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Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
You might have thought of the following advantages: The rectum is an alternative route for when people cannot take oral medication because they are vomiting, unable to swallow or are ‘nil by mouth’ (e.g. preoperatively).Drugs administered rectally are absorbed into the bloodstream and bypass the liver (Greenstein 2009). For example, a person who is having a seizure cannot take oral medication, and rectal administration is safer and more rapid than intramuscular injections. As faecal impaction can inhibit rectal drug absorption, constipation should be prevented in people who might require emergency rectal medication.
Intermittent Home Treatment of Epileptic Relapses with Diazepam
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Members of the family were instructed on how to measure and withdraw the prescribed dose, using tuberculin or insulin syringes. For rectal administration the solution can be administered directly from the syringe with an 80-cm polyethylene catheter (in order to avoid adsorption of the drug theoretically possible when using polyvinyl tubing). An important instruction is not to insert the tube deeper than 3 to 5 cm into the rectum, both to avoid adsorption by fecal material and in order also to utilize the powerful absorbing hemorrhoidal venous system. This precaution might explain the greater consistency we observed in our bioavailability studies as compared to that reported by others. Two to three washings of the syringe and tubing with saline or water follow. Detailed instructions were given to relatives, including advice about monitoring of respiration and of levels of responsiveness. The instructions contain warnings about the use of DZP if the subject is on chronic barbiturates or other benzodiazepines. Monthly report sheets to be filled daily were given, directions including calling their physicians and us whenever relapses occurred, to ensure that medical advice was promptly available in case patients needed to be examined or laboratory tests were advisable.
Pharmacokinetic-Pharmacodynamic Correlations of Corticosteroids
Published in Hartmut Derendorf, Günther Hochhaus, Handbook of Pharmacokinetic/Pharmacodynamic Correlation, 2019
Helmut Möllmann, Stefan Baibach, Günther Hochhaus, Jürgen Barth, Hartmut Derendorf
Saliva levels measured for drug monitoring reflect only the free and not the total HC plasma concentration.35 The HC/cortisone ratio in plasma is about 6:1.30,38 During the absorption phase of oral cortisone, this ratio is larger (10:1) as a result of an intensive first-pass metabolism to HC in the liver. The water-soluble hemisuccinate ester (HCHS), a prodrug for IV administration, is efficiently bioactivated to HC.32 Cortisone acetate (CA) is used for intramuscular and oral treatment. Orally given CA is immediately absorbed and quantitatively transformed into HC with a Cmax reached after approximately 1.7 h.30 However, there has been controversy concerning the efficacy of intramuscularly administered CA. The increased bioavailability of oral vs. i.m. administration is attributed to a better conversion to HC as a result of an intensive first-pass metabolism.39,40 Besides its intra-articular and epidural application in sustained release preparations,27,41 hydrocortisone acetate (HCA) is also used in local therapy of bowel diseases such as ulcerative colitis and Crohn’s disease.42 Rectal administration in the form of enemas or foams is clinically most effective. However, the information about systemic absorption is very inconsistent, since bioavailability values of 2 to 30% have been reported.31,42–44
Opportunities for enteral drug delivery for neonates, infants, and toddlers: a critical exploration
Published in Expert Opinion on Drug Delivery, 2022
Nicole Sheena Kaneria, Catherine Tuleu, Terry Ernest
Solid dosage forms are intuitively easier to administer than liquids and in terms of its retention within the rectum, hence why suppositories may be more prevalent [49]. Generally, opinion for their use has been regarded as relatively unsafe in pre-term neonates due to unpredictable absorption and also as mucosal damage may occur, consequently causing infection [11,49]. In fact, the suppositories and rectal capsule listed in Table 5 are licensed from infant age. However, in recent years, studies for rectal administration in this age group have increased and thus also the evidence for their safe use and possible superiority to other dosage form types (mentioned later). There are several recent papers detailing in vivo safety and efficacy studies in neonates of rectal formulations with various APIs for different conditions [127–130]. This said, exposure of the API via the rectal route can be variable due to inter-patient and intra-patient absorption variability within the rectum, especially between the different developmental age groups. This is illustrated in several studies [131–133].
Advances in rectal drug delivery systems
Published in Pharmaceutical Development and Technology, 2018
Trusha J. Purohit, Sara M. Hanning, Zimei Wu
Any solution, emulsion or suspension for rectal administration is referred to as an enema, or micro-enema if administration volume is small such as 5–10 ml. These formulations contain either oil, glycerin or low molecular weight macrogol as vehicle (van Hoogdalem et al. 1991). Administration volume may vary from 2.5 ml up to few hundred milliliters and applicators can be used to assist administration such as the Macy Catheter®, a recently FDA-approved medical device for rectal administration of fluids (Lam et al. 2016). Enemas are used for rectal stimulation to initiate defecation before operative procedures (Pittet et al. 2015) and for localized treatments of inflammatory bowel disease or ulcerative colitis (Spencer and McTavish 1995; Matuszyk et al. 2016) or as a medium to deliver contrast agent before radiographic examination. Despite micro-enemas being more advantageous than large volume enemas, the packaging and transportation costs make them a less favorable formulation than large volume enemas (Aulton and Taylor 2013).
Real-world safety and efficacy of twice-daily budesonide 2-mg foam in patients with ulcerative colitis: interim analysis of post-marketing surveillance
Published in Expert Opinion on Pharmacotherapy, 2021
Teppei Omori, Masayuki Saruta, Akira Nagaki, Yuki Arai, Akira Ohta, Kiyotoshi Kuramoto, Yasuo Suzuki
According to our self-reported questionnaire, 104 (74.8%) of 139 patients perceived efficacy during the treatment period. Of the 104 patients, 96 (92.3%) perceived an efficacy by week 2. During the treatment period, patient acceptance of the dosing and ease of use of the drug were evaluated using a questionnaire in the safety analysis population (Table 4). More than 70% of patients complied (good compliance) with the dosing regimen during the treatment period, while ≤1.4% reported rarely complying (poor compliance). In addition, more than 80% of patients perceived that rectal administration was ‘very easy’ or ‘rather easy’ to use during the treatment period.