EENT Administration

Question 1

Give an example of a medication that could be used to treat nasal congestion, rhinitis or sinusitis ?

Answer 1

Nasal spray - Otrivine
Contains : Xylometazoline, hydrochloride/ Ipratropium bromide

Question 2

What are the three main reasons for targeting the nose during administration ?

Answer 2

1) for local delivery - this could be for congestion, infection or in response to allergic rhinitis

2) for systemic absorption - this could be for migraines, diabetes insipidus, prostate cancer, endometriosis, osteoporosis, nicotine

3) for nose to brain delivery - this could be used for the delivery of antipsychotic drugs

Question 3

How many arteries does the blood supply to the nose have ?
And what are these arteries ?

Answer 3

5 :
- Anterior ethmoidal artery (superior artery- top of nasal cavity)
- posterior ethmoidal artery (artery inferior to anterior ethmoidal artery - superior to sphenopalatine artery)
- sphenopalatine artery (inferior to both anterior and posterior artery)
- greater palatine artery (inferior to all arteries - bottom of nasal cavity)
-superior labial artery (front of nasal cavity)

Question 4

What is the Kiesselbach’s plexus found in the nose ?

Answer 4

A vascular network formed by five arteries that supply oxygenated blood to the nasal septum.

Question 5

What are the three types of respiratory epithelium cells ?

Answer 5

1) Columnar cells (can be ciliated or non-ciliated)
2) Goblet cells
3) Basal cells

Question 6

Where is mucus secreted from ?

Answer 6

Serous glands and goblet cells

Question 7

Why does mucus form a viscous gel ?

Answer 7

Due to it containing high molecular weight mucins and its ability to form disulfide bridges.

Question 8

What is the function of mucus ?

Answer 8

clearance and air conditioning - prevents drying out

Question 9

What makes up mucus ?

Answer 9

• water
• salts
• lipids
• mucins

Question 10

What are the 3 types of dosage form used for nasal administration ?

Answer 10

• nasal spray
• nasal drop
• nasal powder

Question 11

What are the 5 types of nasal sprays ?

Answer 11

1) Steroid nasal sprays - e.g. fluticasone (decreases inflammation)

2) Alpha-adrenergic agonist e.g. xylometazoline / Antihistamine e.g. azelastine / Anticholinergic e.g. ipratropium nasal sprays (decongestant)

3) Saline nasal sprays and rinses (treats blocked noses)

4) menthol nasal sprays (short-term relief from discomfort of nasal congestion)

5) Intranasal peptides (used for systemic absorption)
E.g. Desmospressin, Buserelin, Nafarelin

Question 12

What size drug particles deposit in the nasal passage so are subject to mucociliary clearance ?

Answer 12

5-10 micrometers

Question 13

Describe how to use nasal sprays ?

Answer 13

1) Blow nose to clear up passageways
2) shake bottle well
3) block one nostril
4) insert nasal applicator into other nostril
5) Squeeze the pump and breathe in gently
6) repeat process for other nostril

Question 14

What can be used for the primary treatment of a sore throat or tonsillitis ?

Answer 14

Difflam spray
Strepsils

Question 15

How does the active ingredient found in Difflam spray (Benzydamine) exert an effect ?

Answer 15

Benzydamine exerts an anti-inflammatory and analgesic action by stabilising the cellular membrane and inhibiting prostaglandin synthesis (produced by almost all nucleated cells)

Question 16

What can be used for the treatment of mouth thrush ?

Answer 16

Daktarin oral gel

Question 17

What are symptoms of oral thrush ?

Answer 17

• inside mouth is red and there are white patches
• the white patches are irritated or wiped off they leave red patches which are susceptible to bleeding.

Question 18

What can be used for the treatment of a mouth ulcer ?

Answer 18

Bonjela

Question 19

What components in Bonjela adult are resistible for paint relief and antiseptic ?

Answer 19

• for relief from pain and inflammation = Choline salicylate
• antiseptic which helps infection control = Cetalkonium chloride

Question 20

What can be used fro the treatment of blocked ears, infections, otitis externa/ media, tinnitus ?

Answer 20

• sodium bicarbonate ear drops
• olive oil ear drops

Question 21

What could be some symptoms of excessive ear wax ?

Answer 21

• hearing loss
• ringing in the ears
• ear pain
• itchiness in ear canal
• sensation of fullness in ear canal
• odor from ear canal
  -dizziness
• cough
• discharge or ear drainage

Question 22

What is the initial recommended dosage advice to give to a patient for the administration/ use of ear drops ?

Answer 22

Drops 3-4 times daily for 3-5 days initially

Question 23

When do you refer to the routine ENT clinic for a patient with excessive ear wax ?

Answer 23

• If there is difficulty removing the wax despite olive oil
• If a child is uncooperative or there is uncertainty about the condition of the tympanic membrane (eardrum)

Question 24

What are the 4 main types of ear drops and are these OTC, P OR POM drugs ?

Answer 24

1) Alcohol and Acetic acid solutions (prevention of swimmers ear) - OTC
2) Antibiotics (treatment of bacterial infections) - POM
3) Anesthetics (to help numb ear pain) - POM
4) Corticosteroid drops (reduce ear inflammation) - POM

Question 25

List how to correctly use ear drops ?

Answer 25

1) Lay on folded towel on counter.
2) Make sure affected ear is facing up.
3) Gently pull earlobe out and up to straighten auditory tube
4) Administer recommended number of drops into ear canal
5) Gently push on ear flap to encourage liquid into ear
6) stay in position for at least 2 mins

Question 26

What can be used to treat dry eyes or conjunctivitis ?

Answer 26

• optrex eye drops
• chloramphenicol antibiotic eye ointment

Question 27

What are 4 serious eye conditions ?

Answer 27

• Glaucoma
• Cataracts
• Macular degeneration
• Vision Loss

Question 28

What are 2 mild eye conditions ?

Answer 28

• dry eyes
• conjunctivitis

Question 29

What are the 4 types of eye drops ?

Answer 29

• Artificial tears
• Antibiotic eye drops/ ointments
• Corticosteroid eye drops/ ointments
• Glaucoma eye drops