Oral (PO) Medications (Nursing)

00:00 So, let's break down the different routes.

00:03 We'll look at oral medications first.

00:05 Now, what about their rate of time in the bloodstream? And we'll look at each one of the different types of routes and talk about how long it takes them to get into the bloodstream, what's the impact of first pass effect, and the same kind of variables as we walk through it.

00:18 So, when we say oral, we mean, that could be a pill, a liquid, or a tablet, but it doesn't include sublingual.

00:25 Sublingual is…right here, underneath your tongue.

00:28 We use that for special medications for like nitroglycerin for people having chest pain.

00:33 We can also use it for certain medications for nausea, which is brilliant, because it works really, really rapidly.

00:39 But when we're talking about oral medications, we're not talking about anything sublingual.

00:44 We're talking about pills, liquids, or tablets.

00:47 Okay.

00:47 So far as how long it takes it to get into the bloodstream, oral routes are much longer than other routes, because they've got to go through several other steps before they make it to the bloodstream.

00:58 It's got to go through multiple steps in the GI and then it finally makes it across the epithelial cells of the GI to the capillary wall.

01:05 Usually, most of it is absorbed in the small intestine where there's a large surface area and villi and microvilli can move it around.

01:12 So that's why we think about the rate of time to make it to the bloodstream, it's much longer in an oral medication because it has lots of other steps to go through.

01:21 Now, impact of first pass effect; remember, it's significant because oral medications go through the GI tract and are often inactivated by the liver.

01:32 Time of onset.

01:33 Well, it's really variable with oral medications, but we know that it is the slowest route, okay? So, if I'm in intense pain, do I want a medication that's oral? Probably not.

01:44 There are some more efficient routes that we'll talk about.

01:47 So, oral routes are also impacted by multiple variables: the pH of the GI system, how fast the stomach empties.

01:54 Was there food in the stomach when they took the medication, other drugs they're on, or coatings of the drug.

02:00 So, there's just a lot of variables with oral medications that can make the onset really variable.

02:06 Now… so, why would we give a medication this way? Well, it's really cost effective.

02:10 It's usually the cheapest route to give medications, and it's pretty convenient; simple and straightforward, if you're okay with swallowing a pill.

02:18 Now, as far as safety, there's not any extra risk for infection, or fluid volume overload, and there's plenty of time to try and reverse the drug, if needed.

02:27 Other routes, you'll see that we have no time for reversibility, but with oral medications, because it takes longer for them to make it to the bloodstream, we've got some time to try and reverse the medication if the patient is having any adverse effects.

02:42 Okay, now, there are 2 times you do not want to crush an oral medication.

02:48 Enteric coated is 1 of them.

02:50 The purpose of an enteric coating is that it's pH sensitive.

02:53 Aha! Remember when we talked about the difference in the pH from your stomach to your small intestine? That's what makes the magic of an enteric-coated tablet.

03:03 It's pH sensitive.

03:04 So it increases the likelihood that the medication will dissolve in the small intestine instead of the stomach.

03:11 That's a really good idea if the medication you're taking is really irritating to your stomach, like aspirin or potassium.

03:19 So, crushing these would result in this being… the medication being absorbed in the stomach instead of the intestine, then we're risking really irritating the stomach lining.

03:29 Now, why is that a bad idea? Well, irritating your stomach lining is no fun, but it also puts your patient at risk for peptic ulcer disease, and we definitely don't want to encourage that.

03:40 So, enteric-coated medications are in a little coating or a little jacket, so that they're more likely to dissolve in the small intestine versus the stomach for medications that are really hard on the stomach.

03:54 Now, the other ones you don't want to crush are sustained release and this can be really dangerous.

04:00 The purpose of sustained release is that small amounts of the medication will be released over time.

04:06 If you crush that medication, you're going to get a boom…a massive overdose.

04:11 This is particularly problematic if you have a patient who's on a sustained release pain medication, you can cause that patient to go into a respiratory arrest.

04:19 So, the 2 types of medications that you don't want to crush are sustained release medications and enteric-coated medications.