Nasal Meds

[Av8or007]

Can anyone tell me if it is possible to give parentral diphenhydramine and dimenhydrinate IN using the nasal MAD or a similar device. I know that IM injection works well and is simple, i would just like to know if it is possible based of off the pharmacokinetics of those drugs and the IN route.

Thanks

 

[Handsome Robb]

That's a good question.

First thought is no but my only reason is because of the severe rhinorrhea often seen in allergic reactions. Other than that I don't see any reason why it would be effective...

 

[Av8or007]

OK. So barring that, the drug should act similarly to normal parental (IM) administration?

What about the gravol? I'm asking in the context of wilderness medicine/travel medicine. If someone was vomiting and couldn't keep oral gravol down, would IN gravol likely work similarly to IM gravol?

 

[Aidey]

Realistically it would be a better idea to find an antiemetic that either dissolves under the tongue or is chewable. I can't imagine that the IV version of gravol would taste very good, and when you give something IN a certain amount will drip down to the throat. I've had pts gag before from IN fentanyl.

 

[mike1390]

I dont understand that point, If you can use it IM why dont you? The only reason I use IN meds is because I dont think trying to restrain the pt to stick them with a needle is a very good risk vs. reward situation ie; Versed for a seizure or combative pt.

 

[usalsfyre]

Versed for a combative pt.

Anecdotally, I've found this doesn't work very well, the usually simply blow it right back out. Distract them, then dart with a large needle works much better.

 

[Sublime]

Anecdotally, I've found this doesn't work very well, the usually simply blow it right back out. Distract them, then dart with a large needle works much better.

Exactly. I've never had good experience trying IN versed on combative patients. Trying to shoot something up someone's nose while they're being pissed and uncooperative isn't the best option.

And as far as IN benadryl, why don't you give it IM? I'm sure it would work IN, just not sure how pleasant that'd be. Never heard of anyone using it IN.

 

[Carlos Danger]

Can anyone tell me if it is possible to give parentral diphenhydramine and dimenhydrinate IN using the nasal MAD or a similar device. I know that IM injection works well and is simple, i would just like to know if it is possible based of off the pharmacokinetics of those drugs and the IN route.

Thanks

Have you looked at the drug insert for those meds? What does the manufacturer say?

Are the formulations lipid or water soluble?

 

[Devilz311]

Anecdotally, I've found this doesn't work very well, the usually simply blow it right back out. Distract them, then dart with a large needle works much better.

I've had this experience too... We had a severely combative postictal patient and were ordered to give 2mg Ativan IN because our Med Control doc stated it "wouldn't be safe" to attempt an IM injection...

With any combative Patient, the first thing they are going to protect is their head, so this goes out the window fairly quickly... it's much easier to do a quick IM injection in less than a second.

 

[rmabrey]

Anecdotally, I've found this doesn't work very well, the usually simply blow it right back out. Distract them, then dart with a large needle works much better.

This is working its way into our protocol soon and this was my initial thoughts.