1.GENERAL PHARMACOLOGY.pptx

BY
DR.J.SAKTHI PRIYA
CLINICAL PHARMACOLOGIST
SOURCES AND
ROUTES OF
ADMINISTRATION

• Drugs can be obtained from:
1. Plants, e.g. atropine, morphine, quinine, and digoxin.
2.Animals, e.g. insulin, heparin, gonadotrophins and antitoxic sera.
3.Minerals, e.g. magnesium sulphate, aluminium hydroxide, iron,
sulphur and radioactive isotopes.
4.Microorganisms—antibacterial agents are obtained from some
bacteria and fungi. We thus have penicillin, cephalosporins,
tetracyclines and other antibiotics.
5.Human—some drugs are obtained from human beings, e.g.
immunoglobulins from blood, growth hormone from anterior
pituitary and chorionic gonadotrophins from the urine of pregnant
women.
NATURAL SOURCES

SYNTHETIC
• Most drugs used now are synthetic,
e.g. quinolones, omeprazole, neostigmine, sulfonamides.
• Many drugs are obtained by cell cultures, e.g. urokinase from
cultured human kidney cells.
• Some are now produced by recombinant DNA technology, e.g.
human insulin, tissue plasminogen activator, haematopoietic
growth factors like erythropoietin and some others by
hybridoma technique eg. monoclonal antibiodies.

ROUTES OF DRUG ADMINISTRATION
• Drugs may be administered by various routes. The choice of the
route in a given patient depends on the properties of the drug
and the patient’s requirements.
• A knowledge of the advantages and disadvantages of the
different routes of administration is essential.
• The routes can be broadly divided into:
Enteral
Parenteral
Local.

FACTORS AFFECTING ROUTE OF
ADMINISTRATION
• Convenience
• State of the patient
• Desired onset of action
• Patient’s co-operation
• The nature of the drug as some drugs may be effective by one route only
e.G., Insulin
• Age of the patient
• Effect of gastric ph, digestive enzymes and first-pass metabolism

ENTERAL ROUTE (ORAL INGESTION)
• Enteral route is the most commonly used, oldest and safest route of drug
administration.
• The large surface area of the gastrointestinal tract, the mixing of its
contents and the differences in pH at different parts of the gut facilitate
effective absorption of the drugs given orally.
• However, the acid and enzymes secreted in the gut and the biochemical
activity of the bacterial flora of the gut can destroy some drugs before
they are absorbed.
Advantages:
1. Safest route
2. Most convenient
3. Most economical
4. Drugs can be self-administered
5. Non-invasive route.

DISADVANTAGES
1. Onset of action is slower as absorption needs time.
2. Irritant and unpalatable drugs cannot be administered.
3. Some drugs may not be absorbed due to certain physical and
chemical characteristics,
e.g. streptomycin is not effective orally.
4. Irritation to the gastrointestinal tract may lead to vomiting.
5. Some drugs may be destroyed by gastric juices, e.g. insulin.
6. Oral preparations cannot be given to unconscious and
uncooperative patients.
7. Some drugs may undergo extensive first pass metabolism in the
liver.
To overcome some of the disadvantages, irritants are given in
capsules, while bitter drugs are given as sugar coated tablets.

Enteric Coated Tablets
• Some tablets are coated with substances like cellulose-acetate, phthalate, gluten,
etc. which are not digested by the gastric acid but get disintegrated in the alkaline
juices of the intestine.
This will:
• prevent gastric irritation.
• avoid destruction of the drug by the stomach.
• provide higher concentration of the drug in the small intestine.
• retard the absorption, and thereby prolong the duration of action.
But if the coating is inappropriate, the tablet may be expelled without being
absorbed at all.
This is useful for short-acting drugs.
Examples:
• Pantoprazole, serattiopeptidase, mycophenolate sodium

Certain precautions are to be taken
during oral administration of drugs
• Capsules and tablets should be swallowed with a glass of water
with the patient in upright posture either sitting or standing.
• This facilitates passage of the tablet into the stomach and its rapid
dissolution
• It also minimises chances of the drug getting into the larynx or
behind the epiglottis.
Though enteral route mainly includes oral ingestion, sublingual and
rectal administration may also be considered as enteral route

Advantages
• Frequency of administration
may be reduced.
• Therapeutic concentration may
be maintained specially when
nocturnal symptoms are to be
treated.
Disadvantages
• There may be ‘failure of the
preparation’ resulting in release
of the entire amount of the drug
in a short time, leading to
toxicity.
• Enteric coated tablets are more
expensive.

PARENTERAL ROUTE
 Routes of administration other than the enteral (intestinal) route are known
as parenteral routes.
 Here the drugs are directly delivered into tissue fluids or blood.
ADVANTAGES
• Action is more rapid and predictable than oral administration.
•These routes can be employed in an unconscious or uncooperative
patient.
• Gastric irritants can be given parenterally and therefore irritation to the
gastrointestinal tract can be avoided.
• It can be used in patients with vomiting or those unable to swallow.
• Digestion by the gastric and intestinal juices and the first pass metabolism
are avoided.
Therefore, in emergencies parenteral routes are very useful routes of drug
administration as the action is rapid and predictable and are useful even in
unconscious patients.

