title: Review of Intranasally Administered Medications for Use in the Emergency Department.
abstract: BACKGROUND
  Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter.
  
  
  OBJECTIVE
  This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine.
  
  
  CONCLUSIONS
  The nasal mucosa is highly vascularized, and the olfactory tissues provide a direct conduit to the central nervous system, bypass first-pass metabolism, and lead to an onset of action similar to IV drug administration. This route of administration has also been shown to decrease delays in drug administration, which can have a profound impact in a variety of emergent scenarios, such as seizures, acutely agitated or combative patients, and trauma management. IN administration of midazolam, lorazepam, flumazenil, dexmedetomidine, ketamine, fentanyl, hydromorphone, butorphanol, naloxone, insulin, and haloperidol has been shown to be a safe, effective alternative to IM or IV administration. As the use of IN medications becomes a more common route of administration in the emergency department setting, and in prehospital and outpatient settings, it is increasingly important for providers to become more familiar with the nuances of this novel route of medication delivery.
  
  
  CONCLUSIONS
  IN administration of the reviewed medications has been shown to be a safe and effective alternative to IM or IV administration. Use of IN is becoming more commonplace in the emergency department setting and in prehospital settings.
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky.
authors.forename: Abby M
authors.initials: AM
authors.lastname: Bailey
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky.
authors.forename: Regan A
authors.initials: RA
authors.lastname: Baum
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky.
authors.forename: Karolyn
authors.initials: K
authors.lastname: Horn
authors.affiliation: Department of Pharmacy, Charleston Area Medical Center, Charleston, West Virginia.
authors.forename: Tameka
authors.initials: T
authors.lastname: Lewis
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky.
authors.forename: Kate
authors.initials: K
authors.lastname: Morizio
authors.affiliation: Department of Pharmacy, Charleston Area Medical Center, Charleston, West Virginia.
authors.forename: Amy
authors.initials: A
authors.lastname: Schultz
authors.affiliation: Department of Pharmacy, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Kyle
authors.initials: K
authors.lastname: Weant
authors.affiliation: Department of Pharmacy, St. Claire Regional Medical Center, Morehead, Kentucky.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Justice
mesh_terms: D000281:Administration, Intranasal / Q000379:methods*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000627:therapeutic use; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000639:trends*; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D005442:Flumazenil / Q000008:administration & dosage / Q000627:therapeutic use; D006220:Haloperidol / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage / Q000627:therapeutic use; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use; D008140:Lorazepam / Q000008:administration & dosage / Q000627:therapeutic use; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000778:Anesthetics, Dissociative; D000927:Anticonvulsants; D000931:Antidotes; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D005442:Flumazenil; D020927:Dexmedetomidine; D007649:Ketamine; D006220:Haloperidol; D008140:Lorazepam; D004091:Hydromorphone; D008874:Midazolam; D005283:Fentanyl
keywords: emergency department; intranasal; medication; nasal; prehospital