Emergency Medicine Book


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. Acute Pain Management
    3. Intranasal Analgesics in Children
    4. Childlife Specialist Measures to Calm Children
    5. Difficult Intravenous Access in Children
  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. Bioavailability is typically better than oral medications, as the nasal route bypasses first pass metabolism
    3. Ideal intranasal medications are lipophilic and small in molecular size
    4. Intranasal medications are best tolerated and absorbed at pH 4.5 to 6.5
    5. Maximal amount that may be absorbed intranasally is 0.3 ml
    6. 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)
      2. Alternatives when atomizer is unavailable
        1. Slow drip into the nose via syringe
        2. Syringe with angiocatheter plastic tip with slow drips into the nose
    7. Technique
      1. Blow nose before administration (Rhinorrhea and mucous may interfere with absorption)
      2. Direct the MAD Atomizer toward the occiput or ipsilateral eye (not up)
  4. Preparations: Intranasal medications for analgesia and sedation
    1. See Procedural Sedation and Analgesia for dosing
    2. Intranasal route administration uses intravenous medication preparations
    3. Analgesia
      1. Fentanyl
      2. Ketamine
      3. Lidocaine
    4. Sedation
      1. Midazolam (Versed)
      2. Dexmedetomidine (Precedex)

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