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Pharmacology > Routes Of Administration & The Absorption of Drugs > Flashcards

Routes Of Administration & The Absorption of Drugs Flashcards

0
Q

Why are synthetic drugs often better than medicine obtained from nature? (e.g. plants, animals, microorganisms or the body itself (biologics))

A

They are widely available and more specific.

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1
Q

What are the 5 rights associated with drug administration?

A 
Right Patient
Right Dose
Right Route
Right Time
Right Documentation
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2
Q

List 2 benefits of oral administration:

A

Convenient for patient

Absorption from small intestine (large surface area)

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3
Q

Name 6 disadvantages of oral administration:

A

Not appropriate for all patients.
Absorption is variable (must be lipid soluble)
Absorption can depend on the stomach contents (acid/alkali)
Rate of gastric emptying
Degradation in stomach
First pass metabolism

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4
Q

What is drug disposition?

A

Comparing what the body does to the drug with what the drug does to the body.
After intake, absorption and distribution, drug-cell interaction competes with metabolism and excretion.

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5
Q

How are drugs degraded in the stomach and what effect does this have on bioavailability?

A

Parietal cells in the stomach secrete HCl (hydrochloric acid) whilst chief cells secrete digestive enzymes.
This gastric acid breaks down the drug, reducing in a low bioavailability - a low dose of drug reaching the circulation

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6
Q

What is first pass metabolism? What effect does this have on bioavailability?

A

Otherwise known as the hepatic first-pass effect, this refers to the extent to which the liver can metabolise the drug. If the drug can be rapidly metabolised this decreases bioavailability.

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7
Q

List the steps of how the drug gets into the circulation via oral administration:

A

Oral/enteral Administration.
Absorption via stomach and intestine (subject to degradation in stomach)
Portal vein to liver (subject to first pass metabolism)
Hepatic vein then Vena Cava

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8
Q

Name 2 benefits of topical administration:

A 
Convenient for patient
Poorly absorbed (minimising overdose risk)
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9
Q

What is the main disadvantage of topical administration?

A

Negative effect on the skin e.g. hydrocortisone thins the skin

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10
Q

What is a good way to remember what topical administration is?

A

TOPical - creams and lotions go on ‘top’ of the skin.

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11
Q

Name 3 advantages of Transdermal administration:

A

Long acting
Useful when want low blood levels for long periods of time
Suitable for many patient groups

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12
Q

What are 4 disadvantages of transdermal administration?

A

Potential adverse skin effects
Variable absorption
Drug must be very lipid soluble
Drug must be very potent

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13
Q

What are 2 advantages of rectal administration?

A

Local or systemic effect

Useful for patients who are vomiting or unable to swallow

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14
Q

Name 4 examples of drugs that can be administered rectally:

A

Analgesics
Diazepam
Prednisolone
Anti-fungals

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15
Q

What is a drawback of rectal administration? (Other than discomfort)

A

Trained staff are needed to administer the drug

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16
Q

List 2 advantages of the inhalation method of administering drugs:

A

Rapid changes in the plasma concentration of the drug
(due to large surface area of lungs and good blood flow in this area)

Local/systemic effect

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17
Q

What is the main disadvantage of the inhalation route?

A

Difficulty in ensuring the drug reaches site of action

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18
Q

Give 4 examples of drugs that can be administered via inhalation:

A

halothane
nitrous oxide
GTN
salbutamol

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19
Q

What are the 6 routes of parenteral administration?

Give an example for each route.

A 
Intravenous: vein - heparin          
Intramuscular: muscle - pre-meds
Intradermal: skin - local anaesthetic
Subcutaneous: lower in skin - insulin
Intrathecal (into subarachnoid space) - chemotherapy
Epidural - nerve blockers
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20
Q

What is transdermal administration?

A

ACROSS the skin - e.g. nicotine or HRT patches

A reservoir of drug diffuses across the skin

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21
Q

Name 4 advantages of the parenteral route of administration:

A

Rapid action
Bypasses stomach and liver
Lower dose is required
Allows for patient controlled analgesia through syringe drivers

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22
Q

What are 4 disadvantages of the parenteral route?

