Lab 1 - SMS232z - Enteral Routes of Administration PDF

‫رؤية ورسالة الكلية‬ Vision “Shaping the future of Dentistry through excellence in Dental Education, innovative Research, patient- centered care, and health promotion Internationally.” ‫الرؤية‬ ‫تشكيل مستقبل طب االسنان من خالل التميز في ال...

‫رؤية ورسالة الكلية‬ Vision “Shaping the future of Dentistry through excellence in Dental Education, innovative Research, patient- centered care, and health promotion Internationally.” ‫الرؤية‬ ‫تشكيل مستقبل طب االسنان من خالل التميز في التعليم الطبي‬ ‫واألبحاث المبتكرة والرعاية الصحية التي ترتكز حول المريض‬.‫وتعزيز الصحة عالميا‬ Mission: “Provide learner-focused dental education, cutting-edge scientific research, patient-centered care, and community engagement all within a positive organizational culture.” :‫الرسالة‬ ‫توفير تعليم طب االسنان الذي يرتكز علي المتعلم والبحث العلمي المتطور والرعاية‬ ‫ كل ذلك في اطار ثقافة تنظيمية‬,‫الصحية المرتكزة علي المريض والمشاركة المجتمعية‬ ‫إيجابية‬ Core Values: Leadership. Excellence. Innovation. Collaboration. Respect. Integrity :‫القيم الجوهرية‬ ‫النزاهة‬. ‫االحترام‬. ‫التعاون‬. ‫االبتكار‬. ‫التفوق‬. ‫القيادة‬  SMS232z Lab1 (Enteral Routes of Administration) (Enteral Routes of Administration)  Effect Of Administered Drug Systemic Local (General) (Topical) If drug is absorbed If drug is not absorbed and distributed. nor distributed.  Routes of Administration Enteral Others Buccal e.g. Sublingual Parenteral e.g. Injection Oral Inhalation Rectal Topical  Enteral Route 1-Sublingual: absorbed directly → Systemic circulation → Good Bioavailability. Thumbnail for version as of 12:11, 20 March 2006 2-Oral: Stomach, Intestine → pH changes & enzymes → Portal circulation → Liver metabolism → Systemic circulation → Most variable Bioavailability. http://t3.gstatic.com/images?q=tbn:ys03VGtrg88UPM:http://images4.wikia.nocookie.net/fci/images/thumb/8/84/Symbol_thumbs_dow 3-Rectal: a- Upper rectum : Portal circulation → Liver metabolism → Systemic circulation. b- Lower rectum : Systemic circulation.  1- Oral Route: ❖Characteristics: Suitable a- Small amount or volume b- Palatable: - If bad taste: Dilute with milk or fruit juice Use sugar coated or effervescent form C- Non-irritant: - If mild irritant: Take after meal Use enteric coated form: covered with acid resistant coat ❖Advantages: Convenient (Safe, Easy & Economic) ❖Disadvantages: 1- Emergency → Delayed Onset 2- Uncooperative Patients NOT in e.g Coma, Very Young 3- Vomiting or Severe Diarrhea 4- Very Irritant Drugs e.g Emetine HCl 5-Unabsorbed drugs when systemic effect is wanted 6-Drugs with extensive First Pass Effect (Metabolism)  ❖Factors Affecting Oral Absorption: 1- State of Health of G.I.T. Mucosa: e.g. Mal-absorption Syndrome. 2- Specific Factors: e.g. Intrinsic Factor for Vit B12 Absorption. 3- Gastric Emptying: a- Metoclopramide: (Primperan, Anti-emetic) Emptying -  Absorption of Paracetamol (Rapid rates of disintegration & dissolution). -  Absorption of Digoxin (Slow rates of disintegration & dissolution). b- Atropine:  Emptying (The reverse effects) 4- Gut Motility: marked alterations (e.g. Morphine) :  Absorption. 5- pH: a- Gastric Acidity:  Absorption of Salicylates & Barbiturates. b- Intestinal Alkalinity:  Absorption of Ephedrine & Amphetamine. 6- Presence of food & other drugs: a- Good: with irritant drugs e.g. aspirin & iron. b- Bad: 1-Food dilutes drugs & may compete with them for absorption e.g. amino acids compete for the same carrier of L-DOPA 2- Milk (Ca2+) & anti-acids → interfere with Tetracycline absorption. 3- Tea (Tannic Acid) & Tetracycline →  Iron absorption. 4- Cholestyramine & Activated Charcoal →  Absorption of most drugs.  7- First Pass Effect (Pre-Systemic Metabolism): ↓ Bioavailability http://t3.gstatic.com/images?q=tbn:ys03VGtrg88UPM:http://images4.wikia.nocookie.net/fci/images/thumb/8/84/Symbol_thumbs_down.svg/463px-Symbol_thumbs_down.svg.png a- Gut: - Gastric Acidity: Benzyl Penicillin. - Digestive Enzymes: Insulin & Pituitary hormones - Mucosal enzymes: Tyramine, L-DOPA, -Methyldopa& Chlorpromazine - Flora: Histamine b- Hepatic: - Extensive: Nitroglycerine, Lidocaine & Natural sex hormones. - Partial: Propranolol & Morphine. - Minimal: Atenolol, Nadolol & Barbitone. How to OVERCOME Hepatic First Pass Metabolism? ? ↑the oral dose of the drug e.g. Morphine & Propranolol Use other routes (NOT ORAL) e.g. Sublingual “Nitroglycerine” 8- Factors related to the drug: e.g. Lipid Solubility.  Enteral Route: 1- Oral. http://t2.gstatic.com/images?q=tbn:cH7C2jyMNOG7yM:http://www.clker.com/cliparts/3/d/e/4/12428083851546739178Symbol_OK.svg.med.png 2- Sublingual. 3- Rectal.  2-Sublingual (Pellet or Linguat) *Example: Isoprenaline & Nitroglycerine. *Advantages: Thumbnail for version as of 12:11, 20 March 2006 1- Easy. 2- Escape gut& hepatic first pass effect → Good bioavailability 3- Rapid onset. 4- Proper control of dose by either spitting or swallowing excess of the drug.  3-Rectal Route 1- Solid (Suppository): Drug (Aminophylline) in a cone of gelatin or cocoa butter. 2- Fluid (Enema): Evacuant (Cleansing) enema Retention enema e.g. for constipation e.g. Nutrient Large volume (1 liter) Small volume (1/4 liter) High head pressure Low head pressure Mild irritant (chamomile) Non-irritant  Advantages: 1 Escape gut & hepatic first pass effects Patients with vomiting Uncooperative patients e.g. coma & young children 2 -Useful in Mild irritant drugs e.g. aspirin and aminophylline Large volume drugs  Enteral Route: 1- Oral. http://t2.gstatic.com/images?q=tbn:cH7C2jyMNOG7yM:http://www.clker.com/cliparts/3/d/e/4/12428083851546739178Symbol_OK.svg.med.png 2- Sublingual. http://t2.gstatic.com/images?q=tbn:cH7C2jyMNOG7yM:http://www.clker.com/cliparts/3/d/e/4/12428083851546739178Symbol_OK.svg.med.png 3- Rectal. http://t2.gstatic.com/images?q=tbn:cH7C2jyMNOG7yM:http://www.clker.com/cliparts/3/d/e/4/12428083851546739178Symbol_OK.svg.med.png http://t3.gstatic.com/images?q=tbn:UVQfnP-mQX7xEM:http://1.bp.blogspot.com/_sW65ilskOC8/SVuWnB-vsXI/AAAAAAAAUeM/VL2foS3Dn7I/s400/SmileyFaceClown.jpg Thank You