which the particles are evenly distributed and will not separate depending on the design. Normal saline solutions are utilized for routine eye care. In contrast, suspensions are medications that have been dispersed in a liquid. This design is associated with uneven distribution, and the contents must be shaken before ad- ministration. A common example includes Pepto-Bismol. Syrups are highly sweetened medications, such as children’s cough syrup. Liquid medication forms are commonly applied for patients pre- senting with nasogastric tubes (NG tubes), though powder forms may be administered by this route as well. Buccal pouches, i.e. cheeks, are a site of medication administra- tion, which allow for prolonged placement to address local inflam- mation. Common examples include throat lozenges. These forms should not be swallowed or bitten, as the mechanism of action is achieved by slow dissolution within the oral cavity to coat the mouth and throat. In addition, liquid medications may be admin- istered in buccal format, such as antifungal medications which are swished around in the mouth and spit out (Watkins, 2013, p. 155). An additional medication route includes sublingual administra- tion. Sublingual administration bypasses the digestive system to some degree by entering systemic circulation via capillaries under the tongue. A common example includes nitroglycerin. Pharmaceuticals may also be administered in rectal form and may include enemas, suppositories, suspension and/or ointments. Enemas and suppositories are both employed in treatment of constipation and to administer certain medications for patients who are unable to swallow or present with poor intravenous line access. Enemas are applied in liquid format, allowing for more widespread reach to cleanse bowels, with a relatively short period of action. Suppositories, in contrast, are composed of a glycerin or cocoa butter base, leading to more localized sites of action, and longer duration of effects. Parenteral administration of medication includes all routes that do not include ingestion or passage through the gastrointestinal system (Watkins, 2013, p. 162). These include topical, ophthalmic, otic, vaginal, nasal, inhaled and injectable medications. The route of injection, in particular, demands strict adherence to protocols and procedures associated with sanitation as well as medication identification. Topical medications may be semisolid or solid and are applied directly to the skin in the form of a patch, ointment, lotion, gel or cream. These medication formats are absorbed di- rectly through the skin. Indications for topical administration in- clude difficulty swallowing, localized treatment for affected body areas, and a desired effect for continuous release of therapeutic doses (Watkins, 2013, p. 162). Prescription semisolid topical medications consist of ointments, creams, gels and plasters that are applied to the directly to the skin surface. Ointments are petroleum-based, which preserves skin contact for continuous medication action. Hydrocortisone, a topical corticosteroid, is a common example. Of note, ointment doses should be wiped completely from the skin between reap- plication, as residual can lead to cumulative effects and overdose. Creams are water-based, which allow them to absorb directly into the skin. A common example is Kwell, a prescription cream applied to treat lice and scabies. Gels are suspension-based. A common example is Voltaren, also known as diclofenac , a non- steroidal anti-inflammatory applied to reduce osteoarthritic pain. Plasters are applied to the skin under a base material such as moleskin, paper, linen or plastic (Watkins, 2013, p. 162). Com- mon examples include salicylic acid for treating fungal warts, and capsaicin plaster, a topical analgesic. Non-prescription semisolids include lotions and liniments. Lotions are water-based like creams, though they contain a higher percentage of water as opposed to medication. A common example is Calamine lotion, used to treat pruritus or itching irritation. Liniments, or salves, are lotions that include a skin irritant, such as alcohol or wintergreen, that draws blood flow to the application area for increased uptake. Common examples include Bengay and Icy Hot, which are often applied to aching muscles.
Cultural background can influence an individual’s knowledge and approach to prescribed medications. While some cultures value the process of scientific testing and relationships with primary- care physicians, others appeal to a more holistic approach that focuses on mind/body/spirit balance and herbal remedies. Still others relate illness to the effects of evil entities or spirits, and may place more trust in local spiritual authorities as opposed to P-glycoproteins are active transporters located throughout the body, and play a critical role in drug absorption, distribution and retention. P-glycoproteins are efflux transporters, meaning they transport molecules away from a given location and return them to the intestinal lumen (Amiji, 2014, p. 9). The primary role of P- glycoproteins is to limit cellular uptake of foreign molecules and toxins. This transporter can also recognize hundreds of pharma- ceutical compounds, including anticancer agents, immunosup- pressants, steroid hormones, calcium-channel blockers and cardi- ac glycosides (Amin, 2013). Thus, P-glycoproteins are an essential biological factor that can limit drug bioavailability and, in turn, restrain the intended effects. Primary p-glycoprotein locations in- clude the blood-brain barrier, as well as endothelial cells lining the small intestine, colon, pancreatic ductules, bile ductules, kid- ney proximal tubules and the adrenal gland. P-glycoproteins are also associated with multi-drug resistance against bacteria, fungi and protozoa (Amin, 2013). They reduce intracellular concentra- tions of anti-microbial agents, thereby impeding entry to affect intended microorganisms. As well, this protein is a key obstruction to cancer treatment, as it prevents absorption and distribution of chemotherapeutic agents, thereby significantly inhibiting chemo- therapy. Current pharmaceutical research has honed in on creat - ing P-glycoprotein inhibitors in order to enhance the capability of the aforementioned drugs. Administrating routes Enteral medications are defined as pharmaceuticals that interact with the gastrointestinal tract. Enteral drugs and are less invasive when compared to parenteral administration. Enteral drugs are subject to degradation from stomach acid, which is a significant consideration depending on the intended effect. Enteral admin- istration may be affected by symptoms of nausea, vomiting, dif- ficulty swallowing, and/or decreased level of arousal. Oral solid medications include tablets and capsules. Tablets are compressed discs of a given drug, formed into various shapes and colors (Wat- kins, 2013, p. 150). Many tablets can be crushed and mixed with food for patients who present with decreased ability to swallow. Enteric-coated medications are not broken down in the stomach. Instead, they remain intact until reaching the intestines, which can be useful for patients with stomach ulcers or sensitivity (Watkins, 2013, p 151). As well, buffered tablet medications include an ant- acid, which can reduce stomach inflammation. Capsules have a gelatin cover, which is easier to swallow and can be split open for the contents to be mixed with food. Capsules may be com- posed specifically for timed-release or delayed action, in which they are broken down in the more alkaline environment of the small intestine, as opposed to the acidic region of the stomach. This design allows for a relatively larger dose of the medication to be administered at once and extends the pharmaceutical effects over a greater time period. medications and physicians. Biological drug resistance Oral liquid medications may be swallowed more easily and are absorbed faster as opposed to solid structures. A common exam- ple includes Alka-Seltzer, an effervescent salt that quickly produc- es carbonation following ingestion. Elixirs are liquid medications that contain alcohol, i.e. ethanol, which can assist in dissolving a medication as well as making it more palatable (Watkins, 2013, p. 153). Elixirs should be avoided by anyone with diabetes or al- coholism, as well as children. Common examples include certain cough suppressants. Emulsions are liquid drugs composed of fats and oils in water. Magmas are liquids and fine particles mixed in water, with a common example of Milk of Magnesia. Powders are finely ground forms of a pharmaceutical, which are then mixed with water (Watkins, 2013, p. 153). Solutions are liquid forms in
Page 164
Book Code: PTCA2624
EliteLearning.com/Physical-Therapy
Powered by FlippingBook