Nasal Metabolism The nasal route of administration avoids

Nasal Metabolism The nasal route of administration avoids hepatic first-pass metabolism, but nasal mucosa does possess enzymatic activity (nasal first pass metabolism) Ex. CYT P 450 enzymes – hydroxylases – carboxylesterases …. (the use of prodrugs)

INTRANASAL ADMINISTRATION OF DRUGS Currently, intranasal drug delivery is primarily employed to treat allergies and infections which cause nasal irritation, sneezing and congestion by the topical action of drugs. The observation that nasally-administered sympathomimetics and antihistamines, used for their local action, produced quite significant systemic effects, suggested that the nasal route could be used effectively to deliver drugs systemically.

Drugs administered for local action Rhinitis is commonly treated with topical administration of corticosteroids, sodium cromoglycate or azelastine, an H 1 -antagonist which is administered via a nasal spray. The a-adrenergic agonist decongestant sprays containing phenylephrine, xylometazoline or tetrahydrozoline, often used in the management of allergic rhinitis, significantly increase nasal mucous velocity within ten minutes of administration.

Nasal dropper spray ﺑﺨﺎﺥ ﺃﻨﻔﻲ Nasal drops

ﺍﻟﻄﺮﻳﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﺘﻄﺒﻴﻖ ﺍﻟﻘﻄﻮﺭﺍﺕ ﺍﻷﻨﻔﻴﺔ How to Use Nose Drops Properly 2 Wash your hands thoroughly with soap and water

ﺍﻟﻄﺮﻳﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﺘﻄﺒﻴﻖ ﺍﻟﻘﻄﻮﺭﺍﺕ ﺍﻷﻨﻔﻴﺔ How to Use Nose Drops Properly 3 Check the dropper tip to make sure that it is not chipped or cracked. 4 Avoid touching the dropper tip against your clean nose.

ﺍﻟﻄﺮﻳﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﺘﻄﺒﻴﻖ ﺍﻟﻘﻄﻮﺭﺍﺕ ﺍﻷﻨﻔﻴﺔ How to Use Nose Drops Properly 5 Tilt your head as far back as possible, or lie down on your back on a flat surface (such as a bed) and hang your head over the edge.

ﺍﻟﻄﺮﻳﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﺘﻄﺒﻴﻖ ﺍﻟﻘﻄﻮﺭﺍﺕ ﺍﻷﻨﻔﻴﺔ How to Use Nose Drops Properly 6 Place the correct number of drops into your nose.

ﺍﻟﻄﺮﻳﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﺘﻄﺒﻴﻖ ﺍﻟﻘﻄﻮﺭﺍﺕ ﺍﻷﻨﻔﻴﺔ 7 Bend your head forward toward your knees and gently move it left and right.

ﺍﻟﻄﺮﻳﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﺘﻄﺒﻴﻖ ﺍﻟﻘﻄﻮﺭﺍﺕ ﺍﻷﻨﻔﻴﺔ 8 - Remain in this position for a few minutes. 9 - Clean the dropper tip with warm water. Cap the bottle right away. 10 - Wash your hands to remove any medication.

ﺍﻟﻄﺮﻳﻘﺔ ﺍﻟﻤﺜﻠﻰ ﻟﺘﻄﺒﻴﻖ ﺍﻟﺒﺨﺎﺧﺎﺕ ﺍﻷﻨﻔﻴﺔ 3 - Gently insert the bottle tip into one nostril. Press on the other side of your nose with one finger to close off the other nostril. 4 - Keep your head upright.

• Rhinitis commonly known as a runny nose • irritation and inflammation of some internal areas of the nose. • It is caused by chronic or acute inflammation of the mucous membrane of the nose due to viruses, bacteria or irritants.

Significance of questions and answers Age Symptoms of allergic rhinitis may start at any age, although its onset is more common in children and young adults

Symptoms A runny nose is a commonly experienced symptom of allergic rhinitis. The discharge is often thin, clear and watery, but can change to a thicker, coloured, purulent one. This suggests a secondary infection

Nasal congestion The inflammatory response caused by the allergen produces vasodilatation of the nasal blood vessels and so results in nasal congestion. Severe congestion may result in headache and occasionally earache. Nasal itching commonly occurs.

Eye symptoms The eyes may be itchy and also watery People who suffer severe symptoms of allergic rhinitis may be hypersensitive to bright light Sneezing Previous history There is commonly a history of hay fever going back over several years.

Danger symptoms/associated conditions When associated symptoms such as tightness of the chest, wheezing, shortness of breath or coughing are present, immediate referral is advised. These symptoms may herald the onset of an asthmatic attack

Treatment timescale Improvement in symptoms should occur within a few days. If no improvement is noted after 5 days, the patient might be referred to the doctor for otherapy.

Management •

Decongestants Oral or topical decongestants may be used short term to reduce nasal congestion alone or in combination with an antihistamine. They can be useful in patients starting to use a preventer such as a nasal corticosteroid (e. g. beclometasone) or sodium cromoglicate where congestion can prevent the drug from reaching the nasal mucosa. Topical decongestants can cause rebound congestion, especially with prolonged use. Oral decongestants are occasionally included such as pseudoephedrine.

Steroid nasal sprays A steroid nasal spray is the treatment of choice for moderate to severe nasal symptoms that are continuous. The steroid acts to reduce inflammation that has occurred as a result of the allergen’s action the patient needs to know that it is likely to take several days before the full treatment effect is reached. Dryness and irritation of the nose and throat as well as nosebleeds have occasionally been reported; otherwise side-effects are rare. Beclometasone and fluticasone nasal sprays can be used in patients over 18 years of age for up to 3 months. They should not be recommended for pregnant women or for anyone with glaucoma.

Sodium cromoglicate is available OTC as nasal drops or sprays and as eye drops. Cromoglicate can be effective as a prophylactic if used correctly. It should be started at least 1 week before the hay fever season is likely to begin and then used continuously. There seem to be no significant side-effects, although nasal irritation may occasionally occur. Cromoglicate eye drops are effective for the treatment of eye symptoms that are not controlled by antihistamines. Cromoglicate should be used continuously to obtain full benefit. The eye drops should be used four times a day. The eye drops contain the preservative benzalkonium chloride and should not be used by wearers of soft contact lenses.

Topical antihistamines Nasal treatments Azelastine is a nasal spray used in allergic rhinitis. The BNF suggests that treatment should begin 2– 3 weeks before the start of the hay fever season. Its place in treatment is likely to be for mild and intermittent symptoms in adults and children over 5 years. Advise the patient to keep the head upright during use to prevent the liquid trickling into the throat and causing an unpleasant taste.