Inside and rectally is usually administered. External route of administration

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A drug can enter the body in a variety of ways. Routes of administration of drugs are determined by the speed of the therapeutic effect, its severity and duration. In some cases, the way the drug enters the body determines the nature of its action, and hence our recovery. There are several main methods of oral administration of drugs, 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 medicines exist.

Basic forms of drugs

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

Solutions is the 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 funds are prepared from vegetable raw materials. But it is worth remembering that they are not stored for a long time, no more than 3 days in a cool and protected from sunlight place.
Tablets- it is a solid which is obtained by pressing. They are mainly taken orally, but an external route of drug administration is also possible if they are crushed into powder.

Dragee- this is another type of product, they are created by layering the base substance on the granule. Used for oral administration.
Capsules- solid form of the drug, is a tablet coated with gelatin or other substance. Most often, capsules contain medicines with a bitter taste or a specific smell, thanks to the shell, the intake of these drugs is greatly facilitated. In addition, it allows you to protect the substance from rapid destruction in the digestive tract.
Candles- this is a dosage form of the drug, which at room temperature remains in solid form, but at the same time melts inside the human body. If we consider the introduction of drugs, the ways for suppositories are divided into two types - rectal and vaginal.
Patch- this is a plastic form of the product, which, under the influence of body temperature, softens and easily sticks to the skin. Suitable for outdoor use only.
Ointments- means of a viscous consistency, used mainly for external use. They must contain about 25% dry matter in their composition.

There are several ways to administer drugs, let's take a closer look at each of them.

Types of enteral administration

The enteral route of drug administration is considered one of the most convenient and safe. There are several subspecies 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. The absorption of drugs received in this way occurs mainly by diffusion in the small intestine, in rare cases - in the stomach. The effect of the application is noticeable after 30-40 minutes. It is for this reason that this method is not suitable for emergency assistance. The rate and completeness of absorption depend on food intake, its composition and quantity. Thus, if you drink the medicine on an empty stomach, then the absorption of weak bases improves, since the acidity in the stomach is low, but the acids are better absorbed after eating. But there are also such drugs, for example, "Calcium chloride", which, entering the body after a meal, 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 comes in a few minutes. This method of administration is most often used for the use of "Nitroglycerin" for angina pectoris, "Clonidine" and "Nifedipine" to eliminate the 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 ways and means of administering drugs have their advantages, enteral also has them:

Simplicity and ease of use.
Naturalness.
Relative safety for the patient.
Does not require sterility, supervision by the 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 on slowly.
Low bioavailability.
Different speed and completeness of absorption.
Influence of food intake and other components on the absorption process.
Impossibility of use by patients in an unconscious state.
It is undesirable to use 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 the digestive system in this process. It can be divided into several types.

Intradermal- this method is mainly used for diagnostic purposes, for example, for Burne allergy tests or for local anesthesia.
subcutaneously- used if you want to get the 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 contributes to rapid absorption.
Intramuscular- used if subcutaneous administration causes irritation or pain, and also when the drug itself is slowly absorbed.

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

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

Intravenously- This method is used to administer a large number of drugs and some drugs that have such a requirement for use.

Intra-arterial- used for which are caused by shock, large blood loss, asphyxia, electric shock, intoxication and infections.
into the lymphatics- this method is used to ensure that the drug does not get into the liver and kidneys, to ensure a more accurate hit to the site of the focus of the disease.

The intravascular administration of drugs is not always convenient, the routes can also lead through the cavities:

Pleural.
Abdominal.
Hearts.
Articular.

pros and cons

Parenteral administration has several advantages:

This method allows you to enter the drug bypassing the digestive tract, which is very important for patients with serious pathologies of the stomach.
Speed of action is essential in emergency situations.
Maximum dosing accuracy.
Receipt of the drug in the blood in unchanged form.

