Medication Route

Aka: Medication Route, Drug Administration Route

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II. Types: Non-Parenteral

  1. Oral (PO)
    1. Medications formulated to withstand Stomach acidity, intestinal absorption and first pass metabolism
    2. Drug Bioavailability is significantly less than the ingested dose and onset of action is also typically delayed
    3. Innate Immunity of the Stomach and intestinal tract nearly eliminates the infection risk seen with Parenteral agents
  2. Sublingual (SL)
    1. Medications (e.g. Nitroglycerin) with good absorption via the capillary network beneath the Tongue
    2. Results in rapid absorption and activity without navigating the acid Stomach, intestinal tract or first pass metabolism
  3. Per Rectum (PR)
    1. Rapid, but variable absorption
    2. Indicated in unconsious patients (e.g. Valium for Status Epilepticus) or young children (e.g. Acetaminophen)
  4. Inhalational
    1. Rapid absorption of aersolized medications
    2. Medications (e.g. Albuterol, Ipratropium) in Obstructive Lung Disease (Asthma, COPD) are typically delivered via inhalations
    3. Higher doses of some resusitation medications may be delivered via Endotracheal Tube (e.g. Lidocaine, Epinephrine, Atropine, Naloxone)
  5. Transdermal
    1. Patch delivered, slow released drugs delivered over an extended period (typically 12 to 72 hours)
    2. Examples include Fentanyl Patch, Clonidine patch, Contraceptive Patch. Lidocaine Patch
  6. Topical
    1. Includes Skin Preparations (e.g. ointments, creams), vaginal agents, ophthalmic drops or ointments, Otic Solutions and nasal preparations
  7. Intranasal
    1. See Intranasal Drug Delivery Route
    2. Excellent route for Procedural Sedation and Analgesia (e.g. Intranasal Fentanyl, intranasal Midazolam)
    3. Topical agents intended for their intranasal activity (e.g. Intranasal Steroids)

III. Types: Parenteral

  1. See Parenteral Drug Delivery
  2. See Intravenous Access
  3. Background
    1. Term Parenteral is derived from "around the intestinal tract" (i.e. bypassing the intestinal tract)
    2. Parenteral Routes are preferred for conditions in which rapid absorption and consistent drug levels are critical (e.g. Resuscitation, Sepsis)
    3. Parenteral Routes risk infection as well as pain of administration
  4. Intravenous (IV)
    1. Rapid onset of action and consistent and predictable drug levels
    2. Requires sterile, soluble drugs and Intravenous Access
  5. Intramuscular (IM)
    1. See Intramuscular Injection
    2. Drugs (e.g. Epinephrine, Penicillin) injected into large Muscle regions (e.g. Shoulder, thigh, buttock) rely on local capillary absorption
    3. Absorption is dependent on formulations (slow absorption with lipid preparations, faster absorption with aqueous preparations)
  6. Subcutaneous (SQ or SC)
    1. See Subcutaneous Injection
    2. Drugs (e.g. Insulin, Morphine, Enoxaparin) are injected beneath the skin and absorbed via local capillaries

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