Which of the following routes of medication administration has the fastest effect?

The Routes of Medication Administration depend upon the medication administered and the patient. Consideration is taken of the particular medication characteristics and the desired effects of the medication. Also, the patient’s mental and physical condition is taken under consideration.

There are various routes of medication administration. The major routes of medication administration are oral, parenteral, and topical.

Oral medications are given by mouth and swallowed with fluid. They are absorbed by the stomach and the small intestine.

POINTS TO REMEMBER

• The oral route of medication administration is simple, convenient and the most common route.
• This route is easy to administer.
• Also, most patients tend to prefer the oral route of administration.
• Oral medications usually have a slower onset than other routes of administration.
• Oral medications come in solids and liquids.
• And, a lot of oral medications come in both the solid and the liquid form.
• Solid medications come in pills, tablets, or capsules.
• Tablets that come scored make them easier to break.
• Some tablets come as Enteric-coated tablets.
  • Enteric-coated tablets are covered with a hard substance.
  • These tablets are not meant to be absorbed in the stomach.
  • They are meant to be absorbed in the small intestine.
• Liquid medications come in syrups, suspensions, and elixirs.
• Sometimes, the liquid medications will come in a multi-dose container.
• Liquid medications can be given via a nasogastric (NG) tube easily.

Under the category of oral routes of medication administration are sublingual and buccal routes.

Sublingual Administration

Sublingual medications are given under the tongue until the medication dissolves.

POINTS TO REMEMBER

• Sublingual medications should not be swallowed immediately but allowed to dissolve.
• Also, the patient should not drink any water until the medication is completely dissolved.
• A common medication given via the sublingual route is nitroglycerin.

Buccal Administration

The buccal route of mediation administration involves using the inside of the cheek.

POINTS TO REMEMBER

• The medication is placed against the mucus membrane of the cheek until it is dissolved.
• As with sublingual administration, the medication should not be swallowed immediately and allowed to dissolve.
• Also, the patient should not drink water with this route of administration.
• And, you should alternate the cheeks with this method of administration.

Parenteral Routes of Medication Administration

The parenteral route of medication administration is considered to be any route other than the gastrointestinal tract. However, it is used to indicate medication given by injection into tissues of the body.

POINTS TO REMEMBER

• Parenteral routes require additional equipment. (ex. Syringe and needle)
• Note: Both syringes and needles come in different sizes.
• Medication to be injected is supplied in ampules, vials, bottles, or prefilled syringes and cartridges.
• Medications used for injections may come in single-dose or multi-dose containers.
• Some medications that come in vials are in powdered form and need to be reconstituted.
• Always check your vial or your drug handbook for the correct fluid for reconstitution and the correct amount of fluid to be used.

The major parenteral routes include: intravenous (IV), intramuscular (IM), subcutaneous (SQ), and intradermal (ID).

Intravenous (IV)

The intravenous route is injected into the vein.

Intramuscular (IM)

The intramuscular route is injection into the muscle.

Subcutaneous (SQ)

The subcutaneous route is injected into the tissue just under the dermis.

Intradermal (ID)

The intradermal route is injected into the dermis of the skin.

Other Parenteral Routes of Medication Administration

Other types of parenteral routes of medication administration are: intraarterial, epidural, intrathecal, intraosseous, intraperitoneal, and intrapleural.

POINTS TO REMEMBER

• These forms of medication administration are not the responsibility of the nurse.
• However, the nurse is responsible for monitoring the sites and dressings.
• Also, the nurse should know the therapeutic effects and side effects of the medication given to their patient.

Intraarterial

The intraarterial route administers medication into an artery.

Epidural

The epidural route of administration uses a catheter to administer medication into the epidural space. This catheter can be placed by a nurse anesthetist or an anesthesiologist. The nurse anesthetist or the anesthesiologist is also the one responsible for administering the medication.

Intrathecal

The intrathecal route uses a catheter place in the subarachnoid space or a ventricle of the brain to administer medication. These catheters are usually surgically inserted and used for long-term therapy. A physician normally administers the medication into an intrathecal catheter.

Intraosseous

The intraosseous route involves the administration of medications directly into the bone marrow. This is usually used when there is poor or no access to an intravenous space. It is often done in emergency situations.

Intraperitoneal

This route of mediation administration uses the peritoneal space of the abdominal cavity. This route allows medications to be absorbed into the circulation.

Intrapleural

The intrapleural route administers medication directly into the pleural space of the chest cavity. This is accomplished with the use of a chest tube.

Topical Routes of Medication Administration

With the topical route of administration, medications are applied to the skin or the mucus membrane. 

POINTS TO REMEMBER

• Topical medications are administered to the skin, eyes, nose, ears, lungs, vagina, and rectum.
• The medication is usually dispensed as liquids or ointments.
• These medications are normally absorbed very slowly.
• And, the medication actions usually occur at the site of administration.

Transdermal

The transdermal route of medication administration is a type of topical route. This route involves a patch or disk containing medication applied to the skin.

POINTS TO REMEMBER

• You should always wear gloves when administering medications and the transdermal route is no exception.
• Always remove the old patch or disk before applying a new one.
• You should always rotate sites if possible to decrease skin irritation.

Mucous Membrane

Medications administered via the mucus membrane are another route of topical medication administration. These medications usually come in a liquid or ointment.

Eye

• Medication for the eye comes as liquids or ointments.
• Eye drops and ointments are placed in the lower conjunctival sac of the eye.
• Eye medications usually have a local effect.
• Irrigations of the eye are performed to remove foreign substances from the eye.

Ear

• Eardrops normally come in a plastic container that is made to administer one drop at a time.
• When administering an eardrop, straighten the auditory canal by pulling the pinna of the ear up and back for adults and down and back for infants.
• You can press the tragus to help move the medication down the ear canal.
• Wait about 5 minutes before administering medication in the other ear.

Nose

• Nasal medications have a systemic effect.
• Nose drops are used to apply medication to the mucus membrane of the nose.
• Have the patient blow their nose before administering the nose drops.
• Position the patient with their head back.

Lungs

• Inhalation is used for medications administered via the lungs.
• The medications are aerosolized (turned into small particles) and breathed in by the patient.
• Atomizers or nebulizers are used to administer inhalation medications.
• Metered-dose inhalers (MDI) are used to break up medication into a mist.
• Make sure the MDI is used properly. Click for proper use of MDI.

Vagina and rectum

• Medications administered vaginally come as creams, foams, tablets, and suppository that melt with body heat. Keep suppositories refrigerated.
• Rectal administrations are normally in the form of suppositories.
• Always, maintain privacy when administering medications via these routes.
• Make sure medications are given via the route orders. Also, remember the Rights of Medication Administration.

Sources

Potter RN, MSN, PhD, FAAN, Patricia A., and Anne G. Perry RN, EdD, FAAN. Fundamentals of Nursing. 9th ed., St. Louis, Mosby Elsevier, 2017.

Taylor, PhD MSN, RN, Carol, et al. Fundamentals of Nursing: The Art and Science of Person-Centered Nursing Care. 8th ed., Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015.

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