes of administration include:

Oral administration (orally, per os)- introduction of medicine into the body by ingestion. In this case, the medicine first enters the stomach and intestines, where it is absorbed into the system within 30-40 minutes portal vein. Next, through the bloodstream, the medicine enters the liver, then the inferior vena cava, the right side of the heart and, finally, the pulmonary circulation. Having passed a small circle, the medicine reaches the left parts of the heart through the pulmonary veins and, with arterial blood, reaches tissues and target organs. Solid and liquid dosage forms (tablets, dragees, capsules, solutions, lozenges, etc.) are most often administered this way.

Advantages of the method

Disadvantages of the method

The most physiological method of administering a medicinal substance is convenient and simple.
No specially trained personnel are required for administration.
The method is safe.

Slow entry of the drug into the systemic circulation.
The rate of absorption is not constant and depends on the presence of food in the gastrointestinal tract and its motility (if motility decreases, the absorption rate decreases).
Medicines taken orally are affected by stomach enzymes and intestinal juice, metabolic enzyme systems of the liver that destroy part of the substance even before it enters the systemic circulation. (For example, when taken orally, up to 90% of nitroglycerin is destroyed).
It is impossible to use medications that are poorly absorbed in the gastrointestinal tract (for example, aminoglycoside antibiotics) or are destroyed in it (for example, insulin, alteplase, growth hormone).
The drug may cause ulcerative lesions of the gastrointestinal tract (for example, corticosteroids, salicylates).
This route of administration is unacceptable if the patient is unconscious (although the medicine can be administered immediately intragastrically through a tube), if the patient has uncontrollable vomiting or a tumor (stricture) of the esophagus, or there is massive edema (anasarca, since this disrupts the absorption of the medicine in the intestine ).

Rectal route (>per rectum)- administration of medication through the anus into the ampulla of the rectum. This way, soft dosage forms (suppositories, ointments) or solutions (using microenemas) are administered. The substance is absorbed into the system of hemorrhoidal veins: upper, middle and lower. From the superior hemorrhoidal vein, the substance enters the portal vein system and passes through the liver, after which it enters the inferior vena cava. From the middle and inferior hemorrhoidal veins, the medicine enters directly into the inferior vena cava system, bypassing the liver. The rectal route of administration is often used in children of the first three years of life.

*Advantages of the method*	*Disadvantages of the method*
Part of the drug avoids metabolism in the liver, immediately entering the systemic circulation. Can be used in patients with vomiting, esophageal strictures, massive edema, and impaired consciousness. The medicine is not affected by digestive enzymes.	Psychological factor: This route of administration may be disliked or overly liked by the patient. The drug may have an irritating effect on the rectal mucosa. Limited absorption surface. Inconsistent absorption rate and extent of drug absorption. Dependence of absorption on the presence of fecal matter in the intestine. Special patient training in insertion technique is required.

Sublingual (under the tongue) and subbucal (into the cavity between the gum and cheek) administration. In this way, solid dosage forms (tablets, powders) are administered, some of them liquid forms(solutions) and aerosols. With these methods of administration, the drug is absorbed into the veins of the mucous membrane oral cavity and then sequentially enters the superior vena cava, the right side of the heart and the pulmonary circulation. After this, the medicine is delivered to the left side of the heart and travels with arterial blood to the target organs.

*Advantages of the method*	*Disadvantages of the method*
The medicine is not affected by digestive enzymes of the stomach and intestines. The drug completely avoids primary hepatic metabolism, entering directly into the systemic circulation. Quick onset of action, the ability to control the rate of absorption of the drug (by sucking or chewing the tablet). The effect of the medicine may be interrupted if the medicine is spat out.	Only highly lipophilic substances can be administered: morphine, nitroglycerin, clonidine, nifedipine or substances with high activity, because absorption area is limited. Excessive salivation during reflex stimulation mechanoreceptors of the oral cavity can provoke ingestion of the drug.

Parenteral administration is a route of administration of a drug in which it enters the body bypassing the mucous membranes of the gastrointestinal tract.

