Internasal Drug Administration
There has been a great need for medicinal therapy through the internasal route for the last 20 years. This technique of drug administration is attaining popularity day by day because of continuous reporting. The induction of medicine in the body for rapid action even in case of emergencies. The use of the technique is rapid, handy, and without fear of needles getting acceptance among technicians and practitioners in clinics and hospitals. Basically, it is more helpful and accepted in the field of pediatrics by the children and their parents (Abdullah, Mohammed, & Ismail, 2014).
Drug Delivery
In hospitals, there are a lot of drug delivery protocols have been followed. As for slow and timely recovery, oral medication techniques are always preferable. In case of a bad situation or need for the fastest administration of the drug in the related tissue or organ, intravenous medications will be used by doctors. This is obviously an insertion mechanism done by different medicated needles and syringes insertion directly in the veins so the drug can be steadily inoculated into the bloodstream.
Intermuscular medications are also used sometimes in this technique needles are inserted into the muscles of the patient. Both the insertion methods are painful, hazardous to any needle injury, and related to fear or anxiety of needling. It is also more time taking and wanted to train staff attention (Holdgate & Lo, 2010). In pediatrics departments, children mostly refused or resist the needling procedures. It becomes more difficult to administer drugs in children than in adults by needling mechanisms.
So, the alternative method which is the medication via nasal route often called internasal administration in medical terminology is considered the easiest, most helpful, low-budget, pain-free, and very effective way of treatment even in cases of emergencies. Usually, in the pediatrics department, there are many traditional practices of drug administration that are followed almost anywhere which includes medication via the oral cavity called oral administration is sometimes problematic when children can vomit. Children often resist taking oral medication like needling so it can be problematic for a health care staff (Singh, Singh, & Madhv, 2012).
Medication via the rectal route is also a known practice in the pediatric section of hospitals but it cannot work in slightly older children or children in their adolescence stages. So, the new emerging technique of drug induction is medication via the nasal route using nasal passage also known as the internasal route which is considered the most effective, quick patient take care and satisfying way of treatment for children and their parent’s point of view.
The inner lining of the nasal cavity the internasal mucosa has a kind of olfactory tissue which are directly connected with the CNS (Central Nervous System). The mucosa is very dilated and rapidly transfers induced drugs towards mainstream blood and the nervous system to the brain as an onset action mechanism as like in intravenous therapy. So, it can be the best alternative approach to intravenous therapy. Every drug is transferred via liver metabolism is avoided. The medication via the nasal cavity is also pain-free and more effective way than the intravenous technique. It has more bioavailability than many other ways of medication. The internasal way of medication has less requirement of trained staff and expense (Wolfe & Braude, 2010).
In Case of Emergency in Pediatrics
The internasal route of drug administration is providing the most professional, effective, rapid, on-the-set, painless, and non-invasive technique of transmitting any sort of quick medication which can intervene in the blood-brain barrier (BBB) easily from the shortest route of induction.
Even the drug that cannot transmit through the Blood-Brain barrier normally this technique can help the therapeutic agent directly transmit to the nervous system within minutes through the olfactory and trigeminal pathways of the nervous system (Holdgate & Lo, 2010). This internasal medication technique has more beneficial aspects than other used clinical techniques like reducing medicine dosage, and best exposure to administration with the least side effects. According to the reports and practices it can be expected that this newly approached technique of easy medication will grow more effectively now not only in the case of chronic and acute diseases but also in the protection of the nasal tract from microbiological agents (Borland, 2007).
Facilitation of Drugs by Nasopharyngeal Tract
As it is very easy to administer drugs from the nasal route due to its delicate and absorbing nature so it is also very well known that our nasal passage has a lot of sensitivity and limitations of procedure which can hinder the treatment and expected side effects. It is a need to improve or overcome that sensitivity issues by developing the best nasal formulations to ease the tract (Suman, 2013). Studying the pathophysiological condition of the internasal tract can help in determining the drug-related factors, absorption timing of chemical agents, and effective penetration of molecules towards the target side these all can lead to the minimization of therapy timing by the internasal administration technique.
