Lec.11

Question 1

Selection Criteria for Route of Administration

Answer 1

Drug physicochemical properties
Drug pharmacokinetic properties
Drug dose & therapeutic index
Patient condition/status
Desired site of action
Desired onset of action
Desired duration of action

Question 2

Routes of Systemic effect:

Answer 2

Enteral
Parenteral
Transdermal
Inhalation

Question 3

Routes of local effect:

(site-specific)

Answer 3

Topical & Inhalation

Question 4

Gives the fast action?

Answer 4

Ans: IV- (quickest) effect
Inhalation
Sublingual
IM
Subcutaneous
rectal
oral transdermal ( lowest)

Question 5

Enteral advantages ?

Answer 5

Ease of administration (No pain or discomfort)
 Safe (No sterility issues)
 Less expensive (Economical)
 Sustained (controlled) release tablet  Better compliance

Question 6

Issues with crushing SR tablets?

Answer 6

Crushing SR tablet =Dose Dumping =Drug toxicity

Question 7

Issues with crushing Enteric-coated tablets?

Answer 7

Crushing enteric coated tablet = Drug degradation = Therapeutic failure

Question 8

Enteral disadvantages?

Answer 8

• Slow onset of action (Not for emergency)
• Drug degradation by gastric juices (acidity and enzymes) (e.g. insulin)
• First-pass effect (first-pass metabolism) (e.g. lidocaine)
• Not suitable for unconscious, vomiting or pediatric patients
• Gastric irritation and unpleasant taste with some drugs

Question 9

The drug is held under the tongue or in the mouth and absorbed
through the oral mucosa?

Answer 9

Sublingual/Buccal

Question 10

Dosage form of; sublingual

Answer 10

tablet, lozenge, gum

Question 11

Sublingual Advantages?

Answer 11

• Rapid absorption and action (e.g. nitroglycerin for angina)
• Bypass first-pass metabolism
• Easy to terminate the effect

Question 12

Sublingual Disadvantages?

Answer 12

• Might be inconvenient (might cause irritation)
• Only suitable for small doses
• Unpleasant taste of some drugs

Question 13

Rectal Advantages?

Answer 13

• Suitable for unconscious, vomiting or pediatric patients
• Bypass first-pass metabolism (“partially”)
• Local (e.g. laxative) or systemic effects (e.g. analgesic/antipyretic)

Question 14

Rectal disadvantages?

Answer 14

• Discomfort

- Erratic absorption

Question 15

Parental Dosage form?

Answer 15

• Subcutaneous (SC/SQ)
• Intramuscular (IM)
• Intravenous (IV)

Question 16

Parenteral advantages?

Answer 16

Rapid onset of action (suitable for emergency)
Suitable for unconscious or vomiting patients
Bypass first-pass metabolism and GIT enzymes
No Bioavailability issues

Question 17

Parenteral disadvantages?

Answer 17

• Painful administration
• Sterility issues (risk of infection)
• Safety issues (cannot terminate effect)
• Expensive preparation and administration
• Requires equipment: syringe, needles, cannula. infusion set, vial, ampoule

Question 18

The short needle length is used for?

Answer 18

Subcutaneous route

Question 19

The long needle length is used for?

Answer 19

IM

Question 20

What are lower gauge ( thicker) needles used for?

Answer 20

Viscous Medication ( for deeper injection)

Question 21

What are higher gauge (thinner)needles used for?

Answer 21

less painful

Question 22

drug delivered directly under the skin?

Answer 22

Subcutaneous

Question 23

Drugs used subcutaneously?

Answer 23

• only suitable for small volumes ( less than 2ml)

- commonly used for insulin

Question 24

IM absorption depends on?

Answer 24

Muscle type & blood flow

Question 25

Used to test allergy of penicillin?

Answer 25

Intradermal

Question 26

Drug delivered directly into a vein?

Answer 26

IV

Question 27

Advantages of IV ?

Answer 27

Suitable for large volume/dose Immediate onset of action Suitable for irritant drugs (e.g. anti-cancer drugs) Titratable dosing without fluctuation (infusion) Total parenteral nutrition (TPN) in critical illness

Question 28

Disadvantages of IV?

Answer 28

- Not suitable for oily solutions & insoluble substances - Risk of embolism - Thrombophlebitis - Extravasation - Increased risk of allergic & adverse drug reactions - Special skills required for administration

Question 29

Intravenous Delivery Systems

Answer 29

- Direct Push (IV Bolus) - Continuous Infusion (IV Drip or Infusion Pump) - Intermittent Infusion (IV Piggyback)

Question 30

IV access?

Answer 30

- Peripherally ( Short-term ) | - Centrally (Large volumes)

Question 31

Which Iv access is used for anti-cancer drugs?

Answer 31

Centrally

Question 32

Why do we sterile IV material?

Answer 32

IV route =Bypass natural body barriers (Skin & GIT)= Risk of Infection

Question 33

2 types of laminar airflow?

Answer 33

- Horizontal ( air flows outward | - Vertically ( air flows downwards

Question 34

which airflow is used for anti-cancer/toxic drugs?

Answer 34

Vertically (AWAY FROM YOU)

Question 35

which airflow is used for regular/nontoxic drugs?

Answer 35

Horizontally ( towards you)

Question 36

Types of IV incompatibilities?

Answer 36

- Physically - Therapeutic/Pharmacological - Chemically

Question 37

Causes of IV incompatibilities?

Answer 37

Drug in inappropriate IV diluents or adjuvants Drug in inappropriate IV containers Interaction between two or more drugs

Question 38

Consequences of IV incompatibilities ?

Answer 38

- Toxicity - Therapeutic failure - Particulate embolism

Question 39

Examples of High alert medications? IMP*

Answer 39

``` PINCH: Potassium chloride injection Insulin Narcotics and opiates Neuromuscular blocking agents Chemotherapeutic agents Heparin ```

Question 40

Drug is delivered to the bloodstream through the skin | via absorption from an applied patch

Answer 40

Transdermal

Question 41

Examples of transdermal patch: *IMP

Answer 41

Nicotine, nitroglycerin, scopolamine, clonidine, fentanyl patches

Question 42

Advantages of topical formulations:

Answer 42

Local & direct therapeutic effect | Minimal systemic side effects

Question 43

Topical Dosage forms:

Answer 43

Cream, ointment, gel, drops, spray etc.

Question 44

Inhalation Dosage forms:

Answer 44

Metered Dose Inhalers (MDI), Dry Powder Inhalers | (DPI), Nebulizer

Question 45

Transdermal:absorption depends | mainly on ?

Answer 45

drug molecular weight and lipophilicity

Question 46

Rectal dosage form?

Answer 46

Enema & Suppostories

Question 47

Drug is delivered directly under the skin.

Answer 47

Subcutaneous

Question 48

Drug is delivered directly into the muscle (gluteal muscle (buttock) or deltoid muscle (upper arm)).

Answer 48

Intramuscular

Question 49

Drug is delivered directly into a vein (systemic circulation).

Answer 49

IV

Question 50

(Immediate injection, small volume, rapid high drug concentration)

Answer 50

Direct Push (IV Bolus)

Question 51

(long duration, with or without drug (fluids), uninterrupted)

Answer 51

Continuous Infusion (IV Drip or Infusion Pump)

Question 52

(shorter duration, dilute drug solution, given periodically)

Answer 52

Intermittent Infusion (IV Piggyback)