I. ROUTE OF ADMINISTRATION

II. INTERVAL OF ADMINISTRATION

III. TIME OF ADMINISTRATION

IV. DURATION OF THERAPHY

V. TECHNIQUE OF ADMINISTRATION

The reasons :1. Most Convenience (oral)2. To maximize concentration at the site of action3. Minimize it else where (topical)4. To prolong the duration of drug absorption5. Avoid the first – pass – effect

6. Economical7. Safest

Dose of Drug in Blood Drug in General Drug Circulation

Drug at sites of Action

Pharmacologic Effect

Clinical Effect

Toxicity Efficacy

Utility

INPUT

LOSS

DISTRIBUTION

6

- Enteral route : Oral Route

Sublingual Route

Buccal Route

Rectal Route

- Parenteral route : Intravenous bolus (I.V.)

Intravenous Infusion (I.V.inf)

Intramuscular (I.M.)

Subcutaneous (S.C.)

etc

- Other route : Transdermal

Inhalation

Topical

etc

Classification Of Route Of Drug Administration

7

Oral routeDrug administered orally pass through various part of GIT/oral cavity

- the most commonly used route of administration- convenient for self administration- effective for most drug

except : rapidly in activated by gastric or intestinal secretion or by passage via hepatic portal

circulation through the liver- unsuitable for surgical patients, unconscious, vomiting and malabsorption state patients

8

Sublingual RouteBucal route

useful for self-administered drugs to overcome some of the problems of the oral route (avoiding immediate inactivation by the liver) may also be used in the unconscious patient

Rectal Route

- Drugs are absorbed mainly into the systemic circulation, some entry into the hepatic portal circulation- Absorbtion from the rectal mucose is less predictable than from the small intestine- Use for drugs know to cause G.I irritation or to a patient who is unconscious or vomiting

9

Parenteral RouteDrugs may be administered directly into circulation by the intravenous route

- Distribution of the drug throughout the circulatory system is rapid and bypasses many biological membranes which may delay absorption into the circulation - The dose volume of an intravenous injection many vary from a fraction of millilitre given as a bolus injection to 500 ml or more given as a slow infusion - Intra-arterial injections used mainly for diagnostic purposes- Rapid absorption in aqueous solution- Intramuscular route slower than intravenous (i.v), and follow subcutaneous tissues (s.c)

10

Transdermal RouteDrugs applied to the skin surface absorbed slowly into the systemiccirculationUse for : - drugs with a short duration of action

- rapidly metabolized by the liver - may provide sustained concentration of the drug in the circulation

Inhalation RouteThe high blood flow through the lungs and the large surface area of the alveolar membrane provide a route for rapid absorption of drugs into the general circulation

Anaesthetic gases, volatile liquid and drugs that can be dispersed in an aerosol form may be administered by inhalation in order to produce a systemic effect. The nasal mucosa may also be used as route of systemic administration.

11

Topical Route

Application of dosage form to the epithelium covering one of the body surfaces to exert a local effect at the site of application

Example : - skin

- the cornea of eyes

- the nasal

- rectal

- vagina/urethra mucosa

Oral Route for Local EffectDosage form of absorbents, antimicrobial compound, antacidDesigned to exert a local effect within the G.I.T after oral administration

12

ROUTE BIOAVAILABILITY ADVANTAGES DISADVANTAGES

Enteral Routes

Oral (PO) Absorption may vary.Generally slower absorption rate compared to IV bolus or IM injection.

Safest and easiest route of drug administration. May use immediate- release and modified-release drug products.

Some drugs may have erratic absorption, be unstable in the gastro intestinal tract or be metabolized by liver prior to systemic absorption.

Buccal or sublingual (SL)

Rapid absorptionfrom lipid-soluble drugs.

No “first-pass” effect.

Some drugs may be swallowed.Not for most drugs or drugs with high doses

Rectal (PR) Absorption may vary from suppository. More reliable absorption from enema (solution).

Useful when patient can not swallow medication. Used for local and systemic effects.

Absorption may be erratic. Suppository may migratedifferent position. Some patient discomfort.

Some Cracteristics of Common Routes of Drug Some Cracteristics of Common Routes of Drug AdministrationAdministration

13

ROUTE BIOAVAILABILITY ADVANTAGES DISADVANTAGESParenteral RoutesIntravenous (IV)

Complete (100%) systemic drug absorption.

.

Drug is given for immediate effect.

Increase chance for adverse reaction.Possible anaphylaxis.

Intravenousinfusion (IV inf)

Complete (100%) systemic drug absorption.Rate of drug absorption controlled by infusion pump.

