Medicine and Health Sciences Commons^™

Analyses Of Patients Who Self-Administered Diazepam Nasal Spray For Acute Treatment Of Seizure Clusters, Sunita Misra, Michael R Sperling, Vikram Rao, Jurriaan Peters, Patricia Penovich, James Wheless, R. Edward Hogan, Charles Davis, Enrique Carrazana, Adrian Rabinowicz

Department of Medicine Faculty Papers

For acute treatment of seizure clusters in patients with epilepsy, intranasal administration of acute seizure therapies has been shown to provide accessibility and ease of use to care partners as well as the potential for self-administration by patients. Diazepam nasal spray (Valtoco®) was approved by the US Food and Drug Administration for acute treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) in patients with epilepsy aged ≥6 years. Self-administration consistent with the prescribing information is feasible and was reported by a subgroup of patients (n = 27 of 163) in a long-term phase …

Nasal Iodophor Antiseptic Vs Nasal Mupirocin Antibiotic In The Setting Of Chlorhexidine Bathing To Prevent Infections In Adult Icus: A Randomized Clinical Trial, Susan S Huang, Edward J Septimus, Ken Kleinman, Lauren T Heim, Julia A Moody, Taliser R Avery, Laura Mclean, Syma Rashid, Katherine Haffenreffer, Lauren Shimelman, Whitney Staub-Juergens, Caren Spencer-Smith, Selsebil Sljivo, Ed Rosen, Russell E Poland, Micaela H Coady, Chi Hyun Lee, Eunice J Blanchard, Kimberly Reddish, Mary K Hayden, Robert A Weinstein, Brandon Carver, Kimberly Smith, Jason Hickok, Karen Lolans, Nadia Khan, S Gwynn Sturdevant, Sujan C Reddy, John A Jernigan, Kenneth E Sands, Jonathan B Perlin, Richard Platt

Student and Faculty Publications

IMPORTANCE: Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization.

OBJECTIVE: To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing.

DESIGN, SETTING, AND PARTICIPANTS: Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) …

Exploring The Potential Of Intranasally Administered Naturally Occurring Quercetin Loaded Into Polymeric Nanocapsules As A Novel Platform For The Treatment Of Anxiety, Shady Swidan, Khaled Younis Mahmoud, Nahla Ahmed Elhesaisy, Abdelrahman Rashed, Ebram Mikhael, Mahmoud Fadl, Mahmoud Elsadek, Merna Mohamed, Merna Mostafa, Mohamed Hassan, Omar Halema, Youssef Elnemer

Pharmacy

Anxiety is one of the most prevalent forms of psychopathology that afects millions worldwide. It gained more importance under the pandemic status that resulted in higher anxiety prevalence. Anxiolytic drugs such as benzodiazepines have an unfavorable risk/beneft ratio resulting in a shift toward active ingredients with better safety profle such as the naturally occurring quercetin (QRC). The delivery of QRC is hampered by its low water solubility and low bioavailability. The potential to enhance QRC delivery to the brain utilizing polymeric nanocapsules administered intranasally is investigated in the current study. Polymeric nanocapsules were prepared utilizing the nanoprecipitation technique. The best …

Prevention Of Pre-Operative Anxiety In Pediatric Tonsillectomy Using Intranasal Dexmedetomidine Versus Intranasal Midazolam, Ahmed Mahmoud Mohammed Abdelnaby, Hamed Ahmed Sanad Al Ezza, Ali Abdallah Al Kumity

Al-Azhar International Medical Journal

Background; The pre-operative stage is an important frustrating process for almost all patients who need operations, especially children. As a consequence, an anesthesiologist's first concern involves reducing patient stress prior to surgery, Aim and objectives; the aim of this study was to make a comparison between the impact of intranasal dexmedetomidine versus intranasal midazolam in prevention of pre-operative anxiety in children group undergoing tonsillectomy. Subjects and methods: The current study is a randomized clinical trial carried out at department of Anesthesia and Intensive Care and pain management, Al-Azhar faculty of medicine. Seventy-five children aged 5-10 years, of either sex, BMI …

