W11 Routes of administration- EENT Flashcards
Eye, ear, nose and throat
Treatment for Nasal congestion, rhinitis, sinusitis?
Otrivine
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
The blood supply to the nose has 5 arteries:
Superior labial artery
Greater palatine artery
Sphenopalatine artery
Anterior ethmoidal artery
Posterior ethmoidal artery
What is Kiesselbach’s plexus?
A vascular network formed by five arteries that supply oxygenated blood to the nasal column.
The respiratory epithelium contains:
Which types of cells?
- Columnar cells (ciliated or non-ciliated)
- Goblet cells
- Basal cells
Mucus (for info)
Where is it secreted from?
- 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)
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? ( 3 dosage forms)
Nasal spray
Nasal drop
Nasal powder
Types of nasal sprays:
- 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
- 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
Explain to a patient how you would use a nasal spray.
- 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
What medications are suitable for a Sore throat, tonsilitis?
What is the active ingredient?
Strepsils
Difflam spray
- Benzydamine exerts an anti-inflammatory and analgesic action by stabilising the cellular membrane and inhibiting prostaglandin synthesis (produced by almost all nucleated cells)
What medication is suitable for oral thrush?
What are the symptoms of oral thrush?
Antifungals e.g Daktarin
- Your mouth is red inside and you have white patches (red/yellow sores)
- When you wipe off the white patches, they leave red spots that can bleed
Where do mouth ulcers occur?
What medication is suitable?
- Usually appear inside the
mouth, on the cheeks or lips - Can also appear on the
tongue
Bonjela
Bonjela Adult contains :
- Cetalkonium chloride, an antiseptic which helps to fight infections
- Choline salicylate, for relief from pain and inflammation
What are the symptoms of excessive ear wax? (wax impaction)
What can improve the hearing?
Hearing loss, Ringing in ears, Ear pain, A sensation of fullness in the ear canal, Itchiness in the ear canal, Discharge or ear drainage, Cough, Dizziness, Odour from the ear canal.
Wax removal
What are the symptoms of Blocked ear, ear infections, otitis externa/media, tinnitus?
What medications can be taken?
Wax shed skin, pus
Narrowing of ear canal from inflammation
Sodium bicarbonate ear drops
Olive oil ear drops
What are the types of ear drops?
- 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)
How to use ear drops correctly?
- Lay a folded towel on a (kitchen/bathroom) counter
- Lay your head on the towel with the affected ear up
- Gently pull your earlobe out and up to straighten your auditory lobe
- Administer the recommended number of drops into your ear canal
- Gently push on your ear flap to encourage liquid
- Stay here for at least 2 minutes
Types of eye drops:
- 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 do you administer eye drops?
- Check the expiry date on your 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 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 does not touch the eye, eyelashes or eyelid
- Close your eye and press gently on the inner corner of your eye for 30-60 seconds to ensure the drop is fully absorbed.
Symptoms of Dry eyes, conjunctivis?
What should be used as treatment?
Red/pink eye
Optrex or Chloramphenicol eye drops
What are some mild eye conditions?
What are some serious eye conditions?
Mild eye conditions:
* Dry eyes
* Conjunctivitis
Serious eye conditions:
* Glaucoma
* Cataracts
* Macular degeneration
* Vision Loss
What should be used first, eye drops or eye ointment?
=Use the eye drop first then eye ointment
How do you administer eye ointment?
- If you need to use eye drops and eye ointment in conjunction, use the eye drops first, then wait FIVE mins before using the eye ointment
- Check the expiry date on your eye ointment and wash your hands before opening the tube.
- Lie down or sit down and tilt your head back
- Make a fist with with one hand and use your knuckles to pull your lower eyelid downwards. Place your other hand with the eye ointment onto your knuckles with the nozzle facing downwards towards your eye.
- Look up and squeeze about 1cm of the ointment along the inside of the lower eyelid, making sure the nozzle does not touch the eye, eyelashes or eyelid
- Close your eye for a moment, then blink a few times to spread the ointment around the inside of the eye.
