Parenteral Drug Administration

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Parenteral Drug Administration

• Department of Anaesthesia
• University of Glasgow

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Parenteral Route in Dentistry

• General Dental Council
• Intravenous sedation drugs
• Emergency drugs

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Drug Administration
subcutanous
oral
intramuscular
topical
intravenous
Absorbtion
Site of Action
Tissue
Plasma water
Metabolism
Excretion
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Parenteral Injection Sites
subcutanously
intramuscularly
intravenously
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Subcutaneous Route

• Absorption depending on blood flow
• Constant slow absorption
• Prolonged effect
• Drugs
• Insulin
• Heparin

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Subcutaneous Injection Sites

• Abdominal wall
• Thigh
• Deltoid area

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Intramuscular Route

• Absorption depending on blood flow
• Rapid onset shorter duration
• Shock
• Drugs
• Glucagon
• Adrenaline

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Intramuscular Injection Sites
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Intramuscular Injection Sites
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Intramuscular Injection Sites
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Intramuscular Route

• Limitations
• Neurovascular damage
• Bleeding (eg anticoagulant therapy)
• Pain
• Infection
• Delayed absorption in shock
• Interpretation of diagnostic tests

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Intravenous Route

• Rapid immediate onset
• Permits titration
• Administer slowly
• Drugs
• Midazolam

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Intravenous Injection Sites

• Peripheral
• Central

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Intravenous

• Limitations
• May be more difficult to obtain
• Increased risk of adverse effects
• Requires intravenous access
• Infection
• Pain

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Anaphylaxis

• Definition
• Immunologically mediated reaction to antigen
  causing systemic symptoms
• Potentially life threatening
• Frequent Antigens
• Antibiotics
• Latex
• Anaesthetic agents
• Colloid fluids

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Anaphylaxis

• Diagnosis
• Collapse
• Difficulty breathing
• Wheeze
• Angio-oedema
• Urticaria

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Management Anaphylaxis

• Prevention
• Avoid unnecessary drugs particularly iv
• Take drug history
• Adequate staff training and facilities

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Immediate Management 1

• Remove trigger agent
• Stop injection or infusion of drug
• Remove triggering materials
• Remember latex allergy
• Chlorhexidine
• Summon assistance

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Immediate Management 2

• Basic life support
• Check airway, breathing, circulation
• Oxygen
• Give adrenaline (0.5-1mg im)
• Elevate legs
• (Give intravenous fluids)

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Subsequent Management

• Antihistamines
• Chlorpheniramine iv
• Steroids
• Hydrocortisone iv
• Intensive care unit
• Immunological Testing

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Summary

• Parenteral drug administration
• Sites
• Drug availability
• Limitations
• Anaphylaxis

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Questions ?