PO meds can be given rectal?

[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 :)

[OneThunder, BSN, RN]

While oral meds CAN be given rectally, it is generally an emergency kind of action. Oral meds are not forumlated for breakdown in the rectum. Absorption and bioavailability can vary highly according to circumstance. For instance, a pharmacist told me that dilantin can be compounded into suppositories but there has been only one very small scale study done and it "suggests" that the dosage must be about double what the oral would be to achieve the same levels.

we have a pharmacy that will work with the case manager, medical director and "compound" a custom suppository with the required medications. This is the exception,rather than the norm, but it is all part of individualized care for the hospice patient.

[Arjaye LPN]

I have been a hospice nurse for 7 years. When a pt is in pain and dying; we do what it takes to make them comfortable. Of course we still do what is safe, but the "safe" perimeters change when a person is in their last minutes of life...and pain control is of the utmost importance. Our medical director goes over the listed meds and adjusts doses as needed so that route of administration remains safe.:redbeathe

[tewdles, RN]

It is important to remember that we are talking about rectal administration of a few drugs with the intent to palliate pain or other noxious symptoms in the last hours of life. Generally the meds are limited to those which treat pain, dyspnea, and anxiety or agitation. Nobody is planning on administering, say lisinopril PR, because the patient is actively dying and cannot swallow.

We DO have MD orders for that route when it is used. The hospice medical directors at my hospice will NOT "throw the nurse under the bus", they are professionals certified in their areas of specialty, and will support those nurses who practice professionally and safely. Professional hospice literature as well as our PharmDs support this practice of PR admin of appropriate comfort meds.

[eternalsunshine]

I recently had to give a patient Methadone rectally. he had an order for this in case he began to experience Dysphagia, which he did. The rectal dose was lower than the oral dose & our Medical Director explained that absorption was higher rectally, so, what athomas91 states in his first response is correct about how medications are metabolized when taken orally versus rectally.

I would have this in the back of your mind if you ever have to give something rectally and perhaps just double check & clarify the dosage before administering rectally.

[MJ Marx]

I have only been in Hospice a few months. In a crisis, until getting something subcutaneously, we will utilize the rectal route. This has been determined by the Medical Director of my agency and he tells us which medications we can do this with, as well as we have a pharmacist that collaborates with us and assists the doctors in which medications can be safely given rectally. Check with your policy and procedure manual, and the physician. If the physician has ordered something rectally, it's good to know which medications can be given that route. We will utilize that route for Morphine tablets, i.e. MS Contin, MS IR, etc. Some anti-anxiety medications, we will also use that route until we get something better. I do know that pharmacists recommend not giving any NSAID by rectal route.