Injection administration. With this route of administration, the drug immediately enters the systemic circulation, bypassing the tributaries of the portal vein and the liver. TO injection include all methods in which the integrity of the integumentary tissues is damaged. They are carried out using a syringe and needle. The main requirement for this route of administration is to ensure the sterility of the drug and aseptic injection.
Intravenous administration. With this method of administration, the syringe needle pierces the skin, hypodermis, and vein wall, and the medicine is directly injected into the systemic bloodstream (inferior or superior vena cava). The medicine can be administered slowly or quickly (bolus), as well as by drip. In this way, liquid dosage forms are administered, which are true solutions or lyophilized powders (after dissolving them).

*Advantages of the method*	*Disadvantages of the method*
Direct introduction of the drug into the blood and almost instantaneous development of the effect. High dosing accuracy. Substances that are irritating or are hypertonic solutions(in an amount of no more than 20-40 ml). You can introduce substances that are destroyed in the gastrointestinal tract.	It is impossible to introduce oil solutions, emulsions and suspensions if they have not undergone special treatment. A very complex manipulation technique that requires specially trained personnel. In organs with good blood supply, toxic concentrations of the substance can be created in the first minutes after administration. Possible infection and air embolism with incorrect technique.

Intramuscular administration. All types of liquid dosage forms and powder solutions are administered this way. The needle of a syringe pierces the skin, hypodermis, muscle fascia and then its thickness, where the medicine is injected. Absorption of the drug occurs in the vena cava system. The effect develops after 10-15 minutes. The volume of the injected solution should not exceed 10 ml. When administered intramuscularly, the drug is absorbed less completely compared to intravenous administration, but better than with oral administration(however, there may be exceptions to this rule - for example, diazepam when administered intramuscularly is absorbed less completely than when administered orally).

*Advantages of the method*	*Disadvantages of the method*
You can administer oil solutions and emulsions, as well as depot preparations, which ensure that the effect remains for several months. Saved high accuracy dosing. You can introduce irritating substances, because muscle tissue does not contain many receptors.	Specially trained personnel are required to perform the injection. Damage to the neurovascular bundles may occur during injection. It is not possible to remove the depot medication if discontinuation of treatment is required.

Subcutaneous administration. Liquid dosage forms of any kind and soluble powders are administered this way. The syringe needle pierces the skin and enters the hypodermis; after injection, the medicinal substance is absorbed immediately into the vena cava system. The effect develops after 15-20 minutes. The volume of the solution should not exceed 1-2 ml.

*Advantages of the method*	*Disadvantages of the method*
The effect lasts longer than with intravenous or intramuscular administration of the same medicine. You can administer medications that are destroyed in the gastrointestinal tract.	Absorption occurs rather slowly due to the low blood flow rate. If peripheral circulation is violated, the effect may not develop at all. You cannot administer substances that have an irritating effect and strong vasoconstrictors, because they can cause necrosis. Risk of wound infection. Special patient training or staff assistance is required.

Intrathecal administration- administration of a medicinal substance under the membranes of the brain (subarachnoid or epidural). Performed by injecting a substance at the level of L4-L5 lumbar vertebrae. In this case, the needle pierces the skin, hypodermis, interspinous and yellow ligaments of the vertebral processes and approaches the meninges. With epidural administration, the medicine enters the space between the bony canal of the vertebrae and the dura mater of the brain. With subarachnoid insertion, the needle pierces the hard and arachnoid membrane brain and the medicine is injected into the space between the brain tissue and soft meninges. The volume of administered medication cannot exceed 3-4 ml. In this case, it is necessary to remove the appropriate amount of liquor. Only true solutions are administered.

Inhalation administration- administration of a medicinal substance by inhalation of its vapors or tiny particles. Gases (nitrous oxide), volatile liquids, aerosols and powders are introduced through this route. The depth of introduction of aerosols depends on the size of the particles. Particles with a diameter of more than 60 microns settle in the pharynx and are swallowed into the stomach. Particles with a diameter of 40-20 µm penetrate the bronchioles, and particles with a diameter of 1 µm reach the alveoli. The medicine passes through the wall of the alveoli and bronchi and enters the capillary, then through the bloodstream it enters the left side of the heart and, according to arterial vessels, is delivered to target organs.

