Nasal disorders

Rheumatic disorders and coUagen diseases Ophthalmic, otic, and nasal disorders Dermatologic diseases Respiratory diseases... 

Nasal disorders Use of the nasal spray is not recommended in patients with known chronic nasal disorders (eg, allergy, rhinitis, nasal polyps, sinusitis) because such use has not been adequately studied. 

This chapter deals with preparations for nasal administration, with a local or a systemic effect. Classical nasal preparations were always associated with local ailments, but nowadays the interest in the nasal route for systemi-cally acting substances and direct nose to brain delivery is increasing. Fast absorption, the possibility of high blood levels and a patient friendly dosage form are the reasons. Nasal administration of medicines with local effect is the first choice for the treatment of topical nasal disorders. It is also an attractive route for low dose active substances with a systemic effect, such as peptides or benzodiazepines (e.g. midazolam). When compared to parenteral administration nasal administration is more easily applied and causes less risk of infection. 

Hypotension and allergic disorders, asthma 25/mg—50 mg IM, SO, or IV topical nasal decongestant instill in each nostril q4h... 

Continuous positive airway pressure Therapy delivered using a nasal mask to improve the patency of the upper airway by maintaining sufficient air pressure to alleviate sleep-disordered breathing. 

Nasal corticosteroids are effective in vasomotor rhinitis, but because of the duration of the disorder, certain caution is advised to avoid systemic effects and local adverse reactions after long-term use. Ipratropium bromide spray works well if the dominating problem is runny nose. 

Local skin disorders (minor Burns, insect Bites, prickly heat, skin manifestations ofchick-enpox, aBrasions), and mucous memBrane disorders (local anesthesia of oral, nasal, and laryngeal mucous memBranes local anesthesia of respiratory, urinary tract relief of discomfort of pruritus ani, hemorrhoids, pruritus vulvae) Topical Apply to affected areas as needed. 

For the treatment of panic disorder, the starting adult dose is 0.25 mg twice a day, which may be increased by one mg daily after three days. Clonazepam s safety and effectiveness has not been determined for individuals under the age of 18. Side effects in the treatment of panic disorders are similar to many of the benzodiazepines, and include allergic reaction, inflamed sinuses or nasal passages, flu, menstrual problems, respiratory infection, speech problems, and vaginal inflammation. 

Breathing-related sleep disorder is a potentially life-threatening abnormal respiratory condition. It includes cessation of both nasal and oral air flow (apnea), which in some patients may last up to 2 min. The most prominent sign is loud snoring. This disorder can also include hypopneas and hypoventilation. There are three forms of breathing-related sleep disorders ... 

Experimentally areocoline (betel nuts) and the hormone vasopressin in a nasal spray have been used to enhance short term memory. A number of other drugs are being investigated most of which are already in use for other disorders. 

Intravenous injection is the most common route although subcutaneous injection may also be used. A concentrated nasal spray formulation has been proved to be efficient for home treatment of patients with bleeding episodes or even minor surgical procedures and has also been used prophylacticly (4). The nasal spray used to treat diabetes insipidus (Desmospray) is too dilute for use in disorders of hemostasis. Similarly, desmopressin in tablet form (Desmotabs) is intended for treatment of nocturnal enuresis in children and is of no use in the treatment of hemostatic disorders. 

In an open trial of high-dose desmopressin 1.5 mg intra-nasally to control bleeding in 278 patients with congenital bleeding disorders, headache occurred in 3.6% and flushing in 3.2% of patients (18). Dizziness and nausea were reported in 1-1.5% and edema in 0.3% of patients. 

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