[rnbackagain]

A hospice nurse told me today that any po med can be given rectally if a patient has difficulty or can no longer swallow. Is this true? Forgive me if this is an ignorant question, but I have been out of nursing for 8 years

[Blackcat99]

I am new to hospice and I was told that most meds can be given rectally but not all. I was told that no digestion meds can be given rectally and no enteric coated meds can be given rectally. She told me not to give senna, protonix,atenolol,imuran,or arava rectally. Good luck.

[rnbackagain]

Originally Posted by Blackcat99

I am new to hospice and I was told that most meds can be given rectally but not all. I was told that no digestion meds can be given rectally and no enteric coated meds can be given rectally. She told me not to give senna, protonix,atenolol,imuran,or arava rectally. Good luck.

Thank you so much for the info.

[athomas91]

that is absolutely inaccurate information. most po medications undergo a first pass effect by the hepatic system which lessens their overall bioavailability. when administered rectally the medications are directly absorbe - bypassing the hepatic first pass effect - this could in turn give your patient substantially more medication than they would get po - and because the absorbtion (rectally) is never accurately known it is an unsafe way to practice.

[michelle126]

Not all po meds....some..I've given MS Contin rectally. That was years ago.

[Blackcat99]

Originally Posted by athomas91

that is absolutely inaccurate information. most po medications undergo a first pass effect by the hepatic system which lessens their overall bioavailability. when administered rectally the medications are directly absorbe - bypassing the hepatic first pass effect - this could in turn give your patient substantially more medication than they would get po - and because the absorbtion (rectally) is never accurately known it is an unsafe way to practice.

What do you do at your hospice if your patients cannot swallow their pain meds or absorb their pain meds sublingually?

[Mej]

As a student nurse we're taught to call the doctor if there is any issue with taking the medication as prescribed. Why not call their doctor and ask for them to prescribe the medicine by a different route? To me that sounds safer for the patient and the nurse.

[athomas91]

sublingual can be bad as well - again - skips that first pass effect.
if they cannot take their meds po - what about IM or if need be - IV - all i am saying is that if you give your meds other than ordered - you are ripping up your own license - if you do not know the metabolism etc of the medication you could be overdosing or underdosing patients.

[Mandee]

I've been a hospice nurse 8 yrs and if it's a crisis we give MSIR and even MS Contin rectally, we do get an order asap for an alternate route/drug but it does work in a crunch, our medical director will write an order for admin. pr. The bedside pain manager which is an excellent resource for any hospice nurse states it can be given safely rectally.

Mandee

[Blackcat99]

Originally Posted by athomas91

sublingual can be bad as well - again - skips that first pass effect.
if they cannot take their meds po - what about IM or if need be - IV - all i am saying is that if you give your meds other than ordered - you are ripping up your own license - if you do not know the metabolism etc of the medication you could be overdosing or underdosing patients.

It's the doctor's who are ordering these meds to be given rectally not me!!!!
If it is so dangerous why do the doctor's keep ordering the meds to be given rectally?