Pharmacokinetic Study Of Intranasal Dexamethasone And Methylprednisolone Compared With Intravenous Administration: Two Open-Label, Single-Dose, Two-Period, Two-Sequence, Cross-Over Study In Healthy Volunteers, Graciela Cárdenas, Raúl J. Bobes, Gladis Fragoso, Nicolas I. Pérez-Osorio, Marisela Hernández, Alejandro Espinosa, Agnes Fleury, José Flores, Juan Carlos Alvarenga, Juan Pedro Laclette

School of Medicine Publications and Presentations

Dexamethasone (DXM) and methylprednisolone (MEP) are potent glucocorticoids used to control several inflammatory conditions. Evidence of delayed DXM reaching the central nervous system (CNS) as well as tachyphylaxis and systemic, undesirable side effects are the main limitations of peripheral delivery. Intranasal administration offers direct access to the brain as it bypasses the blood–brain barrier. The Mucosal Atomization Device is an optimal tool that can achieve rapid absorption into the CNS and the bloodstream across mucosal membranes. This study was designed to evaluate and compare the bioavailability of DXM and MEP after intranasal versus intravenous administration. Two open-label, balanced, randomized, two-treatment, …

The Effects Of Traumatic Stress & Role Of The Neuropeptide Y System As A Therapeutic In Females, Roxanna J. Nahvi

NYMC Student Theses and Dissertations

The incidence of many stress-elicited disorders is markedly influenced by sex. Women are twice as likely as men to develop posttraumatic stress disorder (PTSD), depression, anxiety disorders, and social impairments following exposure to traumatic stress. However, most of the studies in animal models examining putative therapeutics for stress-triggered impairments, including single prolonged stress (SPS), were performed predominantly with males. Previous studies in males demonstrated that intranasal neuropeptide Y (NPY) can provide therapeutic relief of many SPS-triggered symptoms. Nevertheless, the overwhelming majority of studies found that NPY levels in females in many brain regions are lower than in male rodents. NPY …

Positional Installation Of Intranasal Corticosteroids In The Treatment Of Chronic Rhinosinusitis: A Systematic Review Of The Literature., Emily L Cummings, Scott N Fassas, Kevin J Sykes, Amy Sisson, Alexander G Chiu, Meha G Fox

Library Staff Publications

OBJECTIVES: First-line treatment of chronic rhinosinusitis includes topical corticosteroids aimed at decreasing inflammation of sinonasal mucosa. No guidelines exist regarding the effect of head position during administration of corticosteroids. We hypothesize certain positions enhance delivery to the paranasal sinuses, with further improvement in delivery after sinus surgery.

METHODS: A systematic review of the literature was conducted using Medline Ovid, Embase, Scopus, and Cochrane databases. All studies evaluating intranasal medications administered in 2 or more head positions were included. Study population, head position(s), method/volume of delivery, and outcome metrics were recorded.

RESULTS: Twenty-four studies compared head positions and their role in …

Focused Ultrasound-Mediated Drug Delivery To The Brainstem, Dezhuang Ye

McKelvey School of Engineering Theses & Dissertations

Brainstem gliomas are tumors that occur in the brainstem, the brain region that connects the brain to the spinal cord and controls vital body functions. The critical anatomic location of the brainstem precludes surgical intervention and limits the use of invasive therapeutic techniques. Moreover, the frequently intact blood-brain barrier (BBB) of most brainstem gliomas prevents therapeutic agents from reaching the diseased site. The currently available techniques for brain drug delivery are either invasive (e.g., convection-enhanced delivery) or lack targeting to the diseased site (e.g., intranasal brain drug delivery). Novel techniques that can noninvasively overcome the BBB are critically needed for …

Intranasal Dexmedetomidine For Procedural Distress In Children: A Systematic Review., Naveen Poonai, Joseph Spohn, Ben Vandermeer, Samina Ali, Maala Bhatt, Shawn Hendrikx, Evelyne D Trottier, Vikram Sabhaney, Amit Shah, Gary Joubert, Lisa Hartling

Paediatrics Publications

CONTEXT: Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children.

OBJECTIVE: To explore the effectiveness of IND for procedural distress in children.