It can also be helpful in mucociliary clearance from the tract and induce drug bioavailability through the nasal passage. All the progressive studies and approaches are benefitted from internasal transmission over all other clinical administrative routes like oral, muscular, intravenous, rectal, etc. this route can transmit any type of complex compound forms like types of vaccine, peptide non-peptides, proteins, and other biomolecules, etc. This transnasal passage also provides an effective way of transmission to enzymes and another non-invasive way of medications. Another advantage of internasal medication is that patients can be self-medicated in their private premises and comfort zone by doctors’ supervision (American Academy of Pediatrics, 2013).
Route of Administration
Anatomical Description of Intranasal Tract
To study the nasal route of administration it is very important to elaborate on its anatomical features through the brief cross-sectional study of this tract. The internasal pathway transfers the medication via the olfactory pathway that consists of the external layer called epithelium then another layer called lamina propria and an olfactory bulb. There are three types of special cells located in this pathway named progenitor cells, supporting and neuronal cells connected to the olfactory epithelial layer joined by fit junction bond. There is also an information transfer pathway towards the brain cells that are basically made up of neuronal cells that arise from the olfactory bulb in the central nervous system towards the external epithelium of the nasal passage (Leopold, 1988).
The continuous movement of the neural and basal cells in between has greatly enhanced the transformation process of molecules toward brain cells (Caggiano et al., 1994). They contain maxillary branches of trigeminal nerves, lots of blood vessels with special types of mucus-secreting glands also olfactory axons that all are present on the external epithelial layer named previously nasal epithelium. The olfactory bulb is the main part of that system that is responsible for the molecule’s transformations, spread towards their targeted destination of the brain as in the hypothalamus. Amygdala, and piriform cortex parts (Khan et al., 2017).
Drug Administration Pathways
One more vital pathway in this role is the trigeminal pathway. This pathway is also responsible for the targeted delivery of drugs and chemical molecules at another side of the blood-brain barrier. This specific trigeminal nerve is found at the side with three respective branches that are named mandibular nerve, ophthalmic and maxillary nerves, they all control the specific region of the system i.e., the respiratory and sensational part of the internasal passage.
From all these nerves the maxillary, as well as ophthalmic nerves, are responsible for the transfer of information from nasal passage towards the central nervous system by control of the nasal mucosal lining(Holdgate & Lo, 2010). Most of the transformations throughout this passage is using these two nerves. Molecules of drugs intervene in the brainstem by means of pons through the trigeminal nerves which are definitely controlled by the nasal cavity and that molecule then transmits towards the caudal and rostral portions of the brain in this way complete transmission of the compound can be completed. It is not only an olfactory pathway that transmits drugs to the brain portions but also the trigeminal pathway has also played important role in it but it is tough to discriminate between functions of two important pathways when a molecule transfer by means of internasal pathways through the nasal intake (Suman, 2013).
Cross-Sectional Picture of Nasopharyngeal Tract
(Semanticscholar, 2013)
Intranasal Delivery of Medicine
Internasal drug delivery therapy now has been registered as the best form of therapeutic approach in the medical field. It can be trusted as a very capable route of drug delivery. Logically this is the most trusted approach among all other ways of transmission. The internasal passage mucosal lining is very sensitive and has also received consideration as a viable point of transmitting cardiovascular drugs, vaccines, sedatives, hormones, etc. nasopharyngeal passage is also used for drug delivery in case of nasopharyngitis like congestions, local infections of different types. Instead of hormones, vaccines, molecules, proteins peptides, and complex molecules, there is a wide range of anti-migraine drugs that can be delivered Also through this passage. Some examples of drugs are sumatriptan, calcitonin, imitriptan, desmopressin, etc. in case of influenza-related infections the nasal route is very successful to deliver vaccines (Suman, 2013).
Figure 3 Ultra-Section Beneath Mucosal Layer
(Semanticscholar, 2013)
Clinical Dosage
Drug delivery through the nasal tract has a requirement of evaluating optimum conditions, effectiveness, transmission methods, dosage count also the bioavailability of medications. These methodologies consist of different adjustments of quantities like the minimum volume of the drug with its maximum concentration (Holdgate & Lo, 2010). In this way try to calculate actual working or apply concentrations with its volume of inoculations. The use of nostrils also had a great role in their effectiveness because both nostrils mean having a large absorption area for a drug to deliver. Also, scientists have focused on the use of sub-atomized quality particles or molecules in the dose that can enhance absorptivity (American Academy of Pediatrics, 2013).