Plasma drug levels more precisely controlled. May inject large fluid volumes. May use drugs with poor lipid solubility and/or irritating drug.

Requires skill in insertion of infusion set.Tissue damage at site of injection may accort.

Intramuscular injection (IM)

Rapid from aqueous solution. Slow absorption from nonaqueous (oil) solution.

Easier to inject than intravenous injection. Large volumes may be used compared to subcutaneous solution.

Irritating drugs may be very painful.Different rates of absorption depending upon muscle group injected and blood flow.

Subcutaneous injection (SC)

Prompt from aqueous solution. Slow absorption from repository formulation.

Generally used for insulin injection.

Rate of drug absorption depends upon blood flow and injection volume.

14

ROUTE BIOAVAILABILITY ADVANTAGES DISADVANTAGESOther RoutesTransdermal. Slow absorption,

rate may vary. Increased absorption with occlusive dressing.

Transdermal delivery system (patch) is easy to use. Used for lipid-soluble drugs with low dose.

Some irritation by patch of drug.Permeability of skin variable with condition, anatomic site, age,and gender.Type of cream or ointment base affects drug-release and absorption.

Inhalation Rapid absorption. Total dose absorbed is variable.

May be used for Local or systemic effects.

Particle size of drug determines anatomic placement in respiratory tract.May stimulate cough reflex. Some drug may be swallowed.

15

RODA SITES- Oral - Peroral (per os) - Sublingual - Parenteral * Intravenous * Intraarterial * Intracardiac * Intraspinal/intrathecal * Intraosseous * Intraarticular * Intrasynovial * Intracoutaneus/Intradermal * Subcutaneous * Intramuscular- Epicutaneous (Topical)- Transdermal- Conjunctival- Intraoccular- Intranasal- Aural- Intrarespiratory

- Mouth - GI tract system via mouth - Under the tongue- Other sites than GI tract (by injection) * Into vena * Into artery * Into the heart * Into spine * Into bone * Into joint * Synovial fluid cavity * Into skin * Under skin * Into muscle- Skin surface- Skin surface- Conjunctiva- Eye globe- Nose- Ear- Lung

SITE OF ROUTE ADMINISTRATION

THE USAGE OF DOSAGE FORMSTHE USAGE OF DOSAGE FORMS

Route Of Drug Administration Dosage Form

Oral SublingualParenteralEpicutaneous/Transdermal

RectalConjunctivalIntraoccular/IntraauralIntranasalIntrarespiratoryVaginal

Urethral

Solid and Liquid dosage formTablet, trochition and lozengesSolution, suspensionOintment, Cream, Paste, Powder, Aerosol, Lotion,Transdermal, Disc, and SolutionAttachmentSolution, Ointment, SuppositoriaOintmentSolution, OintmentSolution, Spray, Inhalant, OintmentAerosolSolution, Ointment, Emulsified foam, Tablet, Insert, Suppositoria, SpongeSolution, Suppositoria

DRUGS THAT ARE USED SPECIFICALLYDRUGS THAT ARE USED SPECIFICALLY

1. SUBLINGUAL TABLETFor cardiac diseases : angina/asthma (nitroglycerin, isoprenalin)

2. CHEWING TABLETDrugs for gastritis

3. LOZENGESMouth freshener (anti inflammation)

4. TABLETTablets that are destroyed in intestine : * Unchawed tablet* Without milk, alkaline drinks, or antacid

5. DRUG THAT NEED EXCESSIVE DRINK (200 ml – 300 ml)• Sulfa group• Metronidazol• Erythromycin• Amoxicillin• Aspirin

6. DRUGS THAT ARE WITHOUT EXCESSIVE DRINKAnti gastritis drug/antacid suspension

7. DRUGS THAT ARE TAKEN WITHOUT MILK- Vitamin C+ Ferrous- Antienteretis- Enteric coated tablet- Tetracycline

8. PEDIATRIC DRUG ADMINISTRATIONTablet / powder dissolved into:

- Honey- Sugar water- Jelly- Corn oil

Determined by: Half – life time ( t ½ ) of drugs

a. Ultra fast Amoxicillin, Cloxacillin, Flurosemide, Penicillin

b. Fast Paracetamol, Ampicillin, Hydrocortisonc. Slow Doxicillin, Griseo fluvine, Proctolald. Very slow Barbiturate, Diazepam, Digitoxin

Phenilbutazon

STANDARD ADMINISTRATION TIMESSTANDARD ADMINISTRATION TIMES

DAILY……….. times a day

Once : 10.00 (morning)/22.00 (night)Twice : 10.00 , 14.00Three times : 10.00 , 14.00, 18.00Four times : 10.00, 14.00, 18.00, 22.00

EVERYEvery ……….. hours

12-hourly : 10.00, 22.008-hourly : 06.00, 14.00, 22.006-hourly : 06.00, 12.00, 18.00, 24.004-hourly : 06.00, 10.00, 14.00, 18.00. 22.00, 02.00

Base on :1. Chemical properties of drugs

Exp : Anticholinergic drugs reduce secretion and peristaltic of intestinal. These drugs should be taken one hour before meal.