DATA SOURCES: We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register.

STUDY SELECTION: We included randomized trials of IND for procedures in children.

DATA EXTRACTION: Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants …

Intranasal Delivery Of Insulin By Nanoemulsion System, Darshana Mahendrakumar Shah

Theses and Dissertations

The main objective of this research was to develop an o/w nanoemulsion dosage form of insulin for intranasal delivery where insulin is loaded into the oil phase of the nanoemulsion for enhanced absorption. When loaded into the lipid droplets (oil phase), insulin can be protected from enzymatic degradation, can permeate through the mucus gel barrier in a comparatively efficient manner and can be absorbed through transcellular permeation along with paracellular route. To incorporate lipophilicity to insulin molecule, several complexes of insulin with various amphiphiles were developed to load it into the oil phase. The cytotoxicity of these amphiphiles and the …

An Improved Tobacco Mosaic Virus (Tmv)-Conjugated Multiantigen Subunit Vaccine Against Respiratory Tularemia, Ahd A. Mansour, Sukalyani Banik, Ragavan V. Suresh, Hardeep Kaur, Meenakshi Malik, Alison A. Mccormick, Chandra Bakshi

Faculty Publications & Research of the TUC College of Pharmacy

Francisella tularensis, the causative agent of the fatal human disease known as tularemia is classified as a Category A Select Agent by the Centers for Disease Control. No licensed vaccine is currently available for prevention of tularemia in the United States. Previously, we published that a tri-antigen tobacco mosaic virus (TMV) vaccine confers 50% protection in immunized mice against respiratory tularemia caused by F. tularensis. In this study, we refined the TMV-vaccine formulation to improve the level of protection in immunized C57BL/6 mice against respiratory tularemia. We developed a tetra-antigen vaccine by conjugating OmpA, DnaK, Tul4, and SucB proteins of …

Intranasal Administration Of A Two-Dose Adjuvanted Multi-Antigen Tmv-Subunit Conjugate Vaccine Fully Protects Mice Against Francisella Tularensis Lvs Challenge, Alison A. Mccormick, Aisha Shakeel, Chris Yi, Hardeep Kaur, Ahd M. Mansour, Chandra Shekhar Bakshi

Faculty Publications & Research of the TUC College of Pharmacy

Tularemia is a fatal human disease caused by Francisella tularensis, a Gram-negative encapsulated coccobacillus bacterium. Due to its low infectious dose, ease of aerosolized transmission, and lethal effects, the CDC lists F. tularensis as a Category A pathogen, the highest level for a potential biothreat agent. Previous vaccine studies have been conducted with live attenuated, inactivated, and subunit vaccines, which have achieved partial or full protection from F. tularensis live vaccine strain (LVS) challenge, but no vaccine has been approved for human use. We demonstrate the improved efficacy of a multi-antigen subunit vaccine by using Tobacco Mosaic virus (TMV) as …

Intranasal Immunization Of Pigs With Porcine Reproductive And Respiratory Syndrome Virus Like Particles Plus 2’, 3’ –Cgamp Vaccigrade™ Adjuvant Exacerbates Viremia After Virus Challenge, Alexandria Marie Van Noort

Electronic Theses and Dissertations

Porcine reproductive and respiratory syndrome virus (PRRSV) is an economically devastating virus that causes a persistent infection and spreads quickly. The virus causes abortions in sows and respiratory diseases in young piglets. Current PRRSV vaccines appear to provide limited cross-protection. A virus-like particles (VLPs) vaccine is made up of key PRRSV structural proteins, which could be cross protective among the different strains. We tested PRRSV VLPs as a vaccine candidate with a 2’, 3’-cGAMP VacciGradeTM adjuvant against pigs infected with PRRSV after intranasal immunization to evaluate the immune response and protective efficacy by the VLPs and adjuvant. The VLPs contain …