DISADVANTAGES
 Asepsis must be maintained.
 Injections may be painful.
 More expensive, less safe and inconvenient. Injury to nerves
and other tissues may occur.
Parenteral routes include :
1. Inhalation
2. Injections
3. Transdermal route
4. Transmucosal route.

INJECTIONS
Intradermal:
• The drug is injected into the layers of the skin raising a bleb, (e.g.
BCG vaccine, tests for allergy). s
• Only a small quantity can be administered by this route and it may
be painful.

SUBCUTANEOUS (SC) INJECTION
• Here the drug is deposited in the SC tissue,
• e.g. insulin, heparin.
• ADVANTAGES:
• As this tissue is less vascular, absorption is slow and largely uniform
making the drug long-acting.
• It is reliable and patients can be trained for self administration.
• DISADVANTAGES
• As SC tissue is richly supplied by nerves, irritant drugs cannot be
injected because they can cause severe pain.
• Repeated injections at the same site can cause lipoatrophy resulting in
erratic absorption.

INTRAMUSCULAR (IM)
• Aqueous solution of the drug is injected into one of the large
skeletal muscles—deltoid, triceps, gluteus or rectus femoris.
• As the muscles are vascular, absorption is rapid and quite
uniform.
• Drugs are absorbed faster from the deltoid region than gluteal
region especially in women.
• The volume of injection should not exceed 10 ml.
• For infants, rectus femoris is used instead of gluteus because
gluteus is not well-developed till the child starts walking.
• If the drug is injected as an oily solution or suspension, absorption
is slow and steady.

Advantages
• Intramuscular route is reliable.
• Absorption is rapid. • Soluble
substances, mild irritants,
depot preparations,
suspensions and colloids can
be injected by this route.
Disadvantages
• Intramuscular injection may be
painful and may even result in an
abscess.
• Irritant solutions can damage
the nerve if injected near a nerve.
Nerve injury should be avoided.

INTRAVENOUS (IV)
• Here, the drug is injected into one of the superficial veins so that it
directly reaches the circulation and is immediately available for
action.
• Drugs can be given IV as:
1. A bolus—where an initial large dose is given, e.g. heparin. The
drug is dissolved in a suitable amount of the vehicle and injected
slowly.
2. Slow injection—over 15-20 minutes, e.g. aminophylline.
3. Slow infusion—when constant plasma concentrations are
required, e.g. oxytocin in labour or when large volumes have to be
given, e.g. dextrose, saline. Generally about one litre of solution is
infused over 3 to 4 hours.

Advantages
• Most useful route in
emergencies because the drug is
immediately available for action.
• Provides predictable blood
concentrations with 100%
bioavailability.
• Large volumes of solutions can
be given.
• Irritants can be given by this
route as they get quickly diluted
in blood.
• Rapid dose adjustments are
possible—if unwanted effects
occur, infusion can be stopped; if
higher levels are required,
infusion rate can be increased—
specially for short-acting drugs.
Disadvantages
• Once injected, the drug cannot
be withdrawn.
• Irritation of the veins may
cause thrombophlebitis.
• Only aqueous solutions can be
given IV but not suspensions,
oily solutions and depot
preparations.
• Self medication is difficult.

INTRA-ARTICULAR
• Drugs are injected directly into a joint for the treatment of arthritis and
other diseases of the joints, e.g. hydrocortisone is injected into the
affected joint in rheumatoid arthritis.
INTRA-ARTERIAL
• Here drug is injected directly into the arteries. It is used only in the
treatment of (i) peripheral vascular diseases, (ii) local malignancies (iii)
diagnostic studies like angiograms.
INTRAMEDULLARY Injection into a bone marrow— now rarely used.
INTRAPERITONEAL Peritoneum offers a large surface area for
absorption. Fluids are injected intraperitoneally in infants. This route
is also used for peritoneal dialysis
INTRATHECAL
Drugs can be injected into the subarachnoid space for action on the
CNS, e.g. spinal anaesthetics. Strict aseptic precautions are a must.
Drugs are also given extradurally. Morphine can be given epidurally
to produce analgesia.

INHALATION
• Volatile liquids and gases are given by inhalation, e.g. general
anaesthetics.
• In addition, drugs can be administered as solid particles,
• i.e. solutions of drugs can be atomised and the fine droplets are
inhaled as aerosol, e.g. salbutamol.
• These inhaled drugs and vapours may act on the pulmonary
epithelium and mucous membranes of the respiratory tract and are
also absorbed through these membranes.
Almost instantaneous absorption of the drug
is achieved because of the large surface area of
the lungs.
• Hepatic first pass metabolism is avoided.

