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Medications via alternate routes

List of terms for administering medications via alternate routes

Alternate routes of medication administrationSublingual, buccal, rectal, vaginal, topical, transdermal, inhalation
Sublingual routePlaced under the tongue to dissolve and absorb (SL of sl)
Sublingual route advantagesSame as oral, administer for local or systemic effect, rapidly absorbed into blood stream, bypasses the liver
Sublingual route nursing considerationsIf swallowed may be inactivated by gastric juices, must remain under the tongue until dissolved and absorbed
Buccal routeMedication placed against mucous membrane of the cheek, local effect on mucous membrane of the mouth, but systemic if swallowed in saliva
Buccal route advantagesSame disadvantages and advantages as SL
Rectal routePlace patient in Sims position with upper leg flexed, place suppository past anal sphincter, have client hold for at least 30 minutes, should remain lying for 5 minutes after administration
Rectal route advantagesCan have local or systemic effect, use when drug has objectionable taste or odor or patient is nauseated (if supp. is available), avoids irritation of the upper GI tract in clients who have this problem
Rectal route disadvantagesDrug absorption can be unpredictable, may have increased levels as it bypasses the liver and is directly absorbed into the venous blood stream
Transdermal routeApplied to the skin
Transdermal route advantagesTransdermal patches are more specific in dosing than other topicals that are applied by the patient or nursing staff, systemic effects, few side effects, avoids GI absorption problems
Transdermal route nursing considerationsMake sure you remove the old patch before putting on the new one, may leave residue on skin/clothing, wear gloves
Vaginal routeMedication placed into the vagina as a cream, suppository, or gel, usually applied using an applicator with a plunger (creams, jellies and foams), suppositories are inserted using finger of gloved hand
Vaginal route advantagesLocal effect, medications typically used to treat infections or to relieve vaginal discomfort such as itching or pain
Vaginal route disadvantagesLimited use
Topical routeCreams, ointments, sprays applied to circumscribed area of the body, local effect
Topical route advantagesFew side effects,
Topical route disadvantagesMay have systemic effect if skin opens, may be messy or soil clothing, unpredictable absorption secondary to skin thickness as well as user differences if an ointment or cream
Optic routeWear gloves, instillation of drops or ointments into the eye, local effect (can be systemic depending on dosage), administered into conjunctiva sac of the lower lid, do not touch applicator to any part of the eye-for liquid medication; press on the nasolacrimal duct for 30 seconds to prevent the medication from running out of the eye and down the duct, have parents hold infants
Otic routeInstillation of drops into the ear, local effect. Often for cleaning purposes in order to examine, also to provide local therapy to reduce inflammation, destroy infective organisms in the external ear canal or both
Nasal routeInstillation of drops or sprays into the nares, local effect, most common instillations are for astringent effect (shrink swollen mucous membranes), to loosen secretions and facilitate drainage, or to treat infections of the nasal cavity or sinus.
Nasal route nursing considerationsHave client remain in position for at least 1 minute to allow solution to come into contact with all of the surface area desired
Inhalation routeInto the respiratory tract using a MDI (metered dose inhaler), nebulizer or positive pressure breathing apparatus, rapid local effect throughout the respiratory tract; may have some systemic effect
Inhalation route nursing considerationsEnsure correct delivery of prescribed medication by MDI's, attach an extender or spacer to facilitate medication absorption for better results

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