week 13 routes of administration EENT

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 -> Potential for antipsychotic drugs

Question 2

Blood supply to the nose

Answer 2

Has 5 arteries;called the kiesselbatchs plexus
vascular network formed by five arteries that supply
oxygenated blood
to the nasal septum

Question 3

Respiratory epithelium

Answer 3

Comprised of;
-Columnar cells (ciliated or non-ciliated)
-Goblet cells
-Basal cells

Question 4

Nasal mucosa

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

Question 5

Delivery to the nose

Answer 5

->Nasal sprays
->Nasal drops
->Nasal powders

Question 6

Types of nasal sprays

Answer 6

-Steroid nasal sprays (fluticasone) -> reduces inflammation
-Alpha-adrenergic agonist (xylometazoline) / antihistamine (azelastine) / anticholinergic (ipratropium) nasal sprays -> decongestants
-Saline nasal sprays and rinses -> A more ‘natural’ remedy to treat blocked noses, used in babies/infants
-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 7

Fate of particles delivered to the nose

Answer 7

> 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 8

How to use nasal sprays

Answer 8

Question 9

Sore throat, tonsilitis

Answer 9

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

Question 10

Oral thrush (mouth thrush)

Answer 10

Miconazole, anti-fungal as thrush is caused by a fungal infection

Question 11

Mouth ulcer

Answer 11

Usually appear inside the
mouth, on the cheeks or lips, can also appear on the tounge
-> Present as red/yellow sores
Bonjela Adult contains;
-Cetalkonium chloride, an antiseptic which helps to fight infections
-Choline salicylate, for relief from pain and inflammation

Question 12

Throat

Answer 12

Question 13

Ear

Answer 13

Question 14

Symptoms of excessive ear wax

Answer 14

30% of people over the age of 64 years will suffer wax impaction and wax removal can improve the hearing
-Hearing loss
-Ringing in the ears
-Ear pain
-A sense of fullness in the ear canal
-Itchiness of the ear canal
-Discharge/ ear drainage
-Cough
-Dizziness
-Odor from ear

Question 15

OTC ear drops for excessive ear wax

Answer 15

->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 16

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

How to use ear drops correctly;

Answer 17

Question 18

Eye;

Answer 18

Question 19

Eye conditions

Answer 19

Mild eye conditions:
-Dry eyes
-Conjunctivitis
Serious eye conditions:
-Glaucoma
-Cataracts
-Macular degeneration
-Vision Loss

Question 20

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

Question 22

How to administer eye ointments

Answer 22