Editing Route of administration (section)

====Enteral/gastrointestinal route====
Through the [[gastrointestinal tract]] is sometimes termed ''enteral or enteric administration'' (literally meaning 'through the [[intestines]]'). ''Enteral/enteric administration'' usually includes ''[[oral administration|oral]]''<ref name="url195_20-1-3.1.htm"/> (through the [[Human mouth|mouth]]) and ''[[Rectal (medicine)|rectal]]'' (into the [[rectum]])<ref name="url195_20-1-3.1.htm">{{cite web |url=http://www.oar.state.ok.us/viewhtml/195_20-1-3.1.htm |title=Oklahoma Administrative Code and Register > 195:20-1-3.1. Pediatric conscious sedation utilizing enteral methods (oral, rectal, sublingual) |access-date=2009-01-18 |archive-url=https://web.archive.org/web/20110722120920/http://www.oar.state.ok.us/viewhtml/195_20-1-3.1.htm |archive-date=2011-07-22 |url-status=live }}</ref> administration, in the sense that these are taken up by the intestines. However, uptake of drugs administered orally may also occur already in the [[stomach]], and as such ''gastrointestinal'' (along the [[gastrointestinal tract]]) may be a more fitting term for this route of administration. Furthermore, some application locations often classified as ''enteral'', such as [[sublingual administration|sublingual]]<ref name="url195_20-1-3.1.htm"/> (under the tongue) and [[sublabial administration|sublabial]] or [[Buccal administration|buccal]] (between the cheek and gums/[[gingiva]]), are taken up in the proximal part of the [[gastrointestinal tract]] without reaching the intestines. Strictly [[enteral administration]] (directly into the intestines) can be used for systemic administration, as well as local (sometimes termed [[topical]]), such as in a contrast [[enema]], whereby contrast media are infused into the intestines for imaging. However, for the purposes of classification based on location of effects, the term enteral is reserved for substances with systemic effects.

[[File:Administering medication into a gastric tube.jpg|thumb|A medical professional injects medication into a gastric tube.]]
Many drugs as [[Tablet (pharmacy)|tablets]], [[Capsule (pharmacy)|capsules]], or drops are taken orally. Administration methods directly into the stomach include those by [[gastric feeding tube]] or [[gastrostomy]]. Substances may also be placed into the [[small intestine]]s, as with a [[duodenal]] feeding tube and [[enteral administration|enteral nutrition]]. Enteric coated tablets are designed to dissolve in the intestine, not the stomach, because the drug present in the tablet causes irritation in the stomach.
[[File:Administering-med-rectally-2.png|thumb|Administering medication rectally]]
The [[rectal]] route is an effective route of administration for many medications, especially those used at the [[end-of-life care|end of life]].<ref>{{cite journal |vauthors=Davis MP, Walsh D, LeGrand SB, Naughton M | year = 2002 | title = Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions | journal = Support Care Cancer | volume = 10 | issue = 2| pages = 117–38 | doi=10.1007/s00520-001-0311-6| pmid = 11862502 | s2cid = 30569818 }}</ref><ref>{{cite journal |vauthors=De Boer AG, Moolenaar F, de Leede LG, Breimer DD | year = 1982 | title = Rectal drug administration: clinical pharmacokinetic considerations | journal = Clin Pharmacokinetics | volume = 7 | issue = 4| pages = 285–311 | doi=10.2165/00003088-198207040-00002 | pmid=6126289| s2cid = 41562861 }}</ref><ref>{{cite journal |vauthors=Van Hoogdalem EJ, de Boer AG, Breimer DD | year = 1991 | title = Pharmacokinetics of rectal drug administration, Part 1 | journal = Clin Pharmacokinet | volume = 21 | issue = 1| pages = 11–26 | doi=10.2165/00003088-199121010-00002| pmid = 1717195 | s2cid = 35104089 }}</ref><ref>{{cite journal |vauthors=Van Hoogdalem EJ, de Boer AG, Breimer DD | year = 1991 | title = Pharmacokinetics of rectal drug administration, Part 2 | journal = Clin Pharmacokinet | volume = 21 | issue = 2| pages = 110–128 | doi=10.2165/00003088-199121020-00003 | pmid = 1884566| s2cid = 11720029 }}</ref><ref>{{cite journal |vauthors=Moolenaar F, Koning B, Huizinga T | year = 1979 | title = Biopharmaceutics of rectal administration of drugs in man. Absorption rate and bioavailability of phenobarbital and its sodium salt from rectal dosage forms | journal = [[International Journal of Pharmaceutics]] | volume = 4 | issue = 2| pages = 99–109 | doi=10.1016/0378-5173(79)90057-7}}</ref><ref>{{cite journal |vauthors=Graves NM, Holmes GB, Kriel RL, Jones-Saete C, Ong B, Ehresman DJ | year = 1989 | title = Relative bioavailability of rectally administered phenobarbital sodium parenteral solution | journal = DICP: The Annals of Pharmacotherapy | volume = 23 | issue = 7–8| pages = 565–568 | doi=10.1177/1060028089023007-806| pmid = 2763578 | s2cid = 27397387 }}</ref><ref>{{cite journal |vauthors=Moolenaar S, Bakker S, Visser J, Huizinga T | year = 1980 | title = Biopharmaceutics of rectal administration of drugs in man IX. Comparative biopharmaceutics of diazepam after single rectal, oral, intramuscular and intravenous administration in man | journal = International Journal of Pharmaceutics | volume = 5 | issue = 2| pages = 127–137 | doi=10.1016/0378-5173(80)90017-4}}</ref> The walls of the rectum absorb many medications quickly and effectively.<ref>[http://www.hpna.org.] {{webarchive|url=https://web.archive.org/web/20130126195447/http://www.hpna.org/|date=2013-01-26}} Nee, Douglas, Pharm D, MS. "Rectal Administration of Medications at the End of Life". HPNA Teleconference, December 6, 2006, accessed November 2013.</ref> Medications delivered to the distal one-third of the rectum at least partially avoid the "[[first pass effect]]" through the liver, which allows for greater [[bio-availability]] of many medications than that of the oral route. Rectal [[mucosa]] is highly [[vascularized]] tissue that allows for rapid and effective absorption of medications.<ref>{{cite web|url=http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_257.htm|title=Use of Rectal Meds for Palliative Care Patients. End of Life / Palliative Education Resource Center, Medical College of Wisconsin|website=mcw.edu|access-date=14 April 2018|url-status=dead|archive-url=https://web.archive.org/web/20140602060038/http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_257.htm|archive-date=2 June 2014}}</ref> A [[suppository]] is a solid [[dosage form]] that fits for [[rectal administration]]. In [[hospice care]], a specialized rectal [[Macy Catheter|catheter]], designed to provide comfortable and discreet administration of ongoing medications provides a practical way to deliver and retain liquid formulations in the [[distal]] rectum, giving health practitioners a way to leverage the established benefits of rectal administration. The [[Murphy drip]] is an example of rectal infusion.