PO meds can be given rectal?

  1. 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
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    About rnbackagain

    Joined: Mar '05; Posts: 24; Likes: 1

    16 Comments

  3. 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.
  4. by   rnbackagain
    Quote from 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.
    Last edit by rnbackagain on Mar 23, '05
  5. 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.
  6. by   CoffeeRTC
    Not all po meds....some..I've given MS Contin rectally. That was years ago.
  7. by   Blackcat99
    Quote from 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?
  8. by   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.
  9. 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.
  10. by   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
  11. by   Blackcat99
    Quote from 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? :stone
  12. by   athomas91
    i suppose that i am not the first to tell you that just because they have MD behind their name they know what they are doing. Not ALL medicines are harmful when switched - just ones that depend on that first pass effect to lessen their strength. all i am saying is be familiar with your meds and know what effect changing the route will have. a doctor WILL throw you to the wolves when the lawsuit comes - remember that. good luck
  13. by   aimeee
    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.
  14. by   OneThunder
    Quote from aimeee
    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.

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