September 13, 2024

Welcome back to UH EMS-I’s Pharmacy Phriday. As we continue our review of the various medication routes used by our providers, we focus on routes of administration that are included in the enteral tract.  

There are two main routes to administer medications to a patient: the enteral route (via the GI tract) and the parenteral route (any method that does not involve the GI tract). In the prehospital emergency medicine setting, the parenteral route is often used due to the rapid onset of action, but there are some exceptions. 

Some benefits of the enteral route include: 

• Ease 

• Expense 

• Reduced risk of infection associated with administration 

• Safety 

Disadvantages to the enteral route include:  

• An inability to give to an unconscious patient or a patient who is unable to swallow/has no gag reflex and cannot protect their airway  

• The low rate of absorption 

• Varying rates of absorption 

The first example of an enteral route is the oral (PO) route. Medications given by the PO route within the UH EMS protocols include Aspirin and Ticagrelor. Within the special use medications section, one will also find Ciprofloxacin, Doxycycline, and Clopidogrel (the alternative when Ticagrelor is unavailable) as medications given via this route.  

When administering these medications, wear gloves and take appropriate precautions, determine the correct dose (number of pills, tablets, etc.) and instruct the patient on how to take the medicine (chew, swallow, etc.), before handing the medication to the patient. To achieve the correct dose of Aspirin according to UH protocol (324 mg), the provider would need to administer four 81 mg tablets and instruct the patient to chew the tablets. To achieve the correct dose of Ticagrelor (180 mg), the provider would need to administer two 90 mg tablets, again instructing the patient to chew and swallow the medication.  

Another enteral route used in the prehospital setting is the sublingual route. This route should be familiar to providers who administer Nitroglycerin. With the sublingual route, the medication is placed under the tongue where it dissolves and is absorbed through the capillaries in the mucous membranes. It’s important to remind the patient not to chew or swallow the medication. The provider should wear gloves when handling the medication. 

The buccal route is another example of an enteral route that relies on the absorption of medication through the mucous membranes. This route is used when administering oral glucose to the conscious patient experiencing a hypoglycemic event. An important point when administering this medication is the need for the patient to be alert and able to swallow! 

One final enteral route to review in this installment is the Oral Disintegrating Tablet (ODT), which breaks down in the mouth within seconds without needing water. Once disintegrated, the residue is either absorbed through mucosal tissue or the gastrointestinal tract.  

Because of the makeup of the tablets, care must be taken not to crush the tablets before administration. The provider should not push the tablet out of the packaging but peel the backing off and hand the tablet to the patient. The patient should then be instructed to place the tablet on the tongue and allow it to dissolve without chewing or swallowing.  

Two medications approved within the UH protocols for administration via this ODT route include Olanzapine and Ondansetron. Beware! These two medications look alike and sound alike. Be sure you have the right medication for the right indication.  

Look for the next installment where we will consider yet another route of medication administration in the prehospital setting.  

Till then, stay safe! 

Sincerely,



The UH EMS-I Team

University Hospitals