The parenteral route of administration of drugs has several disadvantages:

Be sure to administer the drug by a trained medical professional.
Asepsis and antiseptics are required.
Difficult and even impossible administration of the drug in case of bleeding, 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 the treatment. With this method of administration, drugs quickly get inside and have their therapeutic effect. In addition, the concentration of the agent in the blood is easily controlled - the cessation of inhalation leads to a suspension of the action of the drug. With the help of inhalation of an aerosol, the concentration of the agent in the bronchi is very high with a minimum

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

Pros and cons of inhalation administration

We continue to consider the ways of drug administration. The inhalation method also has advantages and disadvantages. Advantages of inhalation:

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

Cons of inhalation:

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

The main routes of administration of drugs have been considered, 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, then we can say for sure that the effect of the first method comes much faster. The drug is rapidly absorbed into the blood, without being destroyed by the action of digestive tract and liver enzymes.

Suppositories, ointments, and other forms of preparations, 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 candle. The volume of an enema for adults is 50 to 100 ml, and for children it is 10 to 30 ml. But this method of administering drugs has some disadvantages:

Inconvenient application.
Special fluctuations in speed and complete suction pattern.

Vaginal and urethral methods allow you to enter any form of drugs. But both of these methods give the best result if they are used to treat infections in these organs or for diagnostics, for example, for the introduction of contrast agents such as Iodamide, 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 due to a greater extent to the fact that only a qualified specialist should administer the drug by such methods. Such methods require the use of only sterile, completely transparent, true aqueous solutions with a neutral reaction. The action comes very quickly.

Transdermal therapeutic systems

In recent years, more and more drugs in a 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 patches that were made using cutting-edge technologies and are very convenient to use: the patch is glued to the skin, and the film is placed behind the cheek. In this case, the main substance is absorbed into the blood through the skin or mucous membranes.

Many doctors around the world have recently been paying more and more attention to the latest ways of administering drugs. Everyone has advantages and disadvantages, including TTS. Consider the pros:

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.
The complete absence of undesirable effects from the digestive tract.
Reducing the frequency of allergy manifestations.
The possibility of rapid withdrawal of the drug, if suddenly there are contraindications.
Precise dosage.
Possibility of targeted delivery of the drug to the desired part of the body.

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

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 microclysters and soft dosage forms (suppositories). Suppositories are dosage forms. They consist of medicinal substances and bases. The best base is cocoa butter (Oleum Cacao). Rectal suppositories (candles) are usually in the form of 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 system of the inferior vena cava and then, bypassing the liver, into the systemic circulation. 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 it is impossible to administer through the mouth: with vomiting, swallowing disorders, in the unconscious state of the patient, damage to the gastric mucosa.

2. Injected medicinal substances of resorptive action enter the bloodstream bypassing the liver, and, therefore, are not destroyed

Disadvantages of the rectal route of administration:

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

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

3. irritating effect of the medicinal substance on the mucous membrane, as a result of which proctitis may occur.

4. due to the lack of enzymes in the rectum, the administered medicinal substances are not cleaved and the medicinal substances of the protein, fat and polysaccharide base cannot pass through its wall, therefore they can only be prescribed for local exposure in the form of medicinal microclysters.

Insertion of a rectal suppository

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

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

Action algorithm:

I. Preparation for the procedure

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

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

II. Performing a 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 with the other - insert the suppository into the anus (the sheath will remain in your hand).

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

III. End of procedure.

12. Remove the screen.

13. Make an appropriate record of the procedure performed in the medical records.

Remember! Before the introduction of drugs 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 medications. As a rule, patients can motivate their refusal by the lack of improvement in their condition. The nurse should calmly and tactfully explain the importance of regular medication, the need for a continuous course of treatment and strict adherence to these conditions for recovery.

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

the name of the drug prescribed to him;

the purpose of taking this drug;

the time of appearance of the effect (cure, pain reduction);

the rules for taking the drug;

the possible occurrence of side effects;

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

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

The introduction of drugs into the rectum causes patients to feel embarrassed due to the intimate nature of the procedure, which can lead to rejection of it. The nurse should tactfully explain the need to fulfill the doctor's prescriptions and carry out this manipulation in a separate room, without attracting the attention of other patients.

Questions to consolidate knowledge:

1. A selection of medical prescriptions.

2. Requirements for filling out the forms "Requirement - invoice"

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

4. Registration of registers of medicines.

5. Advantages and disadvantages of the introduction of drugs through the mouth.

6. Rules for the distribution of medicines to patients.

7. Rules for taking drugs sublingually.

8. Advantages and disadvantages of the "rectal" route of administration.

9. Possible problems of the patient and nursing interventions for them.

The use of drugs externally and inhalation.

