Pharmacology Basics: Enteral Medications

By Paul Henry / in , , /

This lecture covers enteral medications. With the enteral route drugs are administered directly into the gastrointestinal tract. These medications include tablets, capsules, liquids,suppositories, and enemas. There are some definitely advantages and disadvantages to enteral medications. Enteral medications, first they cost less and they are the preferred route. Those are great advantages. You know patients can easily self administer enteral medications. Some of the disadvantages are that enteral medications, they’re slowly absorbed so they have a longer onset or time before a therapeutic effect is obtained. Also remember that food in the stomach may affect absorption. When medications are taken P.O. or by mouth, there is always a risk of choking. Lastly, stomach acids can completely destroy some medications such as insulin. With this kind of scenario, other routes of administration have to be utilized. Contraindications of enteral medications are nausea, vomiting, inability to swallow, and unconsciousness. So here’s a reminder. Remember the seven rights before you administer any medication. Check the medications three times and wash your hands before and after administering medications to a patient. So tablets; these are dried powdered drugs that have been compressed into small discs. They may contain binders to help hold them together or fillers that make the size of the tablet convenient to take. Scored or grooved tablets may be used to divide the dose. Enteric-coated medications are coated so that they are released in the intestine and not in the stomach. These are good for patients with ulcers or sensitive stomachs. Enteric-coated medications though should not be crushed because you’ll destroy that protective coating. Buffered tablets have an acid added to them which protects stomach irritation. Capsules are gelatin coated and are in many instances time released. Remember, time release capsules and extended release medications are designed to have a gradual continuous release of a drug. This can improve patient’s compliance because they don’t need to take the drug as often, however, these medications cannot be crushed. You will destroy that time release property of the medication which could result in overdose or sub-therapeutic activity. MS Contin is an example of an extended-release medication. It’s an extended release morphine. Could you imagine if you would to crush that medication? Sublingual means under the tongue. there are many capillaries under the tongue which provides a rich blood supply for quick absorption. When you take something sublingual, though do not follow that medication with water. Also we need to teach the patient not to swallow the tablet; you need to let it dissolve. Nitroglycerin for angina or chest pain is a very common medication that’s given sublingual. The buccal pouch or cheek is a good route for applying medications in the mouth or throat to ease local inflammation. A troche which is a lozenge, is made up of medicine powder and sugar and delivers medication topically when allowed to dissolve in the buccal pouch. Remember that it has a systemic effect, you have it between the cheek and the gums, do not follow it with water, and do not swallow these. Buccal medications also need to dissolve. Liquid medications have several advantages over pill forms. They’re easier to swallow. Also, because the drug is already broken down in the liquid, they are absorbed quicker. Here are some different types of liquid medications. First is an elixir. These medications contain alcohol which helps to dissolve the medication and make it more palatable. You must keep the lid of these medications on tight due to the evaporation of alcohol. Als,o because of the alcohol, elixirs are used less often and they can interact with other medications. Elixirs are contraindicated in children, diabetics, and alcoholics. They’re not recommended for diabetics because the liver turns the alcohol to sugar. Emulsion liquids are oils and fats in water. In solutions the medication is evenly distributed. With suspensions, the medication is not evenly distributed so you must shake the liquid prior to administration. Syrups have been dissolved in a concentration solution of sugar. Here’s some things to think about when administering liquid medication. First , dosing cups are always a handy way to give liquid medicines. However, dosing errors have occurred with them so always check to make sure the units whether it’s tablespoons, teaspoons, milliliters, make sure the units are on the cup or the syringe and it matches the units of the dose that you want to give. When you pour the medication make sure it’s on a flat surface and always check the dosage at eye level. Oral syringes may be needed instead of dosing cups for the pediatric patient but no needles. Gastric tube or NG tube runs from the nose to the stomach and are used to administer food and medicines. NG tubes may be placed in a patient if we need to empty the stomach or if the patient has trouble swallowing. Liquid medications are ideal to use with an NG tube but if the liquid medications are not available and all you have is tablets you can crush tablets and dissolve them in warm water. But remember, that extended-release tablets should not be crushed. If you have any questions about what you can crush or about opening capsules, please check with your pharmacist. Before we give medications in a tube you need to flush the tube with water and make sure that it’s patent, that it’s working, and its open. We also need to flush it again after administration of medications to clear the tubing and maintain patency. Always check the tube for proper placement prior to use, always! If an NG tube is displaced it could cause administration of medications directly into the lungs that can lead to aspiration, choking, pneumonia, and death. The rectal route of medications is sometimes necessary if the patient has severe vomiting or is not alert enough to swallow. Some medications don’t come an IV form either so the rectal route may be necessary. Suppositories have a glycerin or a cocoa butter base and it contains the medication. The body temperature dissolves the medicine and is absorbed by the mucous membranes. Suppositories should be stored in a cool place to prevent softening. Enemas are liquids that are administered through the rectum. They can help empty the bowel to relieve constipation, they can cleanse the bowel before medical procedures, or we can administer medications through enemas. Ointments can be given rectally and are usually given with an applicator. After we give medications we then need to document the administration. Then, we need to closely observe the patient for therapeutic effects, side effects, o radverse medication reactions. adverse medication reactions. Make sure you bring in any questions to the Pharm cafe or bring them to class!

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