*Advantages of the method*	*Disadvantages of the method*
Rapid development of effect due to good blood supply and large absorption surface (150-200 m2). In case of illness respiratory tract the medicine is delivered directly to the lesion and it is possible to reduce the administered dose of the medicine and, therefore, the likelihood of developing undesirable effects.	It is necessary to use special inhalers to administer the drug. The patient must be trained to synchronize breathing and inhalation of the medication. Do not administer medications that are irritating or cause bronchospasm.

Transdermal administration- application of a medicinal substance to the skin to ensure its systemic action. Use special ointments, creams or TTS (transdermal therapeutic systems - patches).

Local application. It involves the application of medication to the skin, mucous membranes of the eyes (conjunctiva), nose, larynx, and vagina in order to provide a high concentration of the drug at the site of application, usually without systemic action.

The choice of route of administration of the drug depends on its ability to dissolve in water or non-polar solvents (oils), on the localization of the pathological process and the severity of the disease. Table 1 shows the most common methods of using drugs for various types of pathology.
Table 1. Choice of route of drug administration for various pathologies.

Type of pathology	Mild to moderate course	Severe course
Respiratory diseases	Inhalation, orally	Inhalation, intramuscular and intravenous*
Gastrointestinal diseases	Orally, rectally (for diseases of the anorectal area)	Orally, intramuscularly and intravenously
Diseases of the heart and blood vessels	Sublingual, orally	Intramuscular and intravenous
Skin and soft tissue diseases	Orally, local applications	Intramuscular and intravenous
Endocrine diseases	Intranasal, sublingual, oral, intramuscular	Intramuscular and intravenous
Diseases of the musculoskeletal system	Inside and intramuscularly	Intramuscular and intravenous
Diseases of the eyes, ears, oral cavity	Local applications	Orally and intramuscularly
Diseases genitourinary system	Local applications, orally, intramuscularly	Intramuscular and intravenous

* Note: The choice between intramuscular and intravenous administration may be determined by the water solubility of the drug and the technical capabilities of performing intravenous injection.

Existing methods of administering drugs are divided into enteral (through digestive tract) and parenteral (bypassing the digestive tract).

The method of administration of the drug largely determines its delivery to a specific location (for example, the site of inflammation), the speed of development of the effect, its severity and duration, as well as the effectiveness of treatment in general. In some cases, the method of drug administration is determined by the nature of the drug’s action. An example is Diclofenac tablets with enteric coating and injections of the same drug: tablets begin to act, as a rule, after 2-4 hours, and the drug administered by injection already after 10-20 minutes.

Another example is antibiotics. When taking antibiotics orally, it is advisable to use capsules rather than tablets whenever possible, since the drug from the capsule is absorbed much more quickly. It appears even faster healing effect when injecting antibiotics, in addition, with this method of administration, it is possible to avoid many side effects from the gastrointestinal tract and liver that occur when taken orally.

Enteral methods include the administration of drugs through the mouth (orally), under the tongue (sublingual), behind the cheek (buccal), into the rectum (rectally) and some others. The advantages of the enteral route of administration are its convenience (no assistance required medical personnel), as well as comparative safety and the absence of complications characteristic of parenteral use.

Drugs administered enterally can have both local (some antimicrobial, antifungal and anthelminthic agents) and systemic (general) effects on the body. Most medications are administered enterally.

Oral route of administration

The simplest and most common way to take medications.
Most drugs are taken orally (tablets, capsules, microcapsules, dragees, pills, powders, solutions, suspensions, syrups, emulsions, infusions, decoctions, etc.). The active substance contained in the drug enters the bloodstream, absorbed from the gastrointestinal tract.
To prevent irritation arising from contact of the drug with the mucous membrane of the mouth and stomach, as well as to avoid the destructive effect of gastric juice on the drug itself, dosage forms (tablets, capsules, pills, dragees) coated with coatings resistant to the action of gastric juice are used , but disintegrating in the alkaline environment of the intestine. They should be swallowed without chewing unless otherwise stated in the instructions.
The oral route of administration is characterized by a relatively slow onset of action of the drug (within a few tens of minutes, rarely - a few minutes after administration), which, in addition, depends on individual characteristics (the condition of the stomach and intestines, the regimen of food and water intake, etc.). However, this property is used to create drugs with prolonged (long) action. Their description contains the word “retard” (for example, retard tablets, retard capsules). Retard dosage forms cannot be crushed if they do not have a dividing strip, since this will lose their properties. For example, tablets containing digestive enzyme Pancreatin (Festal, Mexaza, Panzinorm, etc.) should never be divided into parts, since if the integrity of the tablet coating is damaged, already in the oral cavity and then in the stomach, pancreatin is inactivated by saliva and the acidic contents of the stomach.
Some substances, such as insulin and streptomycin, are destroyed in the gastrointestinal tract, so they cannot be taken orally.
It is most rational to take drugs orally on an empty stomach, 20-30 minutes before meals. At this time, digestive juices are almost not secreted, and the likelihood of loss of drug activity due to them destructive action minimal. And in order to reduce irritant effect the drug itself on the gastric mucosa, the medicine should be washed down with water. However, it must be remembered that each drug has its own recommendations for use, which are indicated in the instructions for it.

