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Wikipedia talk:Wikipedia medicine standards
More on Mechanical ventilation
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tracheo(s)tomy
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http://www.baltic.vtt.fi/demo/baltmap.htm
http://www.nlm.nih.gov/medlineplus/
http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/home.html
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Pharmacokinetics article, work in progress, not yet ready for the encyclopedia
In medicine, a route of administration is the route by which a drug, fluid, or other substance is given. Obviously, if the desired effect is not on the body surface, a substance must be transported from the site of entry to the part of the body where its action is desired. However, using the body's transport mechanisms for this purpose can be far from from trivial.
To illustrate this, let us review a simplified example: an antibiotic is given to treat osteomyelitis (an infection of a bone), the drug being administered as a capsule. Before the drug can act on the infected tissue, the following steps will have to be passed:
- intestinal transport: the capsule is swallowed and transported to the stomach and the bowel
- release: the capsule dissolves and releases the antibiotic
- intestinal absorption: the antibiotic is (actively or passively) absorbed through the mucosa and into the blood of the splanchnic circulation
- protein binding: a fraction of the antibiotic is reversibly bound to plasma proteins
- first-pass metabolism: as the blood passes the liver, the antibiotic may be chemically altered or inactivated by the liver's enzymes
- distribution: the antibiotic is distributed throughout the body with the bloodstream
- tissue absorption: it diffuses into tissues, where it may be bound or chemically altered, rediffuse into the blood, or be transported away with the lymph
- action!
Some drugs are used topically to achieve a local effect. If a systemic effect is desired, routes of administration are broadly divided into enteral (via the digestive tract) and parenteral (other routes).
Enteral routes are generally the most convenient for the patient, as no punctures and sterile procedures are necessary. Enteral medications are therefore often preferred in the treatment of chronic disease. However, some drugs can not be used enterally because their absorption in the digestive tract is low or unpredictable.
In acute situations, emergency medicine and intensive care medicine, drugs are most often given intravenously. This is the most reliable route, as the absorption of substances from the tissues and from the digestive tract can often be unpredictable due to altered blood flow or bowel motility.
Historically, most drugs were swallowed, although
invention of the hypodermic needle
Enteral (systemic effect):
- by mouth: tablets, capsules, drops
- by gastric or duodenal tube: many drugs and enteral nutrition
- rectal: various drugs
Parenteral (systemic effect):
- intravenous injection or infusion: into a vein, many drugs and nutrition solutions
- intraarterial injection or infusion: into an artery, sometimes used in vascular disease for
- intramuscular injection: into a muscle, e.g. vaccines
- subcutaneous injection (or, occasionally, infusion): under the skin, various drugs
- transdermal: through the intact skin, e.g. transdermal opioid patches in pain therapy
- transmucosal: through a mucous membrane, e.g. cocaine snorting, sublingual nitroglycerine
- inhalation, e.g. inhalation anesthetics, asthma sprays
Topical (local effect)
- intracutaneous
- epicutaneous (vocabulary?) , allergy tests, topical local anesthesia
- intraperitoneal: into the peritoneal cavity, e.g. peritoneal dialysis
- epidural (or peridural), epidural anesthesia
- intrathecal: into the cerebrospinal fluid, antibiotics, spinal anesthesia
- enema: into the bowel