Plan:

1. Applying ointments to the skin in various ways, powders, plasters, solutions, tinctures. Safety precautions when using ointments.

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

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

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

1. Methods for the external use of drugs.

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

The use of ointments on the skin in various ways, powders, plasters, solutions, tinctures. Safety precautions when using ointments.

External route of administration

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

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

drugs used transdermally , through the skin, are able to create a depot in the subcutaneous tissue that maintains a certain concentration of a substance in the blood. Children of the first years of life have especially delicate skin, which has a thin stratum corneum, so the absorption of drugs through it occurs as easily as when taken orally. In addition, medicines should be applied with extreme caution to damaged skin (wound, maceration in the area of diaper rash, burns). Methods for the external route of administration of various dosage forms (ointments, emulsions, solutions, talkers, powders, tinctures, pastes, etc.) can be as follows:

compresses,

· lotions,

powders,

lubrication,

rubbing,

rubbing;

dressings on the wound surface,

instillation of drops in the eyes, ears, nose,

putting ointments in the eyes, nose, ears.

Rubbing- the introduction through the skin of medicinal substances in the form of liquids or ointments. Rubbing is performed in those areas where the skin is thinner and not covered with hair (flexor surface of the forearms, back of the thighs, lateral surfaces of the chest, abdomen). The skin at the site of application should be clean. If the ointment does not have a strong irritating effect, you can rub it with fingertips in gloves. The required amount of ointment or liquid is applied in a thin layer to the skin and rubbed in circular motions in one direction. For rubbing, you can also use the special devices attached to 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, with a thin layer of 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 are irritating.

Lubrication widely used mainly in skin diseases. A cotton or gauze swab is moistened in the required medicinal substance and applied to the patient's skin with light longitudinal movements (in the direction of hair growth).

Unction

Appointment of a simple medical service (purpose): curative

Indications: as prescribed by a doctor

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

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

Action algorithm:

I. Preparation for the procedure

2. Obtain the consent of the patient for the procedure.

6. Wash your hands, put on gloves.

7. Examine the skin area for rubbing the ointment.

II. Execution of a procedure.

8. Apply the right amount of ointment to a special device; in its absence, rub the ointment only with gloves.

9. Rub the ointment in light circular motions 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. Warmly cover the patient, if required by the instruction.

11. Ask the patient about his well-being

III. End of procedure.

12. Remove gloves, wash hands.

13. Remove the screen.

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

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

Applying an ointment bandage

Appointment of a simple medical service (purpose): curative

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 wipes and cotton wool, waxed paper, scissors, sterile gloves, liquid soap or hand sanitizer, a disposable towel, a container for disinfection.

Action algorithm:

I. Preparation for the procedure

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

2. Obtain the consent of the patient for the procedure.

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

5. Wash your hands, put on sterile gloves.

II. Execution of a procedure.

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

7. Put a tissue with ointment on the patient's skin, wax paper and a small layer of cotton on top of the tissue.

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

9. Ask the patient about his health, and if he feels any discomfort in connection with the applied bandage.

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

III. End of procedure.

11. Remove gloves, wash hands.

12.Make an appropriate record of the procedure performed in the medical records.

Attention! Use the instructions that come with the ointment.

Powder application

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

Appointment of a simple medical service (purpose): curative

Indications: 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 antiseptic for hand treatment, disposable towel, container for disinfection.

Action algorithm:

I. Preparation for the procedure

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

2. Obtain the consent of the patient for the procedure.

4. Ask the patient if he needs to be fenced off with a screen during the procedure (if he is not alone in the ward).

5. Help the patient to take a comfortable (desired) position.

6. Wash your hands, put on gloves.

II. Execution of a procedure.

7. Carefully wash and dry the area to be treated with a gauze pad with blotting movements.

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

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

III. End of procedure.

10. Remove gloves, wash hands

11. Remove the screen.

Instillation of drops in the nose

Appointment of a simple medical service (purpose): curative

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

Action algorithm:

I. Preparation for the procedure

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

2. Obtain the consent of the patient for the procedure.

5. Prepare a pipette.

II. Execution of a procedure.

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

7. Take the drug into the pipette.

8. Raise the tip of the nose with your left hand and drip 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. Drip drops in the same way into the second nostril.

