Pharmaceutics Routes Of Administration Ross University Summer 2024 PDF

PHARMACEUTICS Routes of administration VPP 5343 I PHARMACOLOGY Ronan CHAPUIS, DEDV, MSc, DACVIM-LA I [email protected] I Google Scholar SUMMER 2024 DISCLOSURE The author declares no conflict of interest The references of the pictures’ copyright are NOT all from professional sources Let’s build...

PHARMACEUTICS Routes of administration VPP 5343 I PHARMACOLOGY Ronan CHAPUIS, DEDV, MSc, DACVIM-LA I [email protected] I Google Scholar SUMMER 2024 DISCLOSURE The author declares no conflict of interest The references of the pictures’ copyright are NOT all from professional sources Let’s build strong material at Ross: reach out if you believe there is mistake in the material Acknowledgement: Dr. Melissa Bucknoff Ronan C. VPP 5343, SUMMER 2024 2 OBJECTIVES To recall that route of administration is part of the label To recall how to proceed regarding withdrawal time in food animal if drugs are administered through a different route than stated in the label To recognize the difference between systemic & topical routes of administration To recognize when local application has systemic or topical effect with special attention for enteral administrations To state the route & effect of drugs administrated To describe advantages & disadvantages of each route of administration presented To select a route of administration based on the clinical situation Ronan C. VPP 5343, SUMMER 2024 3 Route of of administration are part of the LABEL Changing a route of administration is considered as ELDU è !! residues Ronan C. VPP 5343, SUMMER 2024 4 ROUTES OF ADMINISTRATION Systemic Topical Ronan C. VPP 5343, SUMMER 2024 5 ROUTES OF ADMINISTRATION Systemic Topical Ronan C. VPP 5343, SUMMER 2024 6 Definitions Enteral Parenteral SYSTEMIC ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 7 Definitions Enteral Parenteral SYSTEMIC ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 8 Definitions Systemic: pertaining to or affecting the body as a whole Systemic administration è the drug is circulating in the systemic circulation Ronan C. VPP 5343, SUMMER 2024 9 ANY ROUTE of APPLICATION + SYSTEMIC CIRCULATION (= reaching one or multiple organs by blood, desirable effects are not at the site of administration does not imply ”no local effect” è effect at the site of administration may occur: irritation, necrosis … Ronan C. VPP 5343, SUMMER 2024 © https://www.clipartkey.com/view/iRJxmTx_sperm-whale-circulatory-system/ - last consulted 01/12/24 10 Definitions Enteral Parenteral SYSTEMIC ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 11 Enteral: absorption in intestine, administration can be PO: oral + swallow Via tubes Feeding / esophageal tubes Nasogastric tubes © Dr Bucknoff M. , PPT RUSVM, VPP 5343 © Dr Bucknoff M. , PPT RUSVM, VPP 5343 © Ronan C. , DEDV, LA-ACVIM, MSc Ronan C. VPP 5343, SUMMER 2024 12 © Dr Bucknoff M. , PPT RUSVM, VPP 5343 Advantages Pharmacology Maintain longer plasma concentration Technic Convenient Including administration at home Tubes For non-compliant patient Needs of multiple medications / high volume of administration Potential to decontaminate Induce vomiting or gastric lavage Ronan C. VPP 5343, SUMMER 2024 13 Disadvantages for pharmacology Delay +/- incomplete absorption è +/- slower onset of action Factors decreasing absorption Food or other drugs interaction Inactivation by gastric pH, digestive enzymes, or rumen microflora Dependent on GI tract activity & integrity (+/- hepatic for some prodrug) First pass effect / first pass metabolism / first pass biotransformation Ronan C. VPP 5343, SUMMER 2024 14 Technical disadvantages PO Patient compliance Owner compliance Palatability © Ronan C. , DEDV, LA-ACVIM, MSc Feeding tubes: infection at tube site Nasogastric tube: Compliance Haemorrhage in horses (ethmoid) Ronan C. VPP 5343, SUMMER 2024 15 Definitions Enteral Parenteral SYSTEMIC ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 16 Injection Inhalation Local PARENTERAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 17 Injection Inhalation Local PARENTERAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 18 IV IM SQ or SC Intraosseous, IO Intraperitoneal, IP © http://www.shagbarkridge.com/info/injections.html - last consulted 1/10/23 Ronan C. VPP 5343, SUMMER 2024 19 IV IM SQ or SC Intraosseous, IO Intraperitoneal, IP © http://www.shagbarkridge.com/info/injections.html - last consulted 1/10/23 Ronan C. VPP 5343, SUMMER 2024 20 © Dr Bucknoff M. , PPT RUSVM, VPP 5343 Double lumen IV catheter