Intranasal Naloxone Adminstration Education, Natalie O. Levchenko

Master's Projects and Capstones

The Clinical Nurse Leader project focused on the provision of education on intranasal naloxone administration to healthcare providers in Lake County in order to educate patients, their families, peers, and members of their social network. Fatal opioid overdose rates from prescribed or illicit opioids are four times greater in Lake County than California. The setting is Lake County, California, with a population of 65, 000, a radius of 1,300 square miles, and an annual per capita income of $21,000, with 24.3 % living in poverty. The CNL project focused on the Clinical Nurse Leader elements: Systems Analyst/Risk Anticipator, Outcomes Manager, …

Rhabdovirus-Based Vaccine Platforms Against Henipaviruses., Drishya Kurup, Christoph Wirblich, Heinz Feldmann, Andrea Marzi, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

UNLABELLED: The emerging zoonotic pathogens Hendra virus (HeV) and Nipah virus (NiV) are in the genus Henipavirus in the family Paramyxoviridae. HeV and NiV infections can be highly fatal to humans and livestock. The goal of this study was to develop candidate vaccines against henipaviruses utilizing two well-established rhabdoviral vaccine vector platforms, recombinant rabies virus (RABV) and recombinant vesicular stomatitis virus (VSV), expressing either the codon-optimized or the wild-type (wt) HeV glycoprotein (G) gene. The RABV vector expressing the codon-optimized HeV G showed a 2- to 3-fold increase in incorporation compared to the RABV vector expressing wt HeV G. There …

Intranasal Delivery Of Therapeutics Targeted To Csf And Brain, Prashanth Manda

Electronic Theses and Dissertations

Blood-brain barrier and blood-cerebrospinal fluid barrier limit the systemic delivery of therapeutics to the brain and cerebrospinal fluid (CSF) respectively. Therapeutic agents targeting CNS are currently being administered by invasive routes which are not patient compliant and do not allow frequent administration. Intranasal delivery of therapeutics to target CSF and brain is a noninvasive route of administration which is patient compliant and allows frequent administration. In the current study, the plausibility of delivering ziconotide and cefotaxime to CSF and brain respectively via intranasal pathway using barrier modulating agents like chitosan was investigated. The ability of chitosan to enhance the permeation …

The Influence Of Immunization Route On The Adjuvant Effect Of Alpha-Galactosylceramide, Ameerah M. Wishahy

Dissertations & Theses (Open Access)

Potent vaccine formulations ideally include adjuvants to activate innate immune responses and enhance antigen-specific adaptive immunity. The synthetic glycolipid alpha-Galactosylceramide (α-GalCer) effectively activates the innate immune mediating NKT cells to produce cytokines and activate downstream immune cells, resulting in development of humoral and cell mediated immune responses to co-administered antigens. While a single intravenous immunization of α-GalCer strongly activates NKT cells, multiple doses by this route are well documented to induce anergy in NKT cells. Anergy is defined as the deficiency in NKT proliferation and cytokine production, including IL-4 and IFNγ. However, our studies have shown that two doses of …

Is Fentanyl Pectin Nasal Spray Safe And Effective For Patients With Breakthrough Cancer Pain?, Salina G. Elengical

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether fentanyl pectin nasal spray (FPNS) is safe and effective treatment for patients with breakthrough cancer pain.

STUDY DESIGN: Review of three English language primary randomized controlled trials published 2010-2011.

DATA SOURCES: Multicenter, randomized, double-blind, double-dummy, placebo-controlled trials comparing fentanyl pectin nasal spray, immediate-release morphine sulfate, and/or nasal spray placebo were found using PubMed, COCHRANE, and Medline databases.

OUTCOME MEASURED: All three studies essentially used similar parameters to measure effectiveness and safety of fentanyl pectin nasal spray compared to oral immediate-release morphine sulfate and/or placebo. Baseline pain intensity …

Intranasal Opioid Compositions, Daniel Wermeling

Pharmaceutical Sciences Faculty Patents

The present invention relates to pharmaceutical compositions for intranasal administration to a mammal that contain an effective amount of an opioid, a liquid nasal carrier for the opioid, and optionally a sweetener, flavoring agent or masking agent. In some embodiments of the present invention, the pharmaceutical compositions have improved bioavailability. In other embodiments of the present invention, the opioid compositions improve patient compliance.