11. Ask the patient how he is feeling.

III. End of procedure.

12. Put the pipette into the container for the used material

13. Remove gloves, wash hands.

14. Make an appropriate record of the procedure performed in the medical records.

Remember! The dropper built into the stopper of the vial is used individually for each patient.

When instilling oil solutions, it is necessary to ask the patient to lie down with his head slightly thrown back. After the introduction, he should feel the taste of the drops, since the drops should fall on the back of the throat.

Introduction of ointment into the nose

Indications: diseases of the nasal mucosa.

Contraindications: individual intolerance.

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

Action algorithm:

I. Preparation for the procedure

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

2. Obtain the consent of the patient for the procedure.

4. Wash your hands, put on gloves.

II. Performing a procedure

5. Ask the patient to sit down, slightly throw back his head.

6. Squeeze 0.5 - 0.7 cm of ointment onto a cotton turunda (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 put it in a waste container.

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 procedure.

11. Remove gloves, wash hands.

12. Make an appropriate record of the procedure performed in the medical records.

Instillation of drops in the eyes

Appointment of a simple medical service (purpose:) curative

Indications: eye diseases.

Contraindications: individual intolerance.

Equipment: drug solution, pipette, drop bottle, sterile cotton balls, liquid soap or hand sanitizer, disposable towel, liquid soap or hand sanitizer, disposable towel, disinfectant container.

Action algorithm:

I. Preparation for the procedure

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

2. Obtain the consent of the patient for the procedure.

4. Wash your hands, put on gloves.

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

II. Execution of a procedure.

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

7. Draw the required number of drops into the pipette, take a gauze ball in your left hand.

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

9. Pull the lower eyelid with a gauze ball.

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

11. Ask the patient to close their eyes.

12. Wipe the spilled drops at the inner corner of the eyes.

13. Repeat the same steps when instilled into the other eye.

14. Ask the patient how they feel. Make sure the patient is comfortable after the procedure.

II. End of procedure.

15. Put the pipette into the container for the used material .

16. Remove gloves, wash hands.

17. Make an appropriate record of the procedure performed in the medical records.

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.

Viewed: 131305 | Added: 24 March 2013

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

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

Advantages of the method

Disadvantages of the method

The most physiological method of drug administration, convenient and simple.
It does not require specially trained personnel for the introduction.
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, its motility (if motility decreases, the rate of absorption decreases).
Ingested drugs are affected by the enzymes of the stomach and intestinal juice, the metabolic enzyme systems of the liver, which 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 drugs 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 gastrointestinal ulceration (eg, corticosteroids, salicylates).
This route of administration is unacceptable if the patient is unconscious (although the drug can be administered immediately intragastrically through a tube), if the patient has indomitable vomiting or a tumor (stricture) of the esophagus, there are massive edema (anasarca, because this disrupts the absorption of the drug in the intestines ).

Rectal path (> per rectum)- the introduction of the drug through the anus into the ampoule of the rectum. This way, soft dosage forms (suppositories, ointments) or solutions (using microclysters) are administered. Absorption of the substance is carried out in 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 immediately into the system of the inferior vena cava, 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, entering the systemic circulation immediately.
Can be used in patients with vomiting, esophageal strictures, massive edema, impaired consciousness.
The drug is not affected by digestive enzymes.

Psychological factor: this route of administration may be disliked or excessively liked by the patient.
Perhaps the irritating effect of the drug on the mucous membrane of the rectum.
Limited absorption surface.
Variable rate of absorption and degree of absorption of the drug. Dependence of absorption on the presence of fecal matter in the intestine.
Special training of the patient in the technique of insertion is required.

