Medication Administration: Oral and Topical

Medication Administration: Oral and Topical

• Oral Route Advantages:

  • Convenient
  • Comfortable
  • Economical
  • Easy to administer
  • Often produces local or systemic effects
  • Rarely causes anxiety for the patient

• Oral Route Disadvantages:

  • Avoided in patients with GI alterations, reduced GI motility, or surgical resection of the GI tract
  • Contraindicated in patients unable to swallow or those that are unconscious or confused
  • Can irritate the GI tract lining, discolor teeth, or have unpleasant taste
  • Gastric secretions may destroy some medications

• Oral Route:

  • Easiest and most common administration method
  • Medications given by mouth and swallowed with fluids
  • Slower onset of action compared to parenteral routes.
  • More prolonged effect than parenteral routes

• Sublingual Route:

  • Medications placed under the tongue
  • Patient instructed not to swallow or drink anything until the medication dissolves completely
  • Ensures the medication works as intended

• Buccal Route:

  • Solid medication placed against the mucous membranes of the cheek until it dissolves.
  • Patients should alternate cheeks with each dose to prevent mucosal irritation.
  • Avoid chewing or swallowing

• Oral Drug Forms:

  • Capsules: Small, cylindrical gelatin containers holding dry powders or liquid medications.
  • Lozenges: Flat disks containing a medicinal agent in a flavored base (often hard sugar candy or sugar/gelatin combination). Held in the mouth to dissolve slowly.
  • Pills: Obsolete form of medication no longer widely manufactured. Still a term sometimes used for tablets and capsules.
  • Syrups: Dissolved medications in a concentrated sugar/water solution. Effective in masking taste.
  • Tablets: Dried powdered medications compressed into small disks.

Topical Administration: Skin

• Skin Advantages:

  • Local effect
  • Painless
  • Limited side effects

• Skin Disadvantages:

  • Patients with skin abrasions at higher risk for rapid medication absorption and systemic effects
  • Medications absorbed through skin slowly

• Topical Drug Forms:

  • Ointment: Semisolid, externally applied preparation, often containing one or more medications
  • Liniment: Usually contains alcohol, oil, or soapy emollient for application to the skin.
  • Lotion: Semiliquid suspension protecting, cooling, or cleansing the skin.
  • Paste: Thicker than ointment, absorbed through skin slower; often used for skin protection
  • Transdermal disk/patch: Medicated disk or patch absorbed through the skin over a long period.

Topical Administration: Transdermal

• Transdermal Advantages:

  • Prolonged systemic effects

• Transdermal Disadvantages:

  • Medication leaves an oily or pasty substance on skin, potentially staining clothing.

• Transdermal Mechanism:

  • Patch containing a sufficient amount of drug to achieve the desired effect when it crosses the skin and enters the systemic system.
  • Includes medications like fentanyl, hyoscine, nicotine, and oestradiol

• Transdermal Patch Types:

  • Adhesive: Simple design with a drug-containing adhesive and backing material.
  • Layered/matrix: Drug-containing matrix, adhesive layer, and backing material; matrix controls drug release.
  • Reservoir: Enclosed reservoir containing drug, with a membrane, adhesive layer, and backing material.

Nursing Responsibilities - Oral & Topical

• Oral Route:

  • Position patient upright (90 degrees) to prevent aspiration
  • Allow self-administration where possible
  • Medications administered one at a time to ensure proper swallowing
  • Assess for signs of swallowing difficulties (dysphagia)
  • Consult medication resources for safe crushing instructions

• Topical Route:

  • Assess condition of affected site for skin integrity
  • Clean and dry the affected area.
  • Apply topical treatments to a hairless area unless otherwise specified.
  • Cover the area with a towel or sheet if necessary
  • Instruct patient to inform the nurse of any itching/rashes.

Oral Route - Equipment

• Medicine Pot: Used for transferring a dosage form from its packaging to the patient.
• Tablet Splitter: Facilitates accurate splitting of tablets for easier administration.
• Tablet Crusher: Useful for preparing medications for patients with swallowing difficulties, without a suitable alternative.
• Oral Syringe: A syringe specifically designed to administer oral doses without attaching to intravenous systems.
• Medicine/Soufflé Cup: Measuring cups for liquids and semi-solids, with various measuring scales.
• Medicine Dropper: A small tool, often used for precise liquid measurements.
• Measuring Teaspoon: Used to measure solid medications.