Sublingual and buccal routes of administration

When the drug is administered sublingually and buccally, its effect begins quite quickly, since the mucous membrane of the mouth is abundantly supplied with blood, and substances are absorbed into it faster.

Some powders, granules, dragees, tablets, capsules, solutions and drops are taken sublingually.
When administered sublingually, medications are not exposed to the destructive effects of gastric juice and enter the bloodstream, bypassing the liver.
Nitroglycerin is especially often used sublingually to relieve angina attacks, Nifedipine and Clonidine for hypertensive crises, and other fast-acting vasodilators.
The drug should be kept under the tongue until completely absorbed. Swallowing the undissolved part of the medicine with saliva reduces the effectiveness of the action.
For buccal administration of drugs, special dosage forms are used, which, on the one hand, ensure rapid absorption in the oral cavity, and on the other hand, allow prolongation of absorption to increase the duration of action of the drug. This is, for example, Trinitrolong - one of the dosage forms of Nitroglycerin, which is a plate made of a biopolymer base, which is glued to the mucous membrane of the gums or cheeks.
It should be remembered that with frequent sublingual and buccal use of drugs, irritation of the oral mucosa is possible.

Rectal, vaginal and urethral routes of administration

At rectal administration active ingredients They are absorbed into the blood faster than when taken orally, without being subject to the destructive effects of gastric juice and liver enzymes.
Suppositories (rectal suppositories), ointments, capsules, suspensions, emulsions and solutions are administered rectally using microenemas, as well as enemas, no more than 50-100 ml for adults; for children - volume 10-30 ml. It should be remembered that the absorption of the active substance from suppositories is slower than from a solution.
The main disadvantages of the rectal route of drug administration are inconvenience in use and individual fluctuations in the speed and completeness of drug absorption. Therefore, drugs are mainly used rectally in cases where their administration through the mouth is difficult or impracticable (vomiting, spasm and esophageal obstruction) or when rapid entry of the drug into the blood is required, and the injection method is undesirable or impracticable due to the lack of the necessary dosage form.
Suppositories, tablets, solutions, creams, emulsions and suspensions are administered vaginally.
Vaginal and urethral routes of administration are most often used for treatment infectious process in these organs or for diagnostic purposes - for example, the introduction of contrast agents (iodamide, triomblast, etc.).

Parenterally, drugs are usually administered subcutaneously, intramuscularly, intravenously (sometimes intraarterially), but always with a violation of the integrity of the skin.

With parenteral routes of administration, the drug enters directly into the blood. This eliminates it side effect on the gastrointestinal tract and liver. Parenteral methods are used to administer drugs that are not absorbed from the gastrointestinal tract, irritate its mucous membrane, as well as those that are destroyed in the stomach under the influence of digestive enzymes.

Most of the above parenteral routes, administration of the drug requires the use of sterile additional equipment (syringe). Must be sterile and dosage form, A infusion solutions(i.e. solutions administered intravenously into large quantities- more than 100 ml) must, in addition, be necessarily pyrogen-free (i.e., not containing waste products of microorganisms). All infusions are carried out by drip under strict medical supervision.

Injections can be carried out on an outpatient basis (i.e. in a clinic, medical center), in a hospital (hospital) or at home, inviting a nurse. Insulin preparations, as a rule, are administered by patients themselves using special single-dose devices - “penfills”.

