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BIO 316 Module 5 Discussion Question 2
BIO 316 Module 5 Discussion Question 2
Why do you think the correct methods for administering medication are called the “Five Rights”?
administration of a medicine is a common but important clinical procedure. It is the manner in which a medicine is administered that will determine to some extent whether or not the patient gains any clinical benefit, and whether they suffer any adverse effect from their medicines.
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For example, intravenous (IV) furosemide administered too quickly can cause deafness; oral penicillin V given with food will not be well absorbed; over-application of topical steroids will cause thinning of the skin and may lead to systemic side-effects.
Two main factors determine whether or not a drug will reach its intended site of action in the body:
- The bioavailability of the drug;
- How the drug is given (route of administration).
Bioavailability is the proportion of an administered drug that reaches the systemic circulation and is therefore available for distribution to the intended site of action.
Drugs that are given by direct IV injection are said to have 100% bioavailability. Some drugs that are particularly well absorbed by the gastrointestinal mucosa may have bioavailability comparable to that of an IV dose – for example the antibiotic ciprofloxacin. Most drugs do not have this availability by the oral route so the dose given orally is usually higher than that given parenterally. For example, the beta-blocker propranolol when given orally is administered in doses of 40mg and above. The equivalent IV dose is 1mg.The route of administration and its formulation (tablet, capsule, liquid) can clearly influence the bioavailability of a drug.
Routes of administration
There are various routes of administration available, each of which has associated advantages and disadvantages. All the routes of drug administration need to be understood in terms of their implications for the effectiveness of the drug therapy and the patient’s experience of drug treatment.
Routes of administration:
- Parenteral – Intravenous, intramuscular, subcutaneous
This is the most frequently used route of drug administration and is the most convenient and economic. Solid dose forms such as tablets and capsules have a high degree of drug stability and provide accurate dosage. The oral route is nevertheless problematic because of the unpredictable nature of gastro-intestinal drug absorption. For example the presence of food in the gastrointestinal tract may alter the gut pH, gastric motility and emptying time, as well as the rate and extent of drug absorption.
The extent to which patients can tolerate solid dose forms also varies, particularly in very young and older patients. In such cases the use of liquids or soluble formulations may be helpful. Many drugs, however, are not stable in solution for liquid formulation and in such cases careful consideration should be given to the option of switching to alternative drug treatment.
Difficulties frequently arise with patients who are prescribed modified-release preparations as these must not be crushed or broken at the point of administration. Modified-release formulations can delay, prolong or target drug delivery. The aim is to maintain plasma drug concentrations for extended periods above the minimum effective concentration.
For patients, their main advantage is that doses usually only need to be taken once or twice daily. Damage to the release controlling mechanism, for example by chewing or crushing, can result in the full dose of drug being released at once rather than over a number of hours. This may then be absorbed leading to toxicity or may not be absorbed at all leading to sub optimal treatment.
Nurses should seek advice from a pharmacist or the prescribing doctor if they are uncertain about a formulation of solid dose forms and whether or not they are suitable for crushing.
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