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

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

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

injection introduction. With this route of administration, the drug immediately enters the systemic circulation, bypassing the tributaries of the portal vein and the liver. Injection includes all methods in which the integrity of the integumentary tissues is damaged. They are carried out using a syringe and a 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, vein wall and the drug is directly injected into the systemic circulation (inferior or superior vena cava). The drug can be administered as a stream slowly or quickly (bolus), as well as drip. Thus, liquid dosage forms are administered, which are true solutions or lyophilized powders (having previously dissolved them).

*Advantages of the method*	*Disadvantages of the method*
Direct injection of the drug into the blood and almost instantaneous development of the effect. High dosing accuracy. You can enter substances that have an irritant effect or are hypertonic solutions (in an amount of not more than 20-40 ml). You can enter substances that are destroyed in the digestive tract.	It is impossible to introduce oily solutions, emulsions and suspensions unless they have 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. Infection and air embolism are possible with improper technique.

Intramuscular administration. In this way, all types of liquid dosage forms and solutions of powders are administered. The syringe needle pierces the skin, hypodermis, muscle fascia and then its thickness, where the medicine is injected. Absorption of the drug occurs in the system of hollow veins. The effect develops in 10-15 minutes. The volume of the injected solution should not exceed 10 ml. When administered intramuscularly, the drug is absorbed less completely than when administered intravenously, but better than when administered orally (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 enter oil solutions and emulsions, as well as depot preparations that ensure the preservation of the effect for several months. High dosing accuracy is maintained. You can enter irritating substances, tk. muscle tissues do not contain many receptors.	Requires specially trained personnel to perform the injection. Possible damage to the neurovascular bundles during the injection. It is not possible to remove the depot drug if discontinuation of treatment is required.

Subcutaneous administration. In this way, liquid dosage forms of any kind and soluble powders are administered. The syringe needle pierces the skin and enters the hypodermis, the medicinal substance after administration is absorbed immediately into the vena cava system. The effect develops in 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 drug. You can enter drugs that are destroyed in the gastrointestinal tract.	Absorption occurs rather slowly due to the low blood flow velocity. If the peripheral circulation is disturbed, then the effect may not develop at all. You can not enter substances that have an irritating effect and strong vasoconstrictors, because. they can cause necrosis. risk of wound infection. Requires special patient education or staff assistance.

Intrathecal administration- the introduction of a medicinal substance under the membranes of the brain (subarachnoid or epidural). Performed by injection of a substance at the level of L4-L5 of the lumbar vertebrae. In this case, the needle pierces the skin, hypodermis, interspinous and yellow ligaments of the processes of the vertebrae and approaches the meninges. With epidural administration, the drug enters the space between the bony canal of the vertebrae and the dura mater. With subarachnoid administration, the needle pierces the dura and arachnoid membranes of the brain and the drug is injected into the space between the brain tissues and the pia mater. The volume of the administered drug cannot exceed 3-4 ml. In this case, it is necessary to remove the appropriate amount of liquor. Enter only true solutions.

Inhalation administration- the introduction of a medicinal substance by inhalation of its vapors or the smallest particles. Gases (nitrous oxide), volatile liquids, aerosols and powders are introduced in this way. 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 microns penetrate the bronchioles, and particles with a diameter of 1 microns reach the alveoli. The drug passes through the wall of the alveoli and bronchi and enters the capillary, then with the blood flow enters the left parts of the heart and, through the arterial vessels, is delivered to the target organs.

*Advantages of the method*	*Disadvantages of the method*
Rapid development of the effect due to good blood supply and large absorption surface (150-200 m2). In the case of a respiratory disease, the drug is delivered directly to the lesion and it is possible to reduce the administered dose of the drug and, therefore, the likelihood of developing undesirable effects.	It is necessary to use special inhalers for the administration of a medicinal substance. Training of the patient to synchronize breathing and inhalation of the drug is required. Do not administer drugs that have an irritant effect or cause bronchospasm.

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

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

The choice of the 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 lists the most common ways to use drugs for various types of pathology.
Table 1. The choice of the route of administration of the drug in various pathologies.

