Mucosal Atomization Device - Centegra Health...
Transcript of Mucosal Atomization Device - Centegra Health...
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®
Mucosal Atomization Device
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Physiology
First pass absorptionMolecules absorbed via ingestion enter
the portal circulation and are transported to the liver. Enzymes break down most of the drug and a small percentage enters the circulation as active drug.
When delivered nasally, the drug is not affected by first pass metabolism.
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PhysiologyNose brain pathway
Membranes of the nose are in direct contact with the brain and CSFMeds absorbed across the
membranes directly enter the CSFThe nose offers a rapid, direct
route from drug delivery to the brain
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Physiology
Amount of drug absorbedIV meds = 100%Oral meds = 5-10% because of
destruction in the digestive system and liver
IN (intranasal) vary, Narcan is very near to 100% (same as IV)
IV and IN serum levels are similar after about 2-3 minutes
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Factors Affecting Absorption
MedicationsMolecular sizeLipophilicity (Affinity for fat)pHDrug concentrationProperties of the solution
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Factors Affecting Absorption
Volume and ConcentrationHigh volume or low concentration may
lead to failure because the drug cannot be absorbed in enough quantity to be effective.
Volumes over ½ to 1 mL per nostril are too large; may result in runoff out of the nose
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Factors Affecting Absorption
Nasal mucosal characteristicsNasal mucosa is defective it
may not absorb meds effectivelyVasoconstrictorsEpistaxis,nasal congestion,
mucous discharge prevent mucosal contact of drugDestruction of mucosa from
surgery or past cocaine abuse results in to mucosa to absorb the drug.
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Factors Affecting Absorption
Particle sizeParticle size 10-50 microns adheres
best to the nasal mucosaSmaller particles pass on to the lungsLarger particles from droplets and run
out of the nose
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Contraindications
Epistaxis, trauma, septal abnormality, nasal congestion, mucous discharge
Destruction of nasal mucosa from surgery or past cocaine abuse
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Advantages of IN medications
Avoid needle stick injuriesIN meds offer a needleless solution
to drug deliveryEasy/ConvenientNose – rapid access point for medsPainlessLittle special training is required to
use the device
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Drugs
Narcan (naloxone)Versed (midazolam)Glucagon
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Narcan
Absorption almost as fast as IVDelivery: Immediately on decision to
treat, inject into nose , then begin IMC
Successful awakening may eliminate the need for any IV or further ALS care
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Narcan
Gradual increase in LOC, respiratory status improves fast or faster than IV due to elimination of IV access delay
NOT 100% effective. If needed follow with IV along with reassessment for other causes of altered mental status
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Action
Narcotic antagonistReverses effects of opiate drugs,
narcotics/synthetic narcotics: morphine, Dilaudid, Fentanyl, Demeral, Paregoric, Methadone, Heroin, Percodan, Tylox, Nubain, Stadol, Talwin, Darvon
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Indications
Narcotic/synthetic narcotic ODComa of unknown etiology with
respiratory depression and/or constricted pupils
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Contraindications/Precautions
HypersensitivityUse with caution in patients
dependent on narcotics as it may cause withdrawal syndrome
Rapid reversal of opiate in patients who took combination drugs including stimulants may result in rapid tachycardias.
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Side Effects
CNS: Sedation, H/ACV: ↓SVR, ↓BP, ↓PResp: DepressionEyes: Dry eyes, blurred visionGI: N/VSkin: Rashes, itching
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Interactions
Depressive effects enhanced if used with other sedatives, hypnotics, antihistamines, anti-emetics, barbiturates, ETOH
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Narcan IN AdministrationInspect nostrils for mucus, blood or other
problems that might inhibit absorptionFill syringe with appropriate dose (2 mg
for adults)(0.1 mg/kg up to 2 mg single dose for peds).Expel air from syringeAttach the MAD device via luer lockBriskly compress syringe plunger via rapid
intranasal mist spray (no more than 0.5- 1 mL per nostril).
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Narcan IN Administration
Secure airway as neededNo response in 3-5 minutes, may
repeat the dose.Increase in LOC eliminates need for
IV or further ALS care
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Narcan IN Administration
Gradual increase in LOC with adequate respiratory efforts: Continue to monitor for 3-5 minutes.
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Versed(Midazolam)
Water-soluble benzodiazepineThick and alkaloticCNS depressantSedative/hypnoticSleep induction ↓ anxietyAmnesiaFast onset/offset
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Indications
Sedation prior to DAI and/or cardioversion
SeizuresSevere anxiety/agitation
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Contraindications
Known hypersensitivityGlaucoma; shockPregnancy unless seizingDose for sedation generally ↓ with:
Age > 60Debilitated patients with chronic
diseaseThose on narcotics or CNS depressants
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Dose
IN dose: Anxiety or seizures:(0.2 mg/kg IN) up to 10 mg. Deliver immediately on decision to
treat; then begin IMCNOT 100% effective – may need
follow-up with IV therapy
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Side Effects
DrowsinessSedationConfusionAmnesiaAtaxiaRespiratory
depressionHypotension
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IN Versed Administration
Inspect nostrils for mucus, blood or other problems that might inhibit absorption
Fill syringe with appropriate doseAttach the MAD device via luer lockBriskly compress syringe to
administer ½ of volume (no more than 0.5 – 1 mL per nostril)
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IV Versed Administration
Secure airway as neededIf no response to IN administration
in 5 minutes give IV or IM versed dose per SOP
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Glucagon
blood glucose by converting liver glycogen stores to glucose
Stimulates release of catecholamines causing HR and contractility
Allows for improved cardiac outputPeaks in <20 minutes
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IndicationsAnaphylaxis if a history of CVD, HTN,
pregnant or on beta blockers and not responding to Epi.Symptomatic bradycardia with pulse if on
Beta or Ca blockers and unresponsive to atropine and pacingHypoglycemia without IVBeta/Ca blocker OD if P<60 and BP<90 and
not responding to atropine or pacing
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Contraindications
Chronic hypoglycemiaAdrenal insufficiencyAdrenal tumorWill not be effective in treating
hypoglycemia if no glycogen stores: peds, liver disease, starvation
Hypersensitivity
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Side Effects
HRAllergic reactionN/VDsypnea
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Dose
AnaphylaxisIf history CVD, HTN, pregnant or on
Beta/Ca blockers and not responding to Epi or Dopamine
1 mg IVP/IN/IO/IM May repeat x1
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Dose
Symptomatic bradycardia with pulseIf on Beta/Ca blockers and
unresponsive to atropine and pacing1 mg IVP/IN/IO May repeat every 1
minute up to total dose of 3 mg as needed
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Dose
Beta/Ca blocker overdoseIf pulse <60 and BP <90 and
unresponsive to atropine and pacing per bradycardia SOP
1 mg IVP/IN/IO/IM. May need initial dose of 3 mg
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Dose
Hypoglycemia without IV1 mg IM/IN/IO
NOTE: Mix diluent with powder, Roll the vial. DON’T SHAKE
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