A

A trained person is required to administer the drug this way
Extreme care is required
Accidental overdose can be easy
Painful (I.M. injections)

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23
Q

What is an excipient?

A

An additional ingredient added to a drug that allows it to spread and transport in the body

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24
Q

What 2 things is a medicine made up of?

A

An active drug and excipients

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25
Q

Name 3 types of drug formulation:

A

Tablet, capsule, granule, powder, gel, emulsion, implant, gas, spray etc…

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26
Q

What 2 things can the formulation of a drug affect?

A

Bioavailability - to absorb quicker

Duration of therapeutic effect (sustained release - lots of layers)

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27
Q

List the 4 types of oral formulation of drug in the order of dissolution rate (fastest to slowest):

A 
Solutions
Suspensions
Powders
Capsules
Tablets
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28
Q

From where are orally administered drugs absorbed?

A

Stomach

Small intestine

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29
Q

Can water soluble drugs cross the cell membrane in the gut?

A

No

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30
Q

What types of drugs can diffuse across the cell membrane in the gut?

A

Lipid-soluble

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31
Q

List the 4 ways lipid soluble drugs can diffuse from the gut into the blood:

A

Passage through water channels (this is passive)
Endocytosis
Passive diffusion
Facilitated or Active Transport

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32
Q

What is endocytosis?

A

An energy using process where cells absorb the drug molecules by engulfing them

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33
Q

Outline facilitated transport

A

The drug moves DOWN the concentration gradient
Proteins provide channels
NO ENERGY is expended
Saturable and selective
Competitive inhibition by other substrates

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34
Q

Outline Active Transport

A

Drug moves AGAINST the concentration gradient
ENERGY is expended
Saturable and selective
Competitive inhibition

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35
Q

Name one drug that passes across the membrane using active transport:

A

Levodopa
Methyldopa
Lithium

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36
Q

What types of tablet are available?

A

Orodispersible, effervescent and dispersible

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37
Q

How are tablets, capsules, elixirs/syrups, emulsions and linctus administered?

A

Orally

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38
Q

What are the two different routes of oral administration? (other than swallowing)

A

Sublingual

Buccal

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39
Q

What type of oral medicine is: convenient to use, can provide an accurate dose, can be enteric-coated or have sustained release
and
Must not be bitten or chewed, not be broken, caution to what liquid it should be taken with?

A

Tablets

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40
Q

How are drugs administered orally that are bitter, but end up being large and coated with a hard gelatin coat?

A

Capsules

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41
Q

Sprays (such as GTN) and uncoated tablets can be rapidly absorbed through mucosa (under the tongue). What is this route called?

A

Sublingual route

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42
Q

What is the name of the route where tablets are placed between the gums and the cheek (upper lip), for rapid absorption?

It is good for antiemetics but increased risk of dental caries.

A

Buccal Route

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43
Q

What is a compound tablet?

A

A tablet containing two or more medicines

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44
Q

What are elixirs and syrups examples of?

A

Liquid medicine

45
Q

Why may elixir medicines not be suitable for kids?

A

Alcohol base

46
Q

What is an emulsion?

A

A mixture of two liquids. It must be shaken well to ensure patient gets the right amount of both.

47
Q

You have to shake emulsions well before dispensing them. What problems may occur however even after doing this?

A

Inaccuracy and danger of liquids separating out

48
Q

What is a linctus?

A

A sweet, syrupy liquid, often mixed with aromatics as a soothing medication. e.g. cough medicine

49
Q

What type of liquid medicine can be difficult to measure due to its viscosity and can have a sticky bottle?

A

Linctus’

50
Q

Why must you always pour liquid medicine AWAY from the label?

A

So if it spills you can tell what the drug is - the label isn’t damaged.

51
Q

Should you shake or agitate all liquid medicines?