Type of pathology	Mild to moderate course	Severe course
Respiratory diseases	Inhalation, oral	Inhalation, intramuscular and intravenous*
Diseases of the gastrointestinal tract	Orally, rectally (for diseases of the anorectal zone)	Orally, intramuscularly and intravenously
Diseases of the heart and blood vessels	Sublingual, oral	Intramuscular and intravenous
Diseases of the skin and soft tissues	Oral, topical 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, mouth	Local applications	Orally and intramuscularly
Diseases of the genitourinary system	Local applications, by mouth, 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 possibilities of intravenous injection.

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

The route of administration of the drug largely determines its entry into a certain place (for example, in the focus of inflammation), the rate of development of the effect, its severity and duration, as well as the effectiveness of the treatment as a whole. In some cases, the method of administration of the drug is determined by the nature of the action of drugs. Diclofenac enteric-coated tablets and injections of the same drug can be cited as an example: the tablets begin to act, as a rule, after 2-4 hours, and the drug, administered by injection, after 10-20 minutes.

Another example is antibiotics. When taking oral antibiotics, it is desirable to use capsules rather than tablets whenever possible, since the drug from the capsule is absorbed much faster. The therapeutic effect is even faster when antibiotics are injected, in addition, with this method of administration, many side effects from the gastrointestinal tract and liver that occur when taken orally can be avoided.

Enteral methods include the introduction of drugs through the mouth (orally), under the tongue (sublingually), behind the cheek (buccal), into the rectum (rectal), and some others. The advantages of the enteral route of administration are its convenience (the assistance of medical personnel is not required), as well as the comparative safety and absence of complications characteristic of parenteral administration.

Drugs administered enterally can have both local (some antimicrobial, antifungal and antihelminthic) and systemic (general) effects on the body. Most drugs are administered by the enteral route.

Oral route of administration

The simplest and most common way to take drugs.
Most drugs are taken orally (tablets, capsules, microcapsules, dragees, pills, powders, solutions, suspensions, syrups, emulsions, infusions, decoctions, etc.). The active substance contained in the preparation enters the blood, being absorbed from the gastrointestinal tract.
To prevent irritation arising from the 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) are used, coated with shells that are resistant to the action of gastric juice. , 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 (after several tens of minutes, rarely after a few minutes after ingestion), which, in addition, depends on individual characteristics (state of the stomach and intestines, food and water intake, etc.). However, this property is used when creating drugs with prolonged (long-term) action. Their description contains the word "retard" (for example, retard tablets, retard capsules). Retard dosage forms are not subject to crushing if there is no separating strip on them, since their properties are lost in this case. For example, tablets containing the digestive enzyme pancreatin (Festal, Meksaz, Panzinorm, etc.) can never be divided into parts, since if the integrity of the tablet coating is violated, pancreatin is inactivated by saliva and acidic stomach contents already in the mouth and then in 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 inside on an empty stomach, 20-30 minutes before meals. At this time, almost no digestive juices are secreted, and the probability of losing the activity of the drug due to their destructive action is minimal. And in order to reduce the irritating effect of the drug itself on the gastric mucosa, the medicine should be taken with water. However, it must be remembered that for each drug there are recommendations for admission, which are indicated in the instructions for it.

Sublingual and buccal routes of administration

With the introduction of the drug sublingually and buccally, its action begins quite quickly, because the oral mucosa is abundantly supplied with blood, and substances are absorbed into it faster.

Some powders, granules, dragees, tablets, capsules, solutions and drops are taken sublingually.
With sublingual use, drugs are not exposed to the destructive effects of gastric juice and enter the bloodstream, bypassing the liver.
Nitroglycerin is especially often used sublingually for the relief of 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 drug with saliva reduces the effectiveness of the action.
For buccal administration of drugs, special dosage forms are used, which, on the one hand, provide rapid absorption in the oral cavity, and on the other hand, allow prolongation of absorption to increase the duration of the drug. This, for example, Trinitrolong - one of the dosage forms of Nitroglycerin, which is a plate 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

With rectal administration, the active substances are absorbed into the blood faster than when taken orally, without being subjected to the destructive action of gastric juice and liver enzymes.
Suppositories (rectal suppositories), ointments, capsules, suspensions, emulsions and solutions are administered rectally using microclysters, as well as enemas, not more than 50-100 ml for adults; for children - a volume of 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 rate and completeness of drug absorption. Therefore, rectally, drugs are mainly used in cases where it is difficult or impossible to administer them through the mouth (vomiting, spasm and obstruction of the esophagus) or when a rapid intake 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 methods of administration are used most often for the treatment of an infectious process in these organs or for diagnostic purposes - for example, the introduction of contrast agents (iodamide, triombrast, 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 its side effects on the gastrointestinal tract and liver. Parenteral methods introduce 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 action of digestive enzymes.

