Route of administration is the path by which a drug is taken into the body.

po is shorthand for Per oral

PR is shorthand for Per rectum (it can also refer to Rectal examination depending on context)

• Buccal is where drugs are given in the buccal area (in the cheek) to diffuse through the oral mucosa (tissues which line the mouth), and enter directly into the blodstream. It may provide better bioavailability of some drugs, and a more rapid onset of action compared to oral administration, because the Rx doesn't pass through the digestive systme, and thus avoids 1st pass metabolism (i.e. where the concentration of a drug is greatly reduced before it reaches systemic circulation, lost during absorption related to the liver and gut wall)

Inh is shorthand for By inhalation

• [Metered-dose] inhaler (MDI, aka puffer) is a device that delivers a specific amount of medication to the lungs, in the form of short bursts of aerosolized medication that is self-administered by the Pt via inhalation. MDI's commonly deliver a bronchodilator and/or corticosteroid to Tx asthma and COPD

YouTube video

• • To reduce the need for precise synchronization of pressing the puffer and breathing at the same time, spacers are often used. Spacers help to deliver more drug into lungs, and can help reduce side effects because less drug sticks in the mouth and throat. Large volume spacers are oval shaped and bigger, and should only be used in kids>5yo. Small volume spacers are more tube-shaped, and more convenient so fit into handbags/schoolbags easier, and can be used in any age group

YouTube video

• • Young kids (<2yo) should use a face mask with a spacer, because they often have trouble sealing their lips around a mouth piece. Masks contain a 2-way valve system which ensure the drug is suspended in the chamber and will not escape, and the exhaled breath exits the device through the exhalation valve

YouTube video

• Nebulizer, which administers medicine as a mist inhaled into the lungs. Starting from a tablet form, the mist is created using oxygen, compressed air, or ultrasonic power to break up the medication, which can be inhaled using the mouthpiece. Inhaler+spacer is preferred, because nebulizers are slower, and therefore have to be taken in a higher dose

YouTube video

• Dry powder inhaler (DPI), which delivers drugs to the lugns in a form of a dry powder. DPI's rely on the force of patient inhalation to entrain powder from the device, and subsequently break up the powder into particles that are small enough to reach the lungs. Thus it is only used in older kids and adults

YouTube video

• Nasogastric intubation (NG) is the insertion of a plastic tube through the nose, past the throat, and down into the stomach
  • Nasogastric aspiration (suction, aka NG output) is the process of draining the stomach's contents via the tube. It is mainly used to remove gastric secretions and swallowed air in Pt's w/ GI obstructions. It can be used in poisoning situations when a potentially toxic liquid has been ingested, for preparation before surgery under anesthesia, and to extract samples of gastric liquid for analysis
• Nasal administration, where drugs are insufflated through the nose

• Intravenous (IV), which is into a vein. IV can be administered by bolus (i.e. as quickly as possible) or drip (i.e. slowly by the action of gravity). IVF can be shorthand for intravenous fluids (depending on context). TKVO stands for to keep vein open, ordered by doctors when a patient's vein has been accessed IV and is to be left open between therapies
  • Infusion therapy, which is usually given by a special infusion pump. It involves the administration of a Rx through needle or catheter. It is prescribed when a patient's condition can't be Tx effectively by oral Tx
• Intraosseous infusion (IO), is the process of injecting directly into the marrow of a bone to provide non-collapsible entry point into the systemic venous system. It is used to provide fluids and Rx when IV access isn't available or not feasiable. It is superior to IM and comparible to IV administration in delivering pediatric anesthetics
• Intra-muscular (IM), which is injection a substance directly into a muscle. I tis used for particular forms of Rx that are administered ins amll volumes. Depending on the Rx, it may either be absorbed fairly quickly or more gradually. Muscles have larger and more blood vessels than S/C tissue and injections here usually have faster rates of absorption than S/C injections or intradermal injections. Depending on the injection site, an administration is limited to between 2-5mL of fluid
• Subcutaneous (SC), which is administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis. It is highly effective in administering vaccines and Rx e.g. insulin, morphine, diacetylmorphine and goserelin. The use of recreational drugs this way is skin popping. Subcut has few blood vessels and so Rx injected here are for slow, sustained rates of absorption. I tis slower than IM, but still faster than intradermal injections
• Intradermal, is the injection of a substance into the dermis, just below the epidermis. It has the longest absorption time as compraed to subcut and IM injections. Thus, it is used for sensitivity tests, liek tuberculin and allergy tests, and for local anesthesia. Also, the body's reaction to substances is more easily visible since it is closer to the surface

• Fluid replacement
• Dosing