Nasal mucosa

The use of a bioadhesive, polymeric dosage form for sustained dehvery raises questions about swallowing or aspirating the device. The surface area is small, and patient comfort should be addressed by designing a small (less than 2 cm ), thin (less than 0.1 mm (4 mil) thick) device that conforms to the mucosal surface. The buccal route may prove useful for peptide or protein dehvery because of the absence of protease activity in the sahva. However, the epithelium is relatively tight, based on its electrophysiological properties. An average conductance in the dog is 1 mS/cm (57) as compared to conductances of about 27 and 10 mS/cm in the small intestine and nasal mucosa, respectively (58,59) these may be classified as leaky epitheha. 

Bende, M., Barrow, ]., Heptonstall, J., Higgins, P. G., Al-Nakib, W., Tyrrell, D.. 4.. ind Aker lund, A. (1989). Changes in human nasal mucosa during experimental coronaviruH common colds, Acta Otolaryngol. (Utockh) 107, 262-269. 

Olsson, P., and Bende, M. (198.5). Influence of environmental temperature on human nasal mucosa. Ann. Otol. Rhinol. Laryngol. 94, 1.53-155. 

If using a spray, do not allow the tip of the container to touch die nasal mucosa and do not share the container witii anyone... 

Opioids are easily absorbed subcutaneously and intramuscularly, as well as from the gastrointestinal tract, nasal mucosa (e.g., when heroin is used as snuff), and lung (e.g., when opium is smoked). About 90% of the excretion of morphine occurs during the first 24 hours, but traces are detectable in urine for more than 48 hours. Heroin (diacetyhnorphine) is hydrolyzed to monoacetylmorphine, which is then hydrolyzed to morphine. Morphine and monoacetylmorphine are responsible for the pharmacologic effects of heroin. Heroin produces effects more rapidly than morphine because it is more lipid soluble and therefore crosses the blood-brain barrier faster. In the urine, heroin is detected as free morphine and morphine glucuronide (Gutstein and Akil 2001 Jaffe et al. 2004). 

Nicotine nasal spray delivers nicotine through the nasal mucosa. One advantage of nicotine nasal spray is that it relieves tobacco cravings quickly. One study found that nicotine nasal spray was 2.6 times more likely to produce smoking cessation, compared with placebo, at 1 year (Sutherland et al. 1992). The active spray was also the most beneficial among highly dependent smokers (Sutherland et al. 1992). 

Radulovic S. Jacobson MR. Durham SR. Nouri-Aria KT Grass pollen immunotherapy induces Foxp3-expressing CD4+ CD25+ cells in the nasal mucosa. J AUergy Clin Immunol 2008 121 1467-1472. 1472 el461. 

Krzymowski T., Grzegorzewski W., Stefanczyk-Krzymowska S., Skipor J., et al. (1999). Humoral pathway for transfer of the boar pheromone androstenol, from the nasal mucosa to the brain and hypophysis of gilts. Theriogenol 52, 1225-1240. 

Kulkami A., Getchell T. and Getchell M. (1994). Neuronal nitric oxide synthase is localized in extrinsic nerves regulating perireceptor processes in the chemosensory nasal mucosae of rats and humans. J Comp Neurol 345, 125-138. 

Scalfari F., Castagna M., Fattori B., Andreini I., et al. (1997). Expression of a lipocalin in human nasal mucosa. Comp Biochem Physiol B 118, 819-824. 

In allergic rhinitis, the normal mechanisms by which the nasal mucosa humidifies and filters inspired air are disrupted due to an immunoglobulin E (IgE)-mediated immunologic reaction. 

Sinusitis, or inflammation of the paranasal sinuses, is better described as rhinosinusitis that also involves inflammation of contiguous nasal mucosa, which occurs in virtually all cases of viral respiratory infections. Acute rhinosinusitis is characterized by symptoms that resolve completely in less than 4 weeks, whereas chronic rhinosinusitis typically persists as cough, rhi-norrhea, or nasal obstruction for more than 90 days. Acute bacterial rhinosinusitis (ABRS) refers to an acute bacterial infection of the sinuses that can occur independently or be superimposed on chronic sinusitis. The focus of this section will be on ABRS and appropriate treatment. 

Nasal Administration. The nasal mucosa is relative permeable to small molecular weight compounds. The most notorious example is cocaine. Cocaine that is snorted is both rapidly and extensively absorbed. Small peptides have also been successfully administered nasally, although the bioavailability is low. However, where the availability is not critical, nasal administration of peptides has been successful. The best example is... 

There are special problems in bioequivalency determinations when conventional pharmacokinetic studies are not possible. For example, when drugs are administered intranasally for direct treatment of receptors in the nasal mucosa, the concentration of drug in plasma may be below the limit of quantification. In such cases we are forced to attempt measurement of clinical response. The subjectivity and/or low precision of this type of study can be a serious problem. 

No treatment related mortality was observed however, two control mice were found dead in cages and two high dose mice (one of each sex) were killed in extremis on days 5 and 6. A statistically significant decrease in weight (about 10% as compared to controls) was observed in both sexes at 80.0 ppm, and 89% of the males and 78% of the females showed minimal to mild inflammation of the nasal mucosa in the anterior segments of the nose. No such effects were observed at the lower doses or in controls. 

Inhalation (IH) The administration of volatile gases and vapours, followed by drug absorption in the lungs or nasal mucosa. Examples include general anaesthetics like nitrous oxide, nicotine from the tar droplets in tobacco smoke, cannabinoids from cannabis leaf smoke and various opiates from burning opium resin. 

Greenhalgh, J.R., A. Birchall, A.C. James, H. Smith and A. Hodgson, Differential Retention of Pb-212 Ions and Insoluble Particles in Nasal Mucosa of the Rat, Phys. Med. Biol. 27 837-851 (1982). 

Patients should be viewed epidemiologically. Save clinical and environmental samples for diagnosis. The best early diagnostic sample for most toxins is a swab of the nasal mucosa. 

Signs and Symptoms High fever coughing thick nasal discharge rapidly spreading, deep ulceration of the nasal mucosa submaxillary lymph nodes swollen and painful nodules on the skin, abdomen, and lower limbs death in 1-2 weeks. In the cutaneous form, the lymphatics are enlarged and nodular abscesses ("buds") of 0.5-2.5 cm develop, which ulcerate and discharge yellow oily pus. 

Sinusitis is an inflammation and/or infection of the paranasal sinus mucosa. The term rhinosinusitis is used by some specialists, because sinusitis typically also involves the nasal mucosa. The majority of these infections are viral in origin. It is important to differentiate between viral and bacterial sinusitis to aid in optimizing treatment decisions. 

Adverse events include ulceration of nasal mucosa and nasal septal collapse, tachycardia, heart failure, hyperthermia, shock, seizures, psychosis (similar to paranoid schizophrenia), and sudden death. 

Topical and systemic decongestants are sympathomimetic agents that act on adrenergic receptors in the nasal mucosa to produce vasoconstriction, shrink swollen mucosa, and improve ventilation. Decongestants work well in combination with antihistamines when nasal congestion is part of the clinical picture. 

Topical decongestants are applied directly to swollen nasal mucosa via drops or sprays (Table 79-3). They result in little or no systemic absorption. 

Other adverse effects of topical decongestants include burning, stinging, sneezing, and dryness of the nasal mucosa. 

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