placed in the lateral saphenous vein of a hospitalized dog © Ronan C., DEDV, LA-DACVIM, MSc. IV injection in a jugular vein of a horse Ronan C. VPP 5343, SUMMER 2024 21 Advantages Pharmacology Highest & earliest plasmatic concentration reached following administration èEarliest onset Technical Avoid tissue irritation IV catheters allow to maintain “constant” plasmatic concentration over (long) time Larger volumes administration Repeated administration CRI (constant rate infusion) Ronan C. VPP 5343, SUMMER 2024 22 Disadvantages Pharmacology Side effects from high concentration Systemic E.g.: tetracyclines è cardiovascular Local: Phlebitis Alternative Slow injection Central catheter Technical Long term catheter or repeated injection (Septic) (thrombo)phlebitis Unlikely administered at home Risk of intraarterial injection (+/-) Ronan C. VPP 5343, SUMMER 2024 23 IV IM SQ or SC Intraosseous, IO Intraperitoneal, IP © http://www.shagbarkridge.com/info/injections.html - last consulted 1/10/23 Ronan C. VPP 5343, SUMMER 2024 24 © http://www.shagbarkridge.com/info/injections.html - last consulted 1/10/23 Ronan C. VPP 5343, SUMMER 2024 © https://www.calvetsupply.com/Administering-Injections-to-Animals.html - last consulted 5/9/24 25 Advantages Pharmacology Rapid absorption è high plasmatic concentration But slower than IV èMay be longer duration of action Technical May be administered at home Multiple exceptions exist Ronan C. VPP 5343, SUMMER 2024 26 Disadvantages Pharmacology Absorption slower than IV & can be incomplete (cf. pharmacokinetics) Drug residues May be painful May be irritant Hypertonic substances Acid or basic drugs Technical Risk of site infection or abscessation Risk of nerve damages Risk of intravenous/intraarterial administration Ronan C. VPP 5343, SUMMER 2024 27 IV IM SQ or SC Intraosseous, IO Intraperitoneal, IP © http://www.shagbarkridge.com/info/injections.html - last consulted 1/10/23 Ronan C. VPP 5343, SUMMER 2024 28 Advantages Pharmacology Slow absorption è Longest duration of action than IV & IM route Technical May be administered at home Multiple exceptions exist Disadvantages Pharmacology Absorption can be even slower & more incomplete Drug residues May be painful May be irritant Hypertonic substances Acid or basic drugs Technical Risk of site infection or abscessation Nerve damage & IV/intraarterial administration (much less risky than IM) Ronan C. VPP 5343, SUMMER 2024 29 ! Off label SC penicillin Ronan C. VPP 5343, SUMMER 2024 30 IV IM SQ or SC Intraosseous, IO Intraperitoneal, IP © http://www.shagbarkridge.com/info/injections.html - last consulted 1/10/23 Ronan C. VPP 5343, SUMMER 2024 31 Intraosseous administration: in bone marrow © Dr Bucknoff M. , PPT RUSVM, VPP 5343 Ronan C. VPP 5343, SUMMER 2024 32 Advantages Pharmacology Same than IV Fluids flow as efficiently as IV Some drug can be administered such as CPR drugs Technical Rapid access for emergencies in neonates & tiny patients Technically uncomplicated (with practice) Disadvantages Pharmacology Most drugs cannot be administered Technical Short-term only Special equipment required Painful Risk of fracture Ronan C. VPP 5343, SUMMER 2024 33 Injection Inhalation Local PARENTERAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 34 Gases, vapors Gas inhalant anesthesia © Dr Bucknoff M. , PPT RUSVM, VPP 5343 Ronan C. VPP 5343, SUMMER 2024 35 Advantages Pharmacology Rapid absorption è Rapid onset Rapid elimination by expiration (exhalation) Technical Able to deliver gas inhalant anaesthesia in noncompliant small animals Multiple exceptions exist Disadvantages Pharmacology May not be tolerated in awake patients May be irritant Ronan C. VPP 5343, SUMMER 2024 36 Injection Inhalation Local PARENTERAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 !! sometimes called topical 37 Transdermal In conjunctive tissue (implant) Ronan C. VPP 5343, SUMMER 2024 38 Transmucosal Buccal: on the cheek Sublingual: under tongue Rectal Intranasal: dense vascular plexus Some drugs may pass directly to the CNS Endotracheal Can be used for emergency drugs during CPR: epinephrine Immersion (fish) Eggs immersion Ronan C. VPP 5343, SUMMER 2024 39 Advantages Pharmacology Absorption can be better than with enteral route Delayed absorption but can be fast (transmucosal) è May have longer duration of action than IV route Technical When other routes not available May be administered at home Disadvantages Pharmacology Absorption slow & can be incomplete Drug residues Technical Can be technical Ronan C. VPP 5343, SUMMER 2024 40 