A

Yes

52
Q

How should medicines be stored?

5 answers

A 
original packaging
locked cupboard or meds trolley
if belong to the patient - bedside locker
locked fridge
room temperature away from sunlight
53
Q

When administering a drug to a patient, where should you document this and where can it be found?

A

Prescribing and recording sheet at patient bedside or document trolley

54
Q

When administering medicine, your hands should be clean, the patient should be upright and you should witness the medicine being taken. What else should you try to get the patient to do?

A

Put the medicine in mouth themselves

55
Q

What should you do with rejected medicine?

A

Retain it

56
Q

What does ‘para’ and ‘enteral’ mean in the word paraenteral?

A 
Para = around
Enteral = the gut

AVOIDING THE GUT - not oral

57
Q

What are the 6 routes of parenteral administration?

A 
Percutaneous
Inhalation
Subcutaneous
Intraarticular/synovial
Intramuscular
Intravenous
58
Q

What is the method called where drugs are absorbed through intact skin, body cavities or mucous membranes?
(other than topical etc - begins with p)

A

Percutaneous

59
Q

What is the route of admin that involves infusion via the lungs?

A

Inhalation

60
Q

What is the route of admin that involves an injection under the skin?

A

Subcutaneous

61
Q

What is the intra articular/synovial route of admin?

A

Injection into a joint

62
Q

Define intramuscular:

A

Injection into muscle

63
Q

Define intravenous

A

Injection into a vein

64
Q

What 5 reasons would you use parenteral administration for?

A 
Faster onset of action
Nil by mouth
Drug digestible
Long term release (depot injection)
Other routes impaired/contraindicated
65
Q

Intramuscular and subcutaneous routes provide a more …………. release?

A

controlled

66
Q

What can localised routes of administration minimise?

A

Unwanted effects

67
Q

Name 5 disadvantages of parenteral routes of admin:

A

Additional training and competence required
Costly
Painful
Aseptic Technique required for protection
Additional tech/professional support often needed

68
Q

What are topical and transdermal routes of admin examples of?

A

Percutaneous routes

69
Q

What are drops, creams, ointments, pastes, gels and lotions examples of? (how are they applied)

A

Topical routes of admin

70
Q

What are patches that allow the slowed absorption of drug to the blood supply below the dermis called? (in terms of route of admin)

A

Transdermal

71
Q

Inhalational, sublingual/buccal, suppositories (low end), enemas (liquid in lower bowel) and pessaries (vagina) are administered through b………. c………..
They are not the most absorbable places but what do they avoid?

A

body cavities

avoid first pass effect

72
Q

Where is a subcutaneous injection placed?

A

Under skin - in the fat layer before the muscle

73
Q

Which injection risks hitting a nerve or important vessel?

A

Intramuscular

74
Q

Which injection is the most risky/irreversible?

A

Intravenous

75
Q

What do you call the name of the injection into joints to relieve arthritic pain?

A

Intra articular/synovial

76
Q

What is an intrathecal injection?

A

Into CSF

77
Q

What is an intracardiac injection?

A

Into the heart

78
Q

Obvious disadvantages of me include fear, pain and bruising.

I can also cause abscess, tissue necrosis, cellulitis, granuloma and lipohypertophy. What am I?

A

An injection

79
Q

What things can minimise the disadvantages of injections?

A

The Rs
Handwashing/infection control
Protocols
Talking to patient to distract

80
Q

What holds a single dose of parenteral medication that may be a plastic or glass container?

A

Ampoule

81
Q

What may hold single or multi doses of parenteral medication that will have a sealed rubber cap to allow multiple doses to be withdrawn? (change needle in between uses to keep it sharp)

A

Vial

82
Q

What is the process whereby a drug comes as a powder and needs a solvent such as sterile water or a normal saline solution to be mixed with it?
What should you do if there are no instructions?

A

Reconstitution

Contact pharmacy - must use right solvent

83
Q

Where might we withdraw small amounts of fluid, allergy testing and do TB screening?