2. Physiological properties of G.I.T.Exp : Gastric pH absorption ↓

G.I. Mortility absorption ↓

3. Possible interaction :Interaction between drug

Exp : Drug that interact with antacid in stomach Amoxicillin, Ampicillin, Cloxacillin, Nitrofurantoin

Interaction Drug and Food

Exp : Drug interferred by gastric chyme Ampicillin, Amoxicillin, Erythromycin, Lincomycin

These drugs should be taken during empty stomach

22

4. Drugs that synchronized with chyme (food)Drugs that synchronized with chyme (food)Exp : Exp : Doxycycline, Doxycycline hyclate, Erthromycin, ethylsuccinate,

Griseofulvin. These drugs should be taken with meals

5. Stomach-irritating drugsStomach-irritating drugsExp : Exp : Aminophylline, Acetyl salicilic acid, Codein, Phenylbutazon

EXAMPLE OF ADMINISTRATION TIME OF THE INTERACTIVE DRUGS

R/ Ampicillin 500 mg cap No. XVS 3. dd.cap.I (1) hac ------- 1 hour before meal

-------------------------------------#--------------------------------------------R/ Antacid tab No.XX

S3.dd.tab.I (1) hpc ------- 1 hour after meal -------------------------------------#--------------------------------------------

Abbreviation Administration times

qd* = quaque die = each day Usually accepted to mean 10:00 AMbid* = bis in die = twice a day 10:00 AM, 2:00 PMtid* = ter in die = three times a day 10:00 AM, 2:00 PM, and 6:00 PMqid* = quater in die = four times a day 10:00 AM, 2:00 PM, 6:00 PM, and 10:00 PMhs = hora somni = at bed time Usually accepted to mean 10:00 PMq12h = quaque duodecin hora = each twice hours 10:00 AM and 10:00 PMq8h = quaque octo hora = each eight hours 6:00 AM, 2:00 PM, and 10:00 PMq6h = quaque six = each six hours 6:00 AM, 12:00 AM, 6:00 PM, and 12:00 PMq4h = quaque quattour = each four hours 6:00 AM, 10:00 AM, 2:00 PM, 6:00 PM, 10:00

PM, and 2:00 AMq3h = quaque tres = each three hours 3:00 AM, 6:00 AM, 9:00 AM, 12:00 AM, 3:00 PM,

6:00 PM, 9:00 PM, and 12:00 PMac = ante cibos before meals (approximately 30 – 45 minutes)pc = past cibos after meals (approximately 1 hour)

* Exceptions:

1. Steroids perhaps should be administered near 7:00 or 8:00 AM when on a qd schedule.

2. Oral hypoglycemic agents and insulin (7:00 AM and/or 4:30 PM) when ordered bid.

3. Antibiotics should be spread evenly over 24 hours. An approximate schedule to avoid meals might be 4:00 AM, 10:00 AM, 4:00 PM, and 10:00 PM.

4. Antihypertensive agents should be spread over the 24 hour period

5. Anticoagulants should be scheduled so as to follow measurement of the patient ’s clotting time.

Standard administration timesStandard administration times

24

FIX TIME OF ADMINISTRATION

- In the morning : Steroid

Diureticum

Antihypertensi

- In the night : Contraceptive agent

Hypnotic agent

- During meal : Drug irritating stomach

Drug that sensitive to gastric pH

Drug absorption increase

- During episode : Antiasthmatic drug

Drug for migraine

Angina pectoris drugs

- Empty stomach : 1 hour before meal 1h.a.c

2 hour after meal 2h.p.c

25

Duration of therapy : Symptomatic therapy : three days, < or > than three days Causative therapy : * eliminate the cause of the case * antimicrobial agent eradicate all infecting organism oral administration : 5 – 7 days or < if given high dose

Depend on :• DRUG DOSAGE FORMS• ROUTE OF ADMINISTRATION• SPECIFIC- DRUG MEDICATION