Standardized Use Of 7 Nasal Medications

When using medication in the nose, the liquid should not seriously affect the ciliary function of the nasal mucosa. The acidity and alkalinity of the surface mucus of the nasal mucosa are between 5.5 and 6.5, and the medication should be compatible with this and isotonic. The nasal mucosa has a large surface area (about 150cm2), and the rich vascular network under the mucosa has a strong ability to absorb absorption, so the side effects of drugs on the whole body should be taken into account when using local drugs. Under normal circumstances, it is not advisable to apply antibiotic solution locally within the nose. Because the main focus of nasal purulent infection is in the sinuses, with poor drainage at the mouth of the sinuses, and inflammatory changes in the nasal turbinate mucosa are mainly reactive inflammation. Intranasal antibiotics have little effect, and long-term use may lead to fungal infections in the nose.
When using nasal medication, the correct posture and method should be used. Before using nasal drops, the nose should be blown clean, and the shoulders should be level with the edge of the bed in a supine position. The head should be tilted back and down, with the nostrils facing vertically upwards. Drip 3-4 drops onto each side of the nostrils, and after 30 seconds, tilt the head left and right for 30 seconds each. Then, return the head to its original position and maintain it for 30 seconds. Finally, sit up and lower the head in front of the nose to fully distribute the medication throughout the entire nasal cavity and various nasal passages, facilitating the opening of the sinus opening. When using nasal spray, sit down. After blowing your nose, hold the medicine bottle in your left hand, and put the nozzle into the right nostril, with the nozzle facing the outer corner of your right eye, so that the liquid medicine can be sprayed to the outer wall of the nasal cavity, and vice versa. The liquid medicine should not be sprayed to the nasal septum, so as to avoid epistaxis or even ulceration and perforation of the nasal septum.
1. Intranasal antibiotics
As mentioned earlier, antibiotic drugs should not be used in the nose. However, for diseases such as atrophic rhinitis, nasal sclerosis, immobile cilia syndrome, and Kartagner's triad (nasal sinusitis, bronchiectasis, and visceral transposition), due to the dysfunction of mucociliary function on the surface of the nasal mucosa, scabs should form on the surface of the mucosa, allowing bacteria to grow subcutaneously. At this time, local application of antibiotics can be considered.
Mupirocin is used for nasal vestibular infection, which can effectively eliminate drug resistant Staphylococcus aureus in the nasal vestibule, so that it can reduce the irritation of enterotoxin produced by it to the nasal mucosa, thus reducing the occurrence of rhinosinusitis. Streptomycin and gentamicin are used to treat atrophic rhinitis; Rifampicin is used to treat nasal sclerosis.
2. Antihistamines
Nasal sprays Azelastine and Levocabastine are given twice a day, 2-3 times a day, for allergic rhinitis. This type of medication takes effect 15 to 30 minutes after being sprayed into the nasal cavity.
3. Glucocorticoids
Nasal spray hormone has become a first-line drug for treating allergic rhinitis and nasal polyps, and is also the main means of treating chronic sinusitis. When applying, it is necessary to strictly follow the dosage and master the correct method of using nasal sprays. Children should choose drugs with low bioavailability. If dexamethasone nasal drops are used, they are easily absorbed and can cause significant systemic side effects if used for a long time or in excessive doses. They have been phased out.
Common medications:
Beclomethasone dipropionate, triamcinolone, budesonide, fluticasone propionate, and mometasone furoate. The clinical application of beclomethasone dipropionate was the earliest, but due to its high bioavailability, it has gradually been replaced by later nasal spray hormones. Nasal hormones have a good absorption effect when sprayed in the morning, usually twice a time, 1-2 times a day.
4. Decongestive agents
The clinical efficacy of decongestants is mainly to relieve nasal congestion and improve nasal ventilation and drainage. It should be noted that this type of drug cannot be used for a long time, and continuous use generally does not exceed 7 days, otherwise it may cause drug-induced rhinitis. When applying, attention should also be paid to the absorption of drugs by the mucosa, and caution should be exercised in patients with cardiovascular disease, hypertension, and other conditions. When used in children, the concentration is halved compared to adults.
1% ephedrine in N.S nasal drops (0.5% concentration) are used in children to contract nasal mucosal blood vessels, improve nasal ventilation, and promote sinus drainage. For severe nasal congestion, 2-4 drops each time, 3 times a day. It is prohibited for children before bedtime to prevent poor sleep.
Oxymetazoline in N.S. has a strong and lasting vasoconstriction effect, while the secondary vasodilation effect is less. Children under 3 years old are not recommended to use, and children aged 3-6 should use it in moderation.
5. mast cell stabilizer
Cromolyn sodium nasal drops and nedocromile are used to prevent allergic symptoms from occurring. Patients with seasonal allergic rhinitis can start using it one week before the pollen period.
6. Mucosal irritants
Compound peppermint camphor nasal drops: peppermint, camphor, eucalyptus oil. Lubricates the nasal mucosa, stimulates nerve endings, promotes mucosal gland secretion, and deodorizes. Used to treat dry rhinitis and atrophic rhinitis. Commonly used drugs include compound cod liver oil nasal drops and liquid paraffin nasal drops.
7. Maxillary sinus flushing solution
Ingredients: 2g metronidazole, 2.5g chloramphenicol, 5mg chymotrypsin, 9g sodium chloride, add distilled water to 1000ml. Function: It has bactericidal effects on both anaerobic and aerobic bacteria, and can dilute mucus. Used for puncture and flushing of the maxillary sinus in chronic maxillary sinusitis.