Route PEMBERIAN obat

D IV Gizi
Cara pemberian obat

Enteral

Parenteral
 Enteral

 Enteral – pemberian obat melalui

saluran cerna
 sublingual – dibawah lidah
 oral – ditelan (p.o., per os)

 rectum – melalui rectum

 Sublingual/Buccal

 Keuntungan
 Cepat diabsorbsi
 Obat relatif stabil
 Terhindar dari first-pass effect

 Kerugian
 Ketaatan kurang inconvenient
 Dosis kecil
 Rasa tidak enak utk beberapa obat
Oral

 Kelebihan
 Kepatuhan tinggi – dapat dilakukan
sendiri, tidak sakit, mudah
 Absorsi – terjadi di sepanjang saluran
cerna
 Murah – dibanding cara lain
Oral
 Kekurangan
 Kadang kurang efisien – hanya
sebagian obat yg dpt diabsorbsi
 Mengalami First-pass effect –
mengalami metabolisme di liver
 Dapat terjadi iritasi mukosa, dpt
menyebabkan mual- muntah
Oral
 Kerugian
 Dpt terjadi kerusakan obat akibat
asam lambung dan enzim
pencernaan
 Efeknya terlalu lambat utk keadaan
emergenci
 Rasa tidak enak
 Tidak bisa digunakan untuk pasien
tidak sadar
First-pass Effect
 The first-pass effect is the term
used for the hepatic metabolism
of a pharmacological agent when
it is absorbed from the gut and
delivered to the liver via the
portal circulation. The greater
the first-pass effect, the less the
agent will reach the systemic
circulation when the agent is
administered orally
First-pass Effect cont.
Magnitude of first pass hepatic effect:
Extraction ratio (ER)
ER = CL liver / Q ; where Q is hepatic
blood flow (usually about 90 L per hour.

Systemic drug bioavailability (F) may be

determined from the extent of absorption
(f) and the extraction ratio (ER):
F = f x (1 -ER)
First-pass Effect
Rectal

 Sesuai untuk pasien tidak sadar dan

anak-anak
 Untuk pasien yang mual atau muntah
 Absorpsi cepat
 Sesuai untuk obat yang mempengaruhi
lambung
 Kontra indikasi utk obat yg mengiritasi
 Rute Parenteral
 Intravascular (IV, IA)- pemberian
obat langsung ke dalam aliran darah
 Intramuscular (IM) – obat diinjeksikan
ke dalam otot
 Subcutaneous - obat diinjeksikan ke
bawah kulit
 Inhalation – Absorbsi melalui paru-
paru
Intravascular
Absorbsi langsung (bioavailabilitas 100% )
1. teliti, tepat dan onset segera,
2. Dapat dlm jumlah besar, relatif tidak sakit
3. Resiko : terjadi embolism
Intramuscular

1. Absorbsi cepat untuk obat yg larut air

2. Menyebabkan rasa sakit untuk beberapa

obat

3. Pelepasan dapat diatur

Subcutaneous

1. Absorbsi lambat dan konstan

2. Absorbsi dipengaruhi kecepatan
aliran darah
3. Pemberian vasokonstriktor
memperlambat absorbsi
Inhalasi

1. Gas atau senyawa yg mudah menguap dan

aerosol
2. Onset cepat, dipengaruhi oleh kecepatan
mencapai sirkulasi:
a. luas permukaan
b. ketebalan membran alveoli
c. kecepatan aliran darah
 Inhalation cont.
 Respiratory system. Except for IN, risk hypoxia.
 Intranasal (snorting) Snuff, cocaine may be partly oral via post-
nasal dripping. Fairly fast to brain, local damage to septum.
Some of the volatile gases also appear to cross nasal membranes.
 Smoke (Solids in air suspension, vapors) absorbed across lung
alveoli: Nicotine, opium, THC, freebase and crack cocaine,
crystal meth.Particles or vapors dissolve in lung fluids, then
diffuse. Longer action than volatile gases. Tissue damage from
particles, tars, CO.
 Volatile gases: Some anaesthetics (nitrous oxide, ether) [precise
control], petroleum distillates. Diffusion and exhalation
(alcohol).
 Lung-based transfer may get drug to brain in as little as five
seconds.
 Topical
•Mucosal membranes (eye drops, antiseptic,
sunscreen, callous removal, nasal, etc.)
•Skin
a. Dermal – dioleskan pada kulit
b. Transdermal – absorpsi melalui kulit
i. stable blood levels
ii. no first pass metabolism
iii. drug must be potent
Rute pemberian obat (1)

21
Rute pemberian obat (2)

22
 Route for administration
-Time until effect-

 intravenous 30-60 seconds

 intraosseous 30-60 seconds
 endotracheal 2-3 minutes
 inhalation 2-3 minutes
 sublingual 3-5 minutes
 intramuscular 10-20 minutes
 subcutaneous 15-30 minutes
 rectal 5-30 minutes
 ingestion 30-90 minutes
 transdermal (topical) variable (minutes to
hours)
 Important
Info

The ROA is determined by the

physical characteristics of the
drug, the speed which the drug is
absorbed and/ or released, as well
as the need to bypass hepatic
metabolism and achieve high
conc. at particular sites
No single method of drug
administration is ideal for all
drugs in all circumstances
Time-release preparations

 Oral - controlled-release, timed-

release, sustained-release
 designed to produce slow,uniform
absorption for 8 hours or longer
 better compliance, maintain effect
over night, eliminate extreme peaks
and troughs
Time-release preparations

 Depot or reservoir preparations

- parental administration (except
IV), may be prolonged by using
insoluble salts or suspensions in
non-aqueous vehicles.
THAT’S IT!!