Editing Pharmacology (section)

== Routes and Administration Techniques ==

* '''Oral''': give with a full glass of water unless fluid restricted. Do not crush enteric-coated or extended-release forms (labels such as EC, SR, XL, XR, CR, LA); crushing can deliver a fatal bolus. Sublingual tablets dissolve under the tongue and are not swallowed.
* '''Enteral tube''': use liquid formulations when available, flush before and after, and give drugs separately. Hold tube feeding around phenytoin and levothyroxine because feedings markedly reduce absorption.
* '''Subcutaneous''': 45 to 90 degree angle, small volume (generally 1 mL or less). Rotate sites. For enoxaparin, use the "love handle" area of the abdomen at least 2 inches from the umbilicus, do '''not''' expel the air bubble in the prefilled syringe, do not aspirate, and do not massage the site.
* '''Intramuscular''': ventrogluteal is the preferred site in adults because it is away from major nerves and vessels; vastus lateralis is preferred in infants. Typical adult volume limit is 3 mL in a large muscle. Use the '''Z-track''' technique for irritating drugs such as iron dextran and haloperidol decanoate.
* '''Intradermal''': 5 to 15 degree angle, bevel up, forming a wheal. Used for tuberculin skin testing and allergy testing.
* '''Intravenous''': fastest onset and least forgiving. Verify compatibility, dilution, and maximum push rate before administering. Assess site patency before and after.
* '''Transdermal''': remove the old patch before applying a new one and document removal. Rotate sites, wear gloves for nitroglycerin and hormone patches, and never cut a reservoir patch.
* '''Ophthalmic''': instill in the lower conjunctival sac, apply punctal pressure for 30 to 60 seconds to limit systemic absorption, and wait 5 minutes between different eye drops. Give drops before ointment.
* '''Inhaled''': with multiple inhalers, give the bronchodilator first, then the corticosteroid, and have the patient rinse the mouth after inhaled corticosteroids to prevent oral candidiasis. Use a spacer when available.