Insufflation

Alkylation of the dihydroxyacetophenone, 44, with epichloro-hydrin results in condensation of two molecules of the phenol with the latent glycerol (45). Reaction of the intermediate with ethyl oxalate affords the chromone ester, 46. Saponification leads to the bronchiodilator cromoglycic acid (47). The agent is usually administered by oral insufflation as its extremely insoluble disodium salt. 

A high proportion of both groups reported abuse of other drugs, including alcohol (51 percent), opiates (38 percent), and marijuana (29 percent). All the PCP abusers in the sample had used PCP for at least 2 years (55 percent more than 5 years) 35 percent used it at least daily. All but one abuser smoked his PCP the exception used it by insufflation. 

Atropine, epinephrine, and lidocaine can be administered through the tracheal tube before venous access is achieved at 2-2.5 times the recommended intravenous dose diluted with 10 mL of normal saline or sterile water. Stop CPR, administer beyond the tip of the endotracheal tube, follow with five quick insufflations to aerosolize the drug, and then resume CPR. 

P. Russo, C. Sacchetti, I. Pasquali, R. Bettini, G. Massimo, P. Colombo, and A. Rossi. Primary microparticles and agglomerates of morphine for nasal insufflation. J Pharm Sci 95 2553-2561 (2006). 

In a study performed in rabbits, rhG-CSF in a powder formulation (aerodynamic diameter < 4 pm) was insufflated via an intratracheal tube and compared to intratracheal instillation of a solution of the drug. In this study it was shown that a direct relation exists between the amount of protein that was deposited deep into the lung and the relative bioavailability [33]. 

A review of the animal studies concluded that a fibronodular response has resulted only from intratracheal insufflation of catalytically active, low-temperature-range transitional aluminas and high-surface-area aluminas. In general, alumina is efficiently eliminated from the lung and has a low degree of fibrogenicity. 

Adequate Airway. Adequate airway must be established and maintained, generally via oropharyngeal or endotracheal airways, cricothyrotomy, or tracheostomy. Ventilation Ventilation may then be performed via mouth-to-mouth insufflation, hand-operated bag (ambu bag) or by mechanical ventilator. 

Of course, in all these cases, the influence of the always-present modulator water cannot be neglected. Its influence increases with decreasing polarity of the added modulator. Even with high modulator concentrations such as those used in the case of n-butanol or ethyl apetate. insuffl-cient control of the water content leads to loss of reproducibility and especially to unpredictable selectivities 61). 

While some stimulants, such as amphetamine and methylphenidate, are taken orally, others are either volatilized for inhalation or snorted as the solid (nasal insufflation). It is necessary to convert cocaine and methamphetamine to their free base so that they can be volatilized. Methamphetamine and cocaine are also abused via the intravenous route. 

Solid dosage form includes capsules, granules, effervescent granules, powders, tablets, insufflations, suppositories (pessaries, bougies and ear cone) etc. 

Insufflations are dusting powder consisting medicaments that are blown by an insufflator (similar to atomiser) into various body cavities, nose, throat, ear etc., where it would be difficult to apply the powder directly. 

The chromone cromolyn sodium (5-5) was at one time considered the forerunner of a novel class of antiallergic and antiasthmatic drugs that act at one of the earliest stages of the allergic reaction. Detailed experiments, acmally conducted after the dmg s clinical effectiveness had been confirmed, suggested that the compound inhibited the release of mediators of the allergic reaction from mast cells. The dmg is not very active when taken orally and is usually applied topically to the lung by insufflation as its sodium salt. Considerable efforts to uncover additional structurally related mediator release inhibitors have had only limited success. 

If disturbances of gastrointestinal function prevent the use of oral sustained-release morphine, the fentanyl transdermal system (fentanyl patch) can be used over long periods. Furthermore, buccal transmucosal fentanyl can be used for short episodes of breakthrough pain (see Alternative Routes of Administration). Administration of strong opioids by nasal insufflation has been shown to be efficacious, and nasal preparations are now available in some countries. Approval of such formulations in the USA is growing. In addition, stimulant drugs such as the amphetamines have been shown to enhance the analgesic actions of the opioids and thus may be very useful adjuncts in the patient with chronic pain. 

Vasopressin (but not desmopressin) can cause vasoconstriction and should be used cautiously in patients with coronary artery disease. Nasal insufflation of desmopressin may be less effective when nasal congestion is present. 

Jeffcoat, A.R., Perez-Reyes, M., and Hill, J.M., Cocaine disposition in humans after intravenous injection, nasal insufflation (snorting), or smoking, Drug Met. Disp., 17, 153-159, 1989. 

Heroin is typically self-administered by intramuscular or intravenous injection and also by nasal insufflation ( snorting ) or smoking. Peak heroin concentrations in blood are achieved within 1 to... 

DPI Dry powder insufflation. Avoids coordination problems lower drug loss by impaction and no propellant problems associated with pMDIs. High inspiratory effort may be required coughing reflex may be less convenient then pMDI. More sophisticated multiple dose devices. 

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