TRANSDERMAL
• Highly lipid soluble drugs can
be applied over the skin for
slow and prolonged absorption,
• e.g. nitroglycerine ointment in
angina pectoris.
Irritant gases may enhance
pulmonary secretions—should be
avoided. This is an important route of
entry of certain drugs of abuse.
Advantages
• Duration of action is prolonged
• Provide constant plasma drug
levels
• Patient compliance is good.
TRANSMUCOSAL
Drugs are absorbed across the mucous membranes.
Transmucosal administration includes
sublingual, nasal and rectal routes.

SUBLINGUAL
• Here, the tablet or pellet containing the drug is
placed under the tongue.
• As the drug dissolves, it is absorbed across the
sublingual mucosa. The formulation should be
lipid soluble,
• e.g. nitroglycerine, nifedipine, buprenorphine.
Advantages
• Absorption is rapid—within minutes the drug reaches the
circulation.
• First pass metabolism is avoided.
• After the desired effect is obtained, the drug can be spat out to
avoid the unwanted effects.
Disadvantages
• Buccal ulceration can occur.
• Lipid insoluble drugs cannot be given.

NASAL
• Nasal Drugs can be administered through nasal route either for
systemic absorption or for local nasal drops, e.g.
oxymetazoline; budesonide nasaleffects.
E.g. (a)for systemic absorption — oxytocin spray
(b)for local effect—decongestant spray for allergic rhinitis.
RECTAL
 Rectum has a rich blood supply and drugs can cross the rectal
mucosa to be absorbed for systemic effects.
 Drugs like indomethacin, chlorpromazine, diazepam and
paraldehyde can be given rectally.
 Some irritant drugs are given rectally as suppositories because
they cannot be given orally.

Advantages
 Gastric irritation is avoided.
 Can be administered by
unskilled persons.
 Useful in geriatric patients;
patients with vomiting and
those unable to swallow.
Disadvantages
 Irritation of the rectum can
occur.
 Absorption may be irregular
and unpredictable.

ENEMA
• Drugs may also be given by rectal route as enema.
• Enema is the administration of a drug in a liquid form into the
rectum.
• Enema may be evacuant or retention enema.
• Evacuant enema : In order to empty the bowel, about 600 ml of
soap water is administered per rectum. Water distends and thus
stimulates the rectum while soap lubricates.
• Enema is given prior to surgeries, obstetric procedures and
radiological examination of the gut.
• Retention enema The drug is administered with about 100 ml of
fluids and is retained in the rectum for local action, e.g.
prednisolone enema in ulcerative colitis.

TOPICAL
• Drugs may be applied on the skin for local action as ointment,
cream, gel, powder, paste, etc.
• Drugs may also be applied on the mucous membrane as in the
eyes, ears and nose as ointment, drops and sprays.
• Drugs may be administered as suppository for rectum, and
pessary and douche for vagina.
• Pessaries are oval shaped tablets to be placed in the vagina to
provide high local concentrations of the drug at the site,
• e.g. antifungal pessaries in vaginal candidiasis.

OCUSERT
• Ocusert systems are thin elliptical units that
contain the drug in a reservoir which slowly
releases the drug through a membrane by diffusion
at a steady rate,
• e.g. pilocarpine ocusert used in glaucoma is placed
under the lid and can deliver pilocarpine for 7
days.
Progestasert is inserted into the uterus where it
delivers progesterone constantly for over one year.
PROGESTASERT
• In order to improve drug delivery, to
prolong the duration of action and thereby
improve patient compliance, special drug
delivery systems are being tried.
SPECIAL DRUG DELIVERY SYSTEMS

PRODRUG
• It is an inactive form of a drug which gets metabolised to the
active derivative in the body.
e.g. dopamine does not cross the BBB; levodopa, a prodrug
crosses the BBB and is then converted to dopamine in the
CNS.
• Prodrugs may also be used to achieve longer duration of
action,
e.g. Bacampicillin (a prodrug of ampicillin) is longer acting
than ampicillin.
• A prodrug may be more stable at gastric pH,
e.g. aspirin is converted to salicylic acid which is the active
drug and aspirin is better tolerated than salicylic acid.

OSMOTIC PUMPS
• Small tablet shaped units containing the drug and an osmotic
substance in two different chambers. The tablet is coated with a
semipermeable membrane in which a minute laser-drilled hole is
made.
• When the tablet is swallowed and reaches the gut, water enters
into the tablet through the semipermeable membrane.
• The osmotic layer swells and pushes the drug slowly out of the
laser-drilled orifice.
• This allows slow and constant delivery of the drug over a long
period of time. It is also called Gastrointestinal Therapeutic
System (GITS).
• Some drugs available in this formulation are iron and prazosin.

COMPUTERISED MINIATURE PUMPS
• These are programmed to release drugs at a definite rate
either continuously as in case of insulin or intermittently
in pulses as in case of GnRH.
• Various methods of drug targeting are tried especially for
anticancer drugs to reduce toxicity.

1.GENERAL PHARMACOLOGY.pptx

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