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Medication administration is one of the most fundamental—and most tested—nursing competencies you'll encounter. Understanding routes isn't just about memorizing where a drug goes; you're being tested on your ability to select the appropriate route based on patient condition, drug characteristics, and therapeutic goals. Every route decision involves weighing onset of action, bioavailability, patient status, and safety considerations.
The NCLEX and your nursing exams will challenge you to think critically about why one route is preferred over another in specific clinical scenarios. A patient who's vomiting can't take oral meds—what's your alternative? A patient needs immediate drug effects in an emergency—which route delivers? Don't just memorize the routes—know what clinical situations call for each and understand the pharmacokinetic principles that make each route unique.
Enteral administration delivers medications through the gastrointestinal system. These routes rely on absorption through the GI mucosa and are subject to first-pass metabolism in the liver, which can significantly reduce the amount of active drug reaching systemic circulation.
Compare: Oral vs. Rectal—both are enteral routes subject to some first-pass metabolism, but rectal bypasses the upper GI tract and works for patients who can't swallow or are vomiting. If an exam question presents an unconscious patient needing fever reduction, rectal is your answer.
These routes deliver medication through highly vascularized mucous membranes, allowing drugs to enter the bloodstream directly. By bypassing the GI tract and liver, these routes avoid first-pass metabolism and achieve faster onset.
Compare: Sublingual vs. Intranasal—both bypass first-pass metabolism for rapid systemic effects, but sublingual requires patient cooperation (no swallowing), while intranasal can be administered to unresponsive patients (think naloxone in overdose). Know which scenarios call for each.
Parenteral routes bypass the GI tract entirely through injection. These routes offer predictable absorption and are essential when oral administration is impossible or when precise drug levels are required.
Compare: IV vs. IM vs. Subcutaneous—all bypass first-pass metabolism, but onset differs dramatically: IV is immediate, IM is moderate (10-30 minutes), and subcutaneous is slowest. Volume capacity also varies—IV unlimited, IM up to 3-5 mL, subcutaneous typically 1 mL or less. Match route to urgency and drug characteristics.
These routes deliver medication to or through the skin. The key distinction is intent: topical aims for local effects at the application site, while transdermal delivers systemic effects through controlled absorption.
Compare: Topical vs. Transdermal—both go on the skin, but the therapeutic goal differs entirely. Topical treats the local area (think hydrocortisone cream for a rash), while transdermal delivers systemic medication (think fentanyl patch for chronic pain). Exam questions often test whether you understand this distinction.
| Concept | Best Examples |
|---|---|
| Fastest onset (emergency use) | IV, Inhalation, Intranasal, Sublingual |
| Bypasses first-pass metabolism | IV, IM, Subcutaneous, Sublingual, Intranasal, Transdermal |
| Subject to first-pass metabolism | Oral, Rectal (partial) |
| Requires sterile technique | IV, IM, Subcutaneous |
| Alternative when patient can't swallow | Rectal, Sublingual, Intranasal, Parenteral routes |
| Sustained/controlled release | Transdermal patches, Subcutaneous, IM depot |
| Local effects only | Topical application |
| Technique-dependent effectiveness | Inhalation (MDIs, nebulizers) |
A patient is experiencing an acute angina attack and needs immediate relief. Which two routes would provide the fastest onset, and why are they preferred over oral administration?
Compare and contrast subcutaneous and intramuscular injection routes in terms of absorption rate, volume capacity, and appropriate clinical uses.
A patient is vomiting and cannot take oral medications but needs systemic fever reduction. Which routes could you consider, and what factors would influence your choice?
Why do sublingual and intranasal medications often have higher bioavailability than oral medications of the same drug? Explain the pharmacokinetic principle involved.
An FRQ asks you to explain why transdermal fentanyl patches are appropriate for chronic pain but not for acute pain management. What key characteristics of this route support your answer?