Enteral vs buccal/sublingual/rectal Some consider buccal/sublingual/rectal as enteral route ! Ronan C. VPP 5343, SUMMER 2024 41 ROUTES OF ADMINISTRATION Systemic Topical Ronan C. VPP 5343, SUMMER 2024 42 Definitions Local: restricted to or pertaining to one spot or part, not general Topical: pertaining to a particular area, as a drug is applied to a certain area it affects only the area to which it is applied Ronan C. VPP 5343, SUMMER 2024 43 LOCAL APPLICATION + LOCAL EFFECT (at the site or the region of administration) does not imply ”no systemic absorption” è Systemic side effect can occur è Residues detections/violations can occur Ronan C. VPP 5343, SUMMER 2024 44 Advantages Pharmacology For same concentration at site of action, the High concentration at site of administration Decreased systemic side effect (lower dosage) topical adminstration will require a lower dose or dosage than by systemic administration (cf. dosage def. in “drug calculation”) Technical Some can be done at home Disadvantages Pharmacology May be irritant Technical Some can be technical Ronan C. VPP 5343, SUMMER 2024 45 TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 46 TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 47 Intradermal injection Ointment, lotion, aerosol … © http://www.shagbarkridge.com/info/injections.html - last consulted 1/10/23 Ronan C. VPP 5343, SUMMER 2024 48 Careful with use of « spot on » in other country Local application topical Topical ?èLocal ? effect Topical ? Local ? è systemic Local application effect TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 50 Enteral: oral administration with no systemic absorption è aimed effect only in the GI Some antimicrobials Sucralfate Lactulose: management of hepatic encephalopathy Rectal with action in rectum Ronan C. VPP 5343, SUMMER 2024 Lactulose (small animal emergency) Enemas 51 TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 52 Drop Sub-palpebral lavage system Subconjunctival injection Intracameral injection Retrobulbar injection Ocular insert, implant or extended drug delivery device Ronan C. VPP 5343, SUMMER 2024 © Dr DePedro, RUSVM, VPP 5433, 2021 © Dr DePedro, RUSVM, VPP 5433, 2021 53 TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 54 Intrauterine (IU) infusion Vaginal (PV) Ronan C. VPP 5343, SUMMER 2024 55 TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 56 © Chapter 8 Antimicrobial therapy, Dr Dowling WCVM Ronan C. VPP 5343, SUMMER 2024 57 TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 58 Metered inhaler Nebulizer Albuterol inhaler administered to cat in lower airway (asthma) crisis © https://barrelhorsenews.com/barrel-racing-articles/horse-health/alternative-therapies-nebulization/ - last consulted 1/12/23 Photo courtesy of VCA Shoreline © Dr Bucknoff M. , PPT RUSVM, VPP 5343 Ronan C. VPP 5343, SUMMER 2024 59 TOPICAL ROUTES OF ADMINISTRATION Ronan C. VPP 5343, SUMMER 2024 Skin ”Enteral” Ocular (OU) Vaginal/uterine mucosa Mammary ducts Otic (AU) Epidural - regional anaesthesia Regional limb perfusion Intrasynovial / intra-articular Pulmonary Nasal mucosa Urinary tract (urethra, bladder) 60 Ronan C. VPP 5343, SUMMER 2024 61 HOW TO SELECT ROUTE OF ADMINISTRATION Technical factors Pharmacological factors Discussion/Application Ronan C. VPP 5343, SUMMER 2024 62 HOW TO SELECT ROUTE OF ADMINISTRATION Technical factors Pharmacological factors Discussion/Application Ronan C. VPP 5343, SUMMER 2024 63 Cost Material/formulation available Home treatment Length of required treatment Ronan C. VPP 5343, SUMMER 2024 64 HOW TO SELECT ROUTE OF ADMINISTRATION Technical factors Pharmacological factors Discussion/Application Ronan C. VPP 5343, SUMMER 2024 65 Therapeutic factors PHARMACOKINETICS/PHARMACODYNAMICS Onset of action IV or IO > Inhalation > Transmuco./Endotracheal > IM > SQ > PO ≥ Transdermal Duration of action Site of action Length of required treatment Adverse reactions Drug/formulation factors Irritating properties pH Solubility Viscosity … Ronan C. VPP 5343, SUMMER 2024 66 HOW TO SELECT ROUTE OF ADMINISTRATION Technical factors Pharmacological factors Discussion/Application Ronan C. VPP 5343, SUMMER 2024 67 What routes would be an option for A drug to a horse with reflux or dog with emesis Dehydrated cattle with poor but present GI motility Managing an animal collapsing Administering a highly toxic drug, fluids Ronan C. VPP 5343, SUMMER 2024 68 QUESTIONS Ronan C. VPP 5343, SUMMER 2024 71 THANK YOU VETERINARY.ROSSU.EDU ©2021 Ross University School of Veterinary Medicine. All rights reserved.