The route of administration of a drug (how it is introduced into body) is very important in determining the rate and completeness of its absorption into the bloodstream and duration of the drug’s action in the body.
The many different methods used by physicians and allied health personnel to administer drugs are listed below, with a brief discussion of each method:
Oral Administration (PO). The route of administration is by mouth. Drugs given orally must pass into the stomach and be absorbed into the bloodstream through the intestinal wall. Although this method is probably most acceptable to patients from the standpoint of convenience, it may have several disadvantages. If the drug is destroyed in the digestive tract by digestive juices or the drug cannot pass through the intestinal mucosa, it will be ineffective. Also, oral administration is slower that other methods and disadvantageous if time is a factor in therapy.
Sublingual Administration (SL). In this route of administration, drugs are not swallowed but are placed under the tongue and allowed to dissolve in the saliva. Absorption may be rapid for some agents. Nitroglycerin tablets are taken this way to treat attacks of chest pain (angina pectoris). The nitroglycerin is rapidly absorbed into the bloodstream and opens coronary arteries to increase blood flow to the heart muscle.
Rectal Administration Suppositories (PR). Suppositories ( cone- shaped objects containing drugs) and aqueous ( water) solutions are inserted into the rectum ( distal end of the digestive tract). At times, drugs are given by rectum when oral administration presents difficulties, such as when the patient is nauseated and vomiting.
Parenteral Administration. This type of administration is accomplished by injection through a syringe ( syring/o = tube) under the skin, into muscle, into a vein, or into a body cavity. There are several types of parenteral injections :
Subcutaneous Injection (SC). This injection is sometimes called a hypodermic injection, and is given just under the several layers of the skin. The other surface of the arm and the anterior surface of the skin are usual locations for subcutaneous injections.
Intradermal Injection. This shallow injection is made into the upper layers of the skin. It is used chiefly in skin testing for allergic reactions. Short needles are used, and an elevation appears on the skin when an intradermal injection is given properly.
Intramuscular Injection (IM). This injection is given into the muscle, usually into the buttocks. when drugs are irritating to the skin or when a large volume of a long-acting drugs is to be given, I. M. injections are advisable.
Intravenous Injection (IV). This injection is given directly into the veins. It is given when an immediate effect from the drug is desired or when the drug cannot be given into other tissues. Good technical skill is needed in administering this injection, since leakage of drugs into surrounding tissues may result in damage to tissues.
Intrathecal Injection. This injection is made into the sheath of membranes (meninges) which surround the spinal cord and brain. The effects of the drug so administered are usually limited to the central nervous system, and intrathecal injections are often used to produce anesthesia.
Intracavitary Injection. This injection is made into a body cavity, as, for example, into the peritoneal or pleural cavity.
Inhalation. In this method of administration, vapors, or gases, are taken into the nose or mouth and absorbed into the bloodstream through the thin walls of the air sacs in the lungs. Aerosols ( particle of the drug suspended in air) are administered by inhalation
Topical Application. This is the local external application of drugs on skin or mucous membranes of the mouth or other surface. It is commonly used to accelerate the healing of abrasions, for antiseptic treatment of a wound, and as an antipruritic (against itching). Topical application may also include administration of drugs into the eyes, ears, nose, and vagina. Lotions are used most often when the skin is moist, or «weeping», and ointments and creams are used when the lesions are dry.
Task I. Match the route of administration of drugs in A) with the medications and procedures in B).
B) a) lotions, creams, ointments; b) tablets and capsules; c) used for allergy skin tests; d) lumber puncture; e) deep injection, usually into the buttocks; f) suppositories; g) used for blood transfusion; h) aerosols.
Task II. Speak about administration of drugs using the following table.
Exercise 1. Finish the sentences adding more information.
1. A doctor prescribing a certain dose or a drug to be taken by a patient should take into consideration not only the strength of the drug but also… .
