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There are two major routes of drug administration: enteral and parenteral. Enteral means to do with the gastrointestinal tract and includes oral and rectal administration. The parenteral route includes all other means of drug administration. There are many routes of parenteral administration, some of which are intended for a drug to have a systemic effect and others for a local effect. See Figure (In some definitions, parenteral is synonymous with injection (for example in the Medicines Act), but here the term is used to describe all routes of administration that are not enteral.
) The vast majority of drugs are administered by mouth as pills, capsules, tablets or liquids.
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Whichever professional is considered, it should be noted that neither of these groups can legally work within a PGD. Also, any regulations and related guidance must be complied with strictly. Another example noted in some PGDs is that working practices may not be in line with Summary of Product Characteristics for that medicinal product. For example some PGDs have indicated that the amount of Omnipaque (an X-ray contrast agent) to be administered can exceed that outlined on the product information sheet.
The only evidence used to support this is that some peers do this in other Trusts. Not only does this practice fall short of minimizing risk but it might also fail one component of the Bolam test (Bolam v Friern Hospital Management Committee, City and Hackney Health Authority, In some departments, it is clear that the implementation and development of prescription, supply and administration of medicines by radiographers has occurred in isolationsemi-isolation to the Trust as a whole.
Drug interactions with sulfonylureas and biguanides are common: non-steroidal antiinflammatory drugs, warfarin, alcohol, monoamine oxidase inhibitors, some uricosurics, some antibacterials and some antifungals can interact with them. All increase the risk of hypoglycaemia. The mechanism is probably competition for metabolizing enzymes or displacement from plasma protein binding sites. Drugs that decrease the effectiveness of sulfonylureas include diuretics and corticosteroids.
There are three other groups of drugs licensed in the United Kingdom for the treatment of NIDDM. Acarbose is an alpha glucosidase inhibitor.
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