A

Inner lower arm

84
Q

When doing TB screening, allergy tests or withdrawing small amounts of fluid from the inner lower arm, what do we call this route?

A

Intradermal injection/in the skin - second layer

85
Q

What site are we likely to inject 0.5ml-1ml of medications such as insulin, heparin and vaccines?

A

Subcutaneous

86
Q

When injecting the IM Deltoid, which part should we inject and what is its limitation?

A

Upper 1/3 to avoid nerve

Only up to 1ml before really painful

87
Q

What is the IM Dorsogluteal?

What is its advantage to injecting here?

A

Upper outer bit of bottom

Avoid nerve and major blood vessels here

88
Q

Other than the deltoid and dorsogluteal, name to other IM injection sites:

A

top of leg - vastus lateralis or rectus femoris (often after surgery but it is painful)
side of hip - ventogluteal

89
Q

What should we try and do when using needles in regard to size?

A

Use smallest possible.

No bigger than 2ml

90
Q

Which type of injection uses a:
25 to 27 gauge needle
less than 0.5ml of drug

A

Intradermal

smallest gauge range

91
Q

Which type of injection uses a:
23 to 28 gauge needle
0.5ml to 1ml of drug

A

Subcutaneous

92
Q

Which type of injection uses a:
18 to 23 gauge needle
0.5ml to 3ml of drug

A

Intramuscular

LOW in depth so lowest gauge in teens

93
Q

What are the 4 main objectives of I.V. therapy?

A

Maintenance and restoration of fluid and electrolyte balance (some can’t take by mouth)
Delivery of parenteral nutrition
Transfusion of blood products
Medication and chemotherapy

94
Q

In I.V. therapy, what type of infusion is continuous over 12-24 hours, and may use isotonic, hypotonic or hypertonic fluid?

A

Large Volume Infusions (e.g. for hydration)

95
Q

What type of I.V. is for a short period of time (2-3minutes)?

A

Rapid injection - e.g. antibiotics

96
Q

What type of I.V. lasts for a period of 30-60minutes and is done every 4 hours?

A

Intermittent Infusions e.g. antibiotics that need to be delivered slowly

97
Q

What is the name of a short catheter that is inserted through the skin into a peripheral vein?
Where are these usually inserted?

A

Peripheral Cannula

Usually the arm and hand.
Extreme cases foot and children sometimes scalp

98
Q

What is the name of a catheter placed in a large vein?

A

Central Venous Catheter

99
Q

Where is the internal jugular vein?

A

Neck

100
Q

Where is the subclavian vein?

A

Chest

101
Q

Where is the femoral vein?

A

Groin

102
Q

Name 3 types of catheter:

TIP

A

Tunnelled Catheter (Hickman Line)
Implanted Port
Peripheral Inserted Central Catheter (PIC)

103
Q

Is the jugular (neck) or tunnelled catheter (chest) used more now?
Why?

A

Tunnelled.

Can cover with clothes, leave for months, safer

104
Q

Where is the connector of an implanted port?

A

Under the skin, so not loose like a Hickman/Tunnelled catheter.

Special needles are used for these to go straight into blood stream

105
Q

Where is the PIC close to?

A

The heart. It can irritate the atrium and it is important to check for inflammation.

106
Q

What do we flush I.V. lines with to prevent blood clots on the end of the catheter?

A

Saline

107
Q

Name 4 I.V. fluids:

BIGS

A

Isotonic saline
Balanced Crystalloid solutions
Glucose and glucose salines
Synthetic colloids

108
Q

What 2 bits of equipment (other than the catheter and bag) can be used to administer I.V. fluids?

A

Tubing with special chambers

Electronic Pump

109
Q

Name 3 complications of I.V. Therapy:

A

Infection (break to skin, organisms into site = swelling, fever, septicaemia)
Phlebitis - irritation of the vein caused by infection
Tissue Infiltration - fluid ends up in surrounding tissue rather than vein

Pharmacology (13 decks)

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