2. A patient taking the drug prescribed by a doctor must know well its indications, … .
3. There are several types of parenteral injections. They are … .
4. There are certain terms to describe the action and interaction of drugs in the body. They are … .
5. All drugs can affect the body in both helpful and harmful ways. For example, … .
Exercise2. Prove that:
1. Any drug, if given in high enough doses can have harmful actions on the body.
2. The prescribed method for administering the medication depends upon the “form” of the medication.
3. It is necessary to reduce drug dosage for a patient with liver disease.
4. Certain interactions of drugs can increase a patient’s risk or adverse effects.
Exercise 3. Extend the idea.
1. The reception theory explains how drugs act on the cell.
2. The chemical reaction between a drug and the body is not a one-way process.
3. Interactions can occur not only with drug combinations.
4. Patients should discuss all medication-related questions with their physicians or pharmacist.
Exercise 4. Speak about actions of the drugs using the following as an outline.
1. Actions of the drug in the body.
2. Different effects of drugs.
3. Drug interactions.
4. Routes of administration of medications.
5. Elimination of drugs from the body.
General principles of the court proceedings
The common principles of court proceedings include:
(1) rule of law, including legality and legal certainty;
(2) judge’s independents and impartiality;
(3) adversarial principle (the principle of competitiveness);
(5) reasonable time-limit;
(6) the duty to motivate (give reasons) judgements;
(7) fundamental rights (the right to a remedy, the right to access to court, the right to be heard, the right to access one’s files, the right of defence etc).
Most of these principles and rights we have already discussed.
Today we’ll talk about such common principles as the principle of adversariness, the proportionality, and the legal certainty.
1. Inquisitorial and Adversarial systems
At least two large families of court procedure may be distinguished in today’s world: those that find their origin in the Common Law and those that have developed on the basis of the Romano-canonical procedure. The Common Law family is the result of the expansion of the British Empire, which brought the English system of proceedings to places all aver the world, for example the USA, Canada, Australia, India and South Africa.
On the Continent of Europe, the medieval Romano-canonical procedure formed the basis of further developments.
A distinction is made between two theoretical extremes: the inquisitorial model and the adversarial model.
In a pure adversarial system the judge acts as an arbitrator. He does nothing but listen to what the parties put before him and declares a ‘winner’ in his judgement.
In a pure inquisitorial system the judge has an active, dominant role. He is, for example, involved in the framing of the issues and the gathering of the evidence. The judge plays the role as a fact finder to ascertain the truth; he is almost like an investigator or a party. Actually the inquisitorial system is aimed at uncovering the truth whereby the judge direct the trial, follow up on the investigation of the case and can ask questions to the parties and witnesses.
Neither extremes exist in practice. Nevertheless, the United States of America and England are often seen as examples of systems tending towards the adversarial model. The Civil Law systems are categorized as less adversarial, but the adjective ‘inquisitorial’ instead of ‘less adversarial’ is often used by English and American authors. This is due to the fact that in these systems the judge is more active then his Anglo-American counterpart.
The differences, however, can easily be exaggerated. In most systems of court procedure the parties enjoy a certain degree of autonomy. The decision whether or not to initiate legal proceedings is left to their decisions, they decide about the subject-matter that is put before the court, and also usually the parties decide whether or not to make use of available procedural techniques and instruments.
2. Inquisitorial system v. adversarial system: some arguments
The opponents of the adversarial system say: where the competing actors are unequal in their capabilities, success often does not accompany the party who is right based on the merits of the case, but rather the party who is stronger – especially in financial terms, as this resource is easily transformed into all others. Winning a case largely depends on the extent of professionalism of the parties’ representatives. This is true even at a very early stage of the process, such as during the initiation of a lawsuit, because the correct choice of the subject of the suit and its factual and legal argumentation often determines its success or failure in court. In these circumstances the role of quality legal aid increases.
Proponents of the adversarial system often argue that the system is more fair and less prone to abuse than the inquisitional approach, because it allows less space for the state to be biased against one of the party. It also allows most private litigants to settle their disputes in an amicable manner through discovery and pre-trial settlements.
In adversarial trial lawyer has wide opportunities to uncover the truth in the courtroom. Most cases that go to trial are carefully prepared through a discovery process that aids in the review of evidence before it is presented to judge or jury. The lawyers involved have a very good idea of the scope of agreement and disagreement of the issues to present at trial.