Intravenous administration

Intravenous administration of the drug ensures rapid achievement of the effect (from several seconds to minutes) and accurate dosing.
Methods of intravenous administration depend on the volume injection solution: up to 100 ml can be administered using a syringe, more than 100 ml (infusion) - using a dropper. Intravenous medications are usually administered slowly. Single, fractional, drip administration is also possible.
It is prohibited to administer intravenously:
- insoluble compounds (suspensions - for example, insulin preparations, Bismoverol, Zymozan, etc., as well as oil solutions), since in this case there is a high probability of embolism - blockage of a vessel, formation of a blood clot;
- agents with a pronounced irritant effect (can lead to the development of thrombosis, thrombophlebitis). For example, a concentrated solution of alcohol (more than 20%);
- drugs that cause accelerated blood clotting

Intramuscular and subcutaneous administration

Intramuscular and subcutaneous injections usually contain up to 10 ml of the drug. The therapeutic effect develops more slowly than with intravenous administration (soluble active ingredients are absorbed within 10-30 minutes). Intramuscular drugs are administered, as a rule, into the gluteal muscle or forearm; subcutaneously - in the forearm or in the abdominal area.
Subcutaneous injections are usually performed (Fig. 2.) in the subscapular region (A) or outer surface shoulder (B). For independent subcutaneous injections, it is recommended to use the anterolateral abdominal region (D). Intramuscular injections carried out into the upper outer quadrant of the buttock (B). For independent intramuscular injections, it is convenient to use the anterolateral surface of the thigh (D).
When the drug is administered intramuscularly, the therapeutic effect occurs relatively quickly if the active substance is soluble in water. However, if there is oil solution the absorption process slows down due to its higher degree of viscosity (compared to water).
To prolong the effect of the drug, medicinal substances are injected into the muscle in a slightly soluble form (suspension or suspension), in oil or other bases that delay the absorption of substances from the injection site.
Thus, by changing the solvent or solubility of the active substance, drugs are created with its delayed release and absorption into the body tissues. When such a medicine is administered, a “depot” of the drug is created in the body (i.e., the bulk of the active substance is localized in one place in the body). From this place the drug enters the blood at a certain speed, creating the necessary concentration of the active substance in the body.
After intramuscular injection Local soreness may appear (redness of the skin, itching) and even abscesses - suppuration inside the muscle layer, which are later opened surgically. This is possible, for example, with the introduction of oily, suspension preparations that are absorbed rather slowly (for example, Bismoverol, camphor oil, hormonal drugs: Sinestrol, Diethylstilbistrol propionate, etc.).
Substances that have a pronounced irritant effect are not administered intramuscularly or subcutaneously, as this can cause inflammatory reactions, infiltrates, the formation of compactions and suppuration, and even necrosis (tissue death).

Intra-arterial administration

Medicines are injected into the arteries, which quickly break down in the body. Wherein high concentration The drug is created only in the appropriate organ, and the general effect on the body can be avoided.

Medicines are administered intra-arterially for the treatment of certain diseases (liver, limbs, heart). For example, the introduction of thrombolytics into the coronary artery (injections of Heparin, Streptokinase, etc.) can reduce the size of the blood clot (up to its resorption) and thereby relieve the inflammatory process.

X-ray contrast agents are also administered intra-arterially, which makes it possible to accurately determine the location of a tumor, blood clot, narrowing of a vessel, or aneurysm. For example, the introduction of a radiopaque substance based on an iodine isotope makes it possible to determine the location of the stone in the urinary system and, based on this, use one or another type of treatment.

For gaseous and volatile compounds the main thing is inhalation method administration, which requires a special device - an inhaler. They are usually supplied with a medicinal product in an aerosol package, or the package itself (aerosol can) has a valve-spray dosing device.

When administered by inhalation, the active substances are quickly absorbed and have both local and systemic effects on the entire body, depending on the degree of their dispersion, i.e., the grinding of the drug. Medicines can penetrate the alveoli of the lungs and enter the blood very quickly, which necessitates their precise dosage.

Inhalation administration of drugs allows you to reduce the absorption time, introduce gaseous and volatiles, and also has a selective effect on the respiratory system.

Source: Encyclopedic reference book. Modern medicines. - M.: Russian Encyclopedic Partnership, 2005; M.: OLMA-PRESS, 2005