Most of the listed parenteral routes require the use of sterile additional equipment (syringe). The dosage form must also be sterile, and infusion solutions (i.e., solutions administered intravenously in large quantities - more than 100 ml) must, in addition, be sure to be pyrogen-free (i.e., not containing waste products of microorganisms). All infusions are carried out by drip method under strict medical supervision.

Injections can be performed on an outpatient basis (i.e., in a clinic, first-aid post), in a hospital (hospital) or at home, inviting a nurse. Insulin preparations, as a rule, are administered by the patients themselves using special single-dose devices - penfills.

Intravenous administration

Intravenous administration of a medicinal substance provides a rapid achievement of the effect (from several seconds to minutes), accurate dosing.
Methods of intravenous administration depend on the volume of the injection solution: up to 100 ml can be administered with a syringe, more than 100 ml (infusion) - with a dropper. Intravenous drugs are usually administered slowly. Single, fractional, drip administration is also possible.
Do not administer intravenously:
- insoluble compounds (suspensions - for example, insulin preparations, Bismoverol, Zymozan, etc., as well as oil solutions), because at the same time, there is a high probability of embolism - vessel blockage, thrombus formation;
- means with a pronounced irritant effect (may 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 substances are absorbed within 10-30 minutes). Intramuscularly, drugs are administered, as a rule, into the gluteus muscle or into the forearm; subcutaneously - in the forearm or in the abdomen.
Subcutaneous injections are usually carried out (Fig. 2.) in the subscapular region (A) or the outer surface of the shoulder (B). For independent subcutaneous injections, it is recommended to use the anterolateral region of the abdomen (D). Intramuscular injections are carried out in the upper outer quadrant of the buttock (B). For independent intramuscular injections, it is convenient to use the anterolateral surface of the thigh (D).
With intramuscular administration of the drug, the therapeutic effect occurs relatively quickly if the active substance is soluble in water. However, in the presence of an oil solution, the absorption process slows down due to its greater degree of viscosity (compared to water).
To prolong the action 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 slow release and absorption into the tissues of the body. With the introduction of such a drug in the body, a "depot" of the drug is created (that is, 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 (reddening of the skin, itching) and even abscesses - suppurations inside the muscle layer, which are later opened surgically, may appear. This is possible, for example, with the introduction of oily, suspension preparations that are rather slowly absorbed (for example, Bismoverol, camphor oil, hormonal agents: Sinestrol, Diethylstilbistrol propionate, etc.).
Substances that have a pronounced irritant effect are not administered intramuscularly and subcutaneously, since this can cause inflammatory reactions, infiltrates, the formation of seals and suppuration, and even necrosis (tissue necrosis).

Intra-arterial administration

Drugs are injected into the arteries, which quickly break down in the body. At the same time, a high concentration of the drug is created only in the corresponding organ, and the overall effect on the body can be avoided.

Drugs are administered intra-arterially in 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 thrombus (up to its resorption) and thereby remove the inflammatory process.

Radiopaque preparations are also administered intra-arterially, which allows you to accurately determine the localization of the tumor, thrombus, vasoconstriction, aneurysm. For example, the introduction of a radiopaque substance based on the isotope of iodine allows you to determine the localization of the stone in the urinary system and, based on this, use one or another type of treatment.

For gaseous and volatile compounds, the inhalation route of administration is the main one, which requires a special device - an inhaler. They are usually supplied with a drug in an aerosol package, or the package itself (aerosol can) has a valve-spray dispenser.

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 fineness of the drug. Drugs can penetrate into the alveoli of the lungs and enter the bloodstream very quickly, which makes it necessary to accurately dose them.

Inhalation administration of drugs allows to reduce the time of absorption, introduce gaseous and volatile substances, 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