Routes of Administration - EENT Flashcards
Nasal congestion, rhinitis, sinusitis
Sinusitis;
Inflammation, fluid, obstructed sinus opening
Nasal cavity content;
Frontal sinus
Sphenoid sinus
Choana
Adenoid pad
Nasal vestibule
Eustachian tube orifice
Fossa ofd Rosenmuller
Why target the nose?
Local delivery
Allergic rhinitis, congestion, infection
Systemic absorption
Migraine, diabetes insipidus, prostate cancer, endometriosis, osteoporosis, nicotine
Nose to brain
Antipsychotic drugs?
Respiratory epithelium
Columnar cells (ciliated or non-ciliated)
Goblet cells
Basal cells
Nasal mucosa
- Free diffusion
- Steric barrier (no access to mucus layer)
- Interactive barrier(drugs get trapped by mucus network in mucus layer
Mucus
From serous glands and goblet cells
Form viscous gels due to high molecular weight mucins and ability to form disulphide bridges
Function + composition of mucus;
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
How to deliver to the nose;
Nasal spray
Nasal drop
Nasal powder
Types of nasal sprays
> 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)
Fate of particles delivered to the nose
> 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
How to use nasal sprays
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
Sore throat, tonsillitis HOW to treat?
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)
Oral thrush (mouth thrush) - symptom
White patches
When you wipe off the white patches, they leave red spots that can bleed
Mouth ulcer, look?
How to treat;
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
Blocked ear, ear infections, otitis external/media, tinnitus
wax shed skin, pus, Narrowing of ear canal from inflammation
Blocked ear, ear infections, otitis external/media, tinnitus
wax shed skin, pus, Narrowing of ear canal from inflammation
Symptoms of excessive ear wax
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
OTC ear drops for excessive ear wax
Dosage?
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)
Types of ear drops:
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)
How to use ear drops correctly; step by step;
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
Dry eyes, conjunctivitis - symptoms?
Red/ pink eye
Revise the eyeball
slide 37 EENT slides MOCK
Eye conditions=
Mild eye conditions:
- Dry eyes
- Conjunctivitis
Serious eye conditions:
- Glaucoma
- Cataracts
- Macular degeneration
- Vision Loss
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
How to administer eye drops? 6 steps
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
How to administer eye ointment? 6 steps
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
