Routes of Administration - EENT

Question 1

Nasal congestion, rhinitis, sinusitis

Answer 1

Sinusitis;
Inflammation, fluid, obstructed sinus opening

Question 2

Nasal cavity content;

Answer 2

Frontal sinus
Sphenoid sinus
Choana
Adenoid pad
Nasal vestibule
Eustachian tube orifice
Fossa ofd Rosenmuller

Question 3

Why target the nose?

Answer 3

Local delivery
Allergic rhinitis, congestion, infection

Systemic absorption
Migraine, diabetes insipidus, prostate cancer, endometriosis, osteoporosis, nicotine

Nose to brain
Antipsychotic drugs?

Question 4

Respiratory epithelium

Answer 4

Columnar cells (ciliated or non-ciliated)
Goblet cells
Basal cells

Question 5

Nasal mucosa

Answer 5

• Free diffusion
• Steric barrier (no access to mucus layer)
• Interactive barrier(drugs get trapped by mucus network in mucus layer

Question 6

Mucus

Answer 6

From serous glands and goblet cells
Form viscous gels due to high molecular weight mucins and ability to form disulphide bridges

Question 7

Function + composition of mucus;

Answer 7

clearance and air conditioning (prevent drying out)

Composition:
Water (90-95%)
Salts (1-2%)
Lipids (2-3%)
Mucins (0.5-5%) – responsible for gel-like structure

Question 8

How to deliver to the nose;

Answer 8

Nasal spray
Nasal drop
Nasal powder

Question 9

Types of nasal sprays

Answer 9

> Steroid nasal sprays (fluticasone)
Decreasesinflammation

> Alpha-adrenergic agonist (xylometazoline) / antihistamine (azelastine) / anticholinergic (ipratropium) nasal sprays
Decongestant

> Saline nasal spraysand rinses
A more ‘natural’ remedy to treat blocked noses

> Menthol nasal sprays
Provide short-term relief from the discomfort of nasal congestion

> Intranasal peptides (systemic absorption)
Desmopressin – control increased thirst and too much urination
Buserelin – treat hormone-responsive cancers (prostate cancer, premenopausal breast cancer)
Nafarelin – treat symptoms of endometriosis (pelvic pain, menstrual cramps, painful intercourse)

Question 10

Fate of particles delivered to the nose

Answer 10

> 10 µm filtered by vibrissae in the nostrils
5-10 µm deposit in the nasal passages but are subject to mucociliary clearance
2 µm pass through to the lungs

Question 11

How to use nasal sprays

Answer 11

1) Blow your nose to clear up the passageways
2) Shake bottle
3) Black one nostril
4) Insert the nasal applicator into the other nostril
5) Squeeze the pump and breathe in gently
6) Repeat the process for the other nostril

Question 12

Sore throat, tonsillitis HOW to treat?

Answer 12

Inflamed tonsills

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

Question 13

Oral thrush (mouth thrush) - symptom

Answer 13

White patches
When you wipe off the white patches, they leave red spots that can bleed

Question 14

Mouth ulcer, look?
How to treat;

Answer 14

Red/yellow sores
Appear in side mouth, lips and cheeks + tongue

Bonjela Adult contains
Cetalkonium chloride, an antiseptic which helps to fight infections
Choline salicylate, for relief from pain and inflammation

Question 15

Blocked ear, ear infections, otitis external/media, tinnitus

Answer 15

wax shed skin, pus, Narrowing of ear canal from inflammation

Question 15

Blocked ear, ear infections, otitis external/media, tinnitus

Answer 15

wax shed skin, pus, Narrowing of ear canal from inflammation

Question 16

Symptoms of excessive ear wax

Answer 16

30% of people over the age of 64 years will suffer wax impaction and wax removal can improve the hearing

• hearing loss
• ringing in ears
• ear pain
• sensation of fullness in the ear canal
• itchiness in ear canal
• discharge
• cough
• dizziness
• odour from ear canal

Question 17

OTC ear drops for excessive ear wax
Dosage?

Answer 17

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

Refer to the routine ENT clinic
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 18

Types of ear drops:

Answer 18

a) Alcohol and acetic acid solutions to prevent swimmer’s ears (OTC)

b) Antibiotics to treat bacterial infections (POM)

c) Anaesthetics to help numb ear pain (POM)

d) Corticosteroid drops to reduce ear inflammation (POM)

Question 19

How to use ear drops correctly; step by step;

Answer 19

1) Lay a folded towel on a kitchen or bathroom counter

2) Lay your head on the towel with the affected ear up

3) Gently pull young earlobe out and up to straighten your auditory tube

4) Administer the recomended number o drops into your ear canal

5) Gently on your ear flap to encourage liquid into your ear

6) Stay for at east 2 minutes

Question 20

Dry eyes, conjunctivitis - symptoms?

Answer 20

Red/ pink eye

Question 21

Revise the eyeball

Answer 21

slide 37 EENT slides MOCK

Question 22

Eye conditions=

Answer 22

Mild eye conditions:
- Dry eyes
- Conjunctivitis

Serious eye conditions:
- Glaucoma
- Cataracts
- Macular degeneration
- Vision Loss

Answer 23

Artificial tears
carboxymethylcellulose (CMC)/hydroxypropyl methylcellulose (HPMC), castor oil/mineral oil

Antibiotic eye drops/ointments
Chloramphenicol, Fusidic acid, Levofloxacin

Corticosteroid eye drops/ointments
Atropine, Cyclopentolate, Homatropine, Tropicamide, Phenylephrine

Glaucoma eye drops
Prostaglandins – Latanoprost, Beta-blockers – timolol, Alpha-adrenergic agonists – Brimonidine, Carbonic anhydrase inhibitors – Brinzolamide

Question 24

How to administer eye drops? 6 steps

Answer 24

1) Check the expiry date on your eye drop bottle and shake if required

2) wash hands before opening bottle

3) Lying down or in a seated position tilt your head back

4) Make a fist with one hand and use your knuckles to pull your lower eyelid downwards. Place your other hand with the eye drop bottle onto your knuckles.

5) Look up and squeeze on drop into your lower eyelid making sure the nozzle does not touch your eye, eyelashes or eyelid

6) close your eyes and press gently on the inner corner of your eye for 30-60s to ensure the drop is fully absorbed

Question 25

How to administer eye ointment? 6 steps

Answer 25

1) If you need to use eye drops and eye ointment, use the eye drops first and then wait 5 mins before using ointment

2)Check the expiry date on your eye ointment and wash you hands before opening the tube

3) Lie down or sit down and tilt your head back

4) Make a fist with one hand and use your knuckles to pull your lower eyelid downwards, Place the eye ointment tube onto your knuckles with the nozzle facing downwards towards eye

5) Look up and squeeze about 1cm of the ointment along the inside of the lower eyelid making sure the nozzle does nit touch the eye, eyelashes or eyelid

6) Close your eye for a moment, then blink the ointment around the inside of the eye