Routes of Administration: eye, ear, nose and throat

Question 1

Why target the nose?

Answer 1

• Local delivery
• Allergic rhinitis, congestion, infection
• Systemic absorption
• Migraine, diabetes insipidus, prostate cancer, endometriosis, osteoporosis,
  nicotine
• Nose to brain
• Antipsychotic drugs?

Question 2

How many blood supplies does the nose have + whats it called?

Answer 2

*the blood supply to the nose has five arteries
*kiesselbach’s plexus

Question 3

What is the respiratory epithelium made of?

Answer 3

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

Question 4

Where is mucus from? What does it do?

Answer 4

• From serous glands and goblet cells
• Form viscous gels due to high molecular weight mucins and ability to
  form disulphide bridges
• Function: clearance and air conditioning (prevent drying out)

Question 5

What is the composition of mucus?

Answer 5

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

Question 6

What are the ways to deliver to the nose?

Answer 6

*nasal spray
*nasal drop
*nasal powder

Question 7

What are the types of nasal sprays?

Answer 7

• Steroid nasal sprays (fluticasone)
• Decreases inflammation
• Alpha-adrenergic agonist (xylometazoline) / antihistamine (azelastine) /
  anticholinergic (ipratropium) nasal sprays
• Decongestant
• Saline nasal sprays and 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 8

What happens to particles delivered to the nose?

Answer 8

• > 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 9

How to use nasal sprays?

Answer 9

*blow your nose to clear up the passageways
*shake the bottle
*block one nostril
*insert the nasal applicator into the other nostril
*squeeze the pump and breathe in gently
*repeat the process for the other nostril

Question 10

What is used to treat a sore throat and tonsillitis?

Answer 10

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

Question 11

What is used to treat oral thrush?

Answer 11

Daktarin

Question 12

What is used to treat mouth ulcers?

Answer 12

bonjela

Question 13

What does bonjela contain to treat mouth ulcers?

Answer 13

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

Question 14

What is used to treat blocked ear, infections, otitis externa/media, tinnitus?

Answer 14

sodium bicarbonate ear drops
olive oil ear drops

Question 15

What are the symptoms to excessive ear wax?

Answer 15

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

Question 16

What are the types of ear drops?

Answer 16

• Alcohol and acetic acid solutions
  to prevent swimmer’s ears (OTC)
• Antibiotics to treat bacterial
  infections (POM)
• Anaesthetics to help numb ear
  pain (POM)
• Corticosteroid drops to reduce
  ear inflammation (POM)

Question 17

What is used to treat dry eyes, conjunctivitis?

Answer 17

chloramphenicol 1.0w/w antibiotic eye ointment

Question 18

What are some mild eye conditions?

Answer 18

• Dry eyes
• Conjunctivitis

Question 19

What are some serious eye conditions?

Answer 19

• Glaucoma
• Cataracts
• Macular degeneration
• Vision Loss

Question 20

What are the types of eye drops?

Answer 20

• 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 21

How to administer eye drops?

Answer 21

*check the expiry date on the eye drop bottle and shake if required
*wash your hands before opening the bottle
*lying down or in a seated position, tilt your head back
*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
*look up and squeeze one drop into your lower eyelid making sure the nozzle doesn’t touch your eye, lashes or lid
*close your eye and press gently on the inner corner of your eye for 30-60 seconds to ensure the drop is fully absorbed

Question 22

How to administer eye ointment?

Answer 22

*if you need to use eye drops and ointment use drops first then wait 5 mins
*check expiry date and wash hands before opening tube
*lie down or sit down and tilt your head back
*make a fist with one hand and use your knuckles to pull your lower eyelid downwards. Place your other hand with the eye ointment tube onto your knuckles
*look up and squeeze about 1cm ointment into your lower eyelid making sure the nozzle doesn’t touch your eye, lashes or lid
*close your eye for a moment, then click a few times to spread the ointment around the inside of the eye.