Programmable Multi-Dose Intranasal Drug Delivery Device, Daniel Wermeling, Ryan Vallance, Aravind Balasubramanian, Bruce L. Walcott, John A. Main, James E. Lumpp

Pharmacy Practice and Science Faculty Patents

An apparatus and method for the self-administration of a plurality of doses of an intranasal liquid pharmaceutical composition, including opioid analgesics, that includes a drug delivery device containing a plurality of sealed vials, each vial containing a predetermined volume of the pharmaceutical composition, a pump assembly for conveying the liquid pharmaceutical composition from the interior of the vial and discharging it as a nasal spray in response to manual activation by the patient, and programmable means for sequentially advancing a vial to the ready position after passage of a prescribed time interval following the last activation of the delivery device.

Nontraditional Epilepsy Treatment Approaches, Michael A. Rogawski, Gregory L. Holmes

Michael A. Rogawski

Overview of articles published in a special issue of Neurotherapeutics (April 2009) on nontraditional (non-drug) epilepsy treatment approaches. From the Fourth Workshop on New Horizons in the Development of Antiepileptic Drugs: Nontraditional Approaches to Treat Epilepsy, which was held at the Clontarf Castle, Dublin, March 5-7, 2008.

Intranasal Administration Of A Parg Inhibitor Profoundly Decreases Ischemic Brain Injury, Guangwei Wei, Dongmin Wang, Huafei Lu, Sophie Parmentier, Qing Wang, S. Scott Panter, William H. Frey Ii, Weihai Ying

Faculty of Health and Behavioural Sciences - Papers (Archive)

Cumulative evidence has indicated a critical role of poly(ADP-ribose) polymerase-1 activation in ischemic brain damage. Poly(ADP-ribose) glycohydrolase (PARG) is a key enzyme in poly(ADP-ribose) catabolism. Our previous studies showed that PARG inhibitors, gallotannin (GT) and nobotanin B, can profoundly decrease oxidative cell death in vitro. Here, we tested the hypothesis that intranasal delivery of GT can decrease ischemic brain damage by inhibiting PARG. Intranasal delivery of GT within 5 hours after the onset of focal brain ischemia markedly decreased the infarct formation and neurological deficits of rats. The GT administration also increased poly(ADP-ribose) in the ischemic brains, suggesting that …

Immune Responses In Mice Immunized Intranasally With Sendai Virus, Gazim Bizanov, Irena Jonauskiene

Turkish Journal of Veterinary & Animal Sciences

Mice were immunized 3 times intranasally (i.n.) at intervals of 2 weeks with a formalin-inactivated Sendai virus (SV) whole virus with and without whole formalin-inactivated Bordetella pertussis (Bp) as adjuvant. The antibody response to SV was measured using the hemagglutination inhibition (HI) test in serum, and the IgA and IgG antibodies were evaluated using enzyme linked immunosorbent assay in saliva and serum. It was demonstrated that repeating immunizations with SV plus Bp could induce HI serum antibodies, IgA and serum IgG antibodies. However, in mice immunized subcutaneously with SV alone, high serum IgG antibodies and HI titers were induced only. …

System And Method For Intranasal Administration Of Lorazepam, Daniel Wermeling

Pharmacy Practice and Science Faculty Patents

A therapeutic composition of lorazepam and its pharmaceutically acceptable derivatives are provided for intranasal administration of at least one predetermined volumetric unit dose in the form of a spray by means that delivers one or more therapeutically prescribed unit doses that are highly accurate as to the volume discharged and which leave no significant quantity of the composition in the delivery means.

Water Soluble Amine Esters Of Testosterone For Intranasal Administration, Anwar A. Hussain

Pharmaceutical Sciences Faculty Patents

The present invention provides novel water soluble testosterone analogs. These testosterone analogs are suitable for intranasal administration to patients requiring increased plasma testosterone levels. The present invention also provides pharmaceutical compositions containing the testosterone analogs of the present invention. The present invention further provides a method of increasing plasma testosterone levels in patients in need of such treatment comprising the intranasal administration of the water-soluble testosterone analogs and pharmaceutical compositions of the present invention.