Substitute Concentration
More concentrations in less volume for example 0.2 to 0.3 ml per nostril are perfect while using the excess quantity of volumes like 1 ml in a nostril that cannot be completely captivated. It is obvious that in that case there can be a saturation attained on the mucosal surface as a result excess liquid can be runoff outer to the nasal passage. This large volume dosage can be more needed in adults than children as per the weight-based dosage (Ozsoy, & Güngör, 2011).
To overcome the issues of absorption of ideal concentration and volume of medicine it is important to use both nostrils one by one with achieving complete absorption and no wastage of the drug also has to enhance the drug bioavailability timing and absorption quality. If a liquid drug is transformed into a spray form this problem can be resolved. In this way loss of drugs can also be minimized. The condition of the nasal epithelium at the time of drug induction is also a very important factor as if there is blood or a large amount of mucus for any reason of abnormality can definitely affect the drug absorption and transformed proper dosage (Wolfe & Braude, 2010).
Advantages and Disadvantages
There are more advantages of the nasal tract medication than disadvantages as like wide area of absorption in the nasopharyngeal tract for optimum dose administration. There can be quick and onset infusion of relative medicine due to the extremely vascularised surface area of mucosal epithelium. The drug can be absorbed and transformed rapidly towards the brain by invading the blood-brain barrier within no time of administration. It can be easy to administer a medicine deeply at their target without taking any pain anxiety of other invasive techniques like intravenous or intramuscular injections (Borland, et al., 2007)
Advantages of Intranasal Administration
This method can effectively be used as an emergency medication approach towards child care as well as can be reliable for adults also. The drug can reach the metabolic stage without passing the intestinal tract. Better and improved bioavailability is also another point of advantage using this method of medication. Transportation of medicinal compounds directly towards the circulation system as well as the central nervous system by means of intranasal inoculation technique. This method is very much effective because its advantage in lower dosage quantity also produced the least side effects. The advantage of self-administration is another benefit of convenience for the patient. The restriction of dosage volume is the biggest limitation of this methodology (Borland, et al., 2007).
Disadvantages of Intranasal Administration
Compounds with high molecular weight are also restricted to infused in this way. The pathological conditions of the patient can affect them adversely. The permeability of medicine towards ciliary movement can also have to check. Instead of all the pros and cons, internasal drug administration has caught the attention of our scientific community as it has been hypothetically discovered.
Limitations
There is the least count of adverse reactions of internasal transmission. Among them commonly observed is the irritation and burning of the nasal tract often post-infusion of midazolam. This type of irritating effect mostly arises in long-term or older patient who is continuously using nasopharyngeal medications. If one can use a hyper dosage of intranasal sufentanil during a surgical procedure this can be observed. In children sometimes severe pain can be observed after overdosage of intranasal medication. Nasopharyngeal medication is more cost-effective than intravenous way of medication (Wolfe & Braude, 2010).
Conclusion
The method of nasopharyngeal administration is a very much effective way of medication in clinical fields in normal as well as in emergencies. It is a much-influenced method in modern medicine practice especially in pediatric patients a trustworthy technique to deliver analgesia, anxiolysis, and anticonvulsants. In pediatric emergencies, it can be a routine practice by selecting proper patients and can reduce time with life-saving practices of internasal administration of medication (Singh, Singh, & Madhv, 2012). This can enhance rapid onset patients care activity by reducing time and workers’ resources, and eradicating invasive approaches like needling in intravenous or intramuscular procedures can lead to improving patient and parent satisfaction. All pediatricians or pediatrics should approach this safe practice instead of doing common traditional methods that give anxiety, pain, and fear to innocent patients (Wolfe & Braude, 2010).
References
Ozsoy, Y., & Güngör, S. (2011). Nasal route: an alternative approach for antiemetic drug delivery. Expert Opinion on Drug Delivery, 8(11), 1439-1453.