Emergency Medicine Book

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Intranasal Drug Delivery Route

Aka: Intranasal Drug Delivery Route, Intranasal Medication Route, Intranasal Route of Medication Delivery
  1. See Also
    1. Procedural Sedation and Analgesia
  2. Indications
    1. Procedural Sedation and Analgesia
    2. Difficult Intravenous Access in Children
    3. Laceration Repair
    4. Lumbar Puncture
  3. Mechanism
    1. Nasal mucosa is well vascularized with rapid medication absorption
    2. Ideal intranasal medications are lipophilic and small in molecular size
    3. Intranasal medications are best tolerated and absorbed at pH 4.5 to 6.5
    4. Maximal amount that may be absorbed intranasally is 0.3 ml
    5. Typical drug delivery is via a Mucosal Atomization Device (MAD Atomizer)
      1. Device has 0.1 ml dead space (draw up extra 0.1 ml medication)
  4. Preparations: Intranasal medications for analgesia and sedation
    1. See Procedural Sedation and Analgesia for dosing
    2. Analgesia
      1. Fentanyl
      2. Ketamine
      3. Lidocaine
    3. Sedation
      1. Midazolam (Versed)
      2. Dexmedetomidine (Precedex)

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