Intranasale steroide

Due to changes in clearance, the mean half-life of butorphanol is increased by 25% (to over 6 hours) in patients over the age of 65 years (see CLINICAL PHARMACOLOGY: Pharmacokinetics ). Elderly patients may be more sensitive to the side effects of butorphanol. In clinical studies of Stadol NS, elderly patients had an increased frequency of headache, dizziness, drowsiness, vertigo, constipation, nausea and/or vomiting, and nasal congestion compared with younger patients. There are insufficient efficacy data for patients ≥65 years to determine whether they respond differently from younger patients.

Acute overdosage by intranasal administration is unlikely since ipratropium bromide is not well absorbed systemically after intranasal or oral administration. Following administration of a 20 mg oral dose (equivalent to ingesting more than two bottles of Atrovent® (ipratropium bromide) Nasal Spray %) to 10 male volunteers, no change in heart rate or blood pressure was noted. Following a 2 mg intravenous infusion over 15 minutes to the same 10 male volunteers, plasma ipratropium concentrations of 22-45 ng/mL were observed (>100 times the concentrations observed following intranasal administration). Following intravenous infusion these 10 volunteers had a mean increase of heart rate of 50 bpm and less than 20 mmHg change in systolic or diastolic blood pressure at the time of peak ipratropium levels.

Seasonsal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) as well as intermittent and persistent allergic rhinitis are widespread diseases. Because a combined occurrence of ocular and nasal symptoms is very common the summarising term allergic rhinoconjunctivitis is frequently used. SAC and PAC representing the two acute forms of allergic conjunctivitis account for more than 90% of all cases of allergic conjunctivitis. Compared to the chronic forms of allergic conjunctivitis their course of disease is milder. Nevertheless because of their high prevalence and the proven influence on patientsʼ quality of life they possess clinical and socioeconomic relevance. Allergic rhinoconjunctivitis is caused by a type 1 IgE-mediated hypersensitivitity reaction that is provoked by aeroallergens in the majority of cases. The pathognomonic sign is itching. Besides, typical ocular findings are chemosis, conjunctival injection,watery secretion and lid swelling. Otorhinolaryngologistsʼ findings include rhinorrhea, postnasal drip and sneezing. Problems in breathing through the nose resulting from nasal obstruction can cause impaired nighttime sleep and daytime somnolence. In addition to a reduction of allergen exposure by modification of environment and life style factors, in mild forms of SAC and PAC artificial tears are recommended. Topical antihistamines can generate rapid relief from acute symptoms and itching. Topical mast cell stabilisers however provide long-term effects. Dual action drugs that combine antihistamines and mast cell stabilisers show increased patient compliance due to reduced application frequency. Use of topical steroids should be cautious and only temporary. For prolonged treatment periods unpreserved anti-allergic eye-drops should be preferred. Combined topical antihistamines and new-generation topical nasal steroids often used by otorhinolaryngologists demonstrate a good safety profile without systemic side effects. In summary, allergic rhinoconjunctivitis represents a common disease pattern that can be treated effectively. Once it is diagnosed correctly targeted treatment results in improved patientsʼ quality of life quickly.

The most common reason one would not choose an oral route and would instead elect to use nasal or buccal routes is due to delays in onset of oral medications and due to gastric acid destruction and first pass metabolism of drug resulting in very low levels available to the blood stream. Failure to utilize the nose brain path also occurs with oral (and buccal) medications - resulting in much slower drug delivery to the brain.  Interestingly, oral  medications are also commonly refused by 30% of pediatric patients making them completely ineffective in this situation.[11] Buccal medications also require a cooperative patient who will retain the medication within their buccal and sublingual mucosal areas and not swallow or spit it out. In fact, even when buccal medications are administered to volunteers in research settings, only about 56% remains in the oral cavity for absorption.[12] Even nasal drug delivery can have problems depending on the delivery method. Yuen et al report that in % of pediatric patients they were unable to dispense drops into the nose due to resistance to this delivery technique.[13] While nasal delivery is possible the majority of the time, to overcome these delivery issues a number of device have been developed that enhance delivery - these are discussed in the delivery techniques section of this web site.

Intranasale steroide

intranasale steroide

The most common reason one would not choose an oral route and would instead elect to use nasal or buccal routes is due to delays in onset of oral medications and due to gastric acid destruction and first pass metabolism of drug resulting in very low levels available to the blood stream. Failure to utilize the nose brain path also occurs with oral (and buccal) medications - resulting in much slower drug delivery to the brain.  Interestingly, oral  medications are also commonly refused by 30% of pediatric patients making them completely ineffective in this situation.[11] Buccal medications also require a cooperative patient who will retain the medication within their buccal and sublingual mucosal areas and not swallow or spit it out. In fact, even when buccal medications are administered to volunteers in research settings, only about 56% remains in the oral cavity for absorption.[12] Even nasal drug delivery can have problems depending on the delivery method. Yuen et al report that in % of pediatric patients they were unable to dispense drops into the nose due to resistance to this delivery technique.[13] While nasal delivery is possible the majority of the time, to overcome these delivery issues a number of device have been developed that enhance delivery - these are discussed in the delivery techniques section of this web site.

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