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Home , Enema

Pharmacist Ghada Hamid

Aqueous These solutions limit the solvent to water and excludes those preparations that are sweet and/ or viscid in character and nonaqueous solutions. This includes those pharmaceutical forms that are designated as Aromatic Waters, Aqueous Acids, Solutions, , Enemas, Gargles, , Juices, Nasal Solutions, Otic Solutions, and Irrigation Solutions.

Douches: A is an aqueous directed against a part or into a cavity of the body. It functions as a cleansing or antiseptic agent. 1. An eye douche, used to remove foreign particles and discharges from the eyes, is directed gently at an oblique angle and allowed to run from the inner to the outer corner of the eye. 2. Pharyngeal douches are used to prepare the interior of the throat for an operation and cleanse it in suppurative conditions. 3. Similarly, there are nasal douches and vaginal douches. Douches are directed to the appropriate body part by using bulb . Douches are often dispensed in the form of :  with directions for dissolving in a specified quantity of water (usually warm).  Tablets for preparing solutions are available.  Ready to use solution. If or tablets are supplied, they must be free from insoluble material to produce a clear solution. Tablets are produced by the usual processes, but any lubricants or diluents used must be readily soluble in water. Boric acid may be used as a lubricant, and sodium chloride is normally used as a diluent. Many tablets deteriorate on exposure to moist air and should be stored in airtight containers. Vaginal douches are the most common type of douche and are used for cleansing the vagina and hygienic purposes. concentrates or powders, which may be prepared in bulk or as single-use packages, should be diluted or dissolved in the appropriate amount of warm water prior to use. The ingredients used in vaginal douches include: . antimicrobial agents, such as benzalkonium chloride, the parabens or chlorothymol. . anesthetics or antipruritics, such as phenol or menthol. . Astringents, such as zinc sulfate or potassium alum. . surface-active agents, such as sodium lauryl sulfate. . chemicals to alter the pH, such as sodium bicarbonate or citric acid, are also used.

Enemas: Enema preparations are rectal injections (solutions) are administered rectally for the local effects of the medication, (e.g., hydrocortisone) or for systemic absorption (e.g., aminophylline). In the case of aminophylline, the rectal minimizes the undesirable gastrointestinal reactions associated with oral therapy. Clinically effective blood levels of the agents are obtained within 30 minutes following rectal instillation. are administered as retention enemas or continuous drip as adjunctive treatment of some patients with ulcerative .

We have two types of enemas: . Evacuation enema: are rectal injections employed to evacuate the bowel. . Retention enema: influence the general system by absorption, or to affect a local .

Sodium chloride, sodium bicarbonate, sodium monohydrogen phosphate, sodium dihydrogen phosphate, glycerin, potassium, and light are used in enemas to evacuate the bowel. Retention enema may possess anthelmintic, nutritive, sedative, or stimulating properties, or they may contain radiopaque substances for examination of the lower bowel. Retention enemas are to be retained in the intestine and should not be used in quantities larger than 150 mL for an adult.

Gargles: Gargles are aqueous solutions frequently containing antiseptics, antibiotics, and/or anesthetics used for treating the pharynx and nasopharynx by forcing air from the lungs through the gargle held in the throat; subsequently, the gargle is expectorated. Many gargles must be diluted with water prior to use. Although mouthwashes are considered as a separate class of pharmaceuticals, many are used as gargles either as is or diluted with water. is a source of nascent oxygen and a weak topical antibacterial agent. Hydrogen peroxide topical solution has been used as a or gargle in the treatment of pharyngitis or stomatitis. Hydrogen peroxide has also been applied in root canals of teeth or other dental pulp cavities. Although used topically as a 1.5-3% solution for cleansing wounds, hydrogen peroxide is diluted with an equal volume of water for use as a mouthwash or gargle.

Mouth washes: Mouthwashes are aqueous solutions, often in concentrated form, containing one or more active ingredients and excipients. They are used by swishing the liquid in the oral cavity. Mouthwashes are of two types depending on their purposes:  Therapeutic rinses or washes can be formulated to reduce plaque, gingivitis, dental caries, and stomatitis.  Cosmetic mouthwashes may be formulated to reduce bad breath through the use of antimicrobial and/or flavoring agents.

Recently mouthwashes are being used as a for a number of specific problems in the oral cavity; for example, mouthwashes containing a combination of antihistamines, hydrocortisone, nystatin, and tetracycline have been prepared from commercially available suspensions, powders, , or solutions for the treatment of stomatitis, a painful side effect of chemotherapy. Other drugs include - allopurinol, also used for the treatment of stomatitis. - pilocarpine for xerostoma (dry mouth). - amphotericin B for oral candidiasis. - chlorhexidine gluconate for plaque control. Mouthwashes components include:  is often present in the range of 10–20%. It enhances the flavor, provides sharpness to the taste, aids in masking the unpleasant taste of active ingredients, functions as a solubilizing agent for some flavoring agents, and may function as a preservative.  Humectants, such as glycerin and , may form 5–20% of the mouthwash. These agents increase the viscosity of the preparation and provide a certain body or mouth feel to the product. They enhance the sweetness of the product and, along with the ethanol, improve the preservative qualities of the product.  Surfactants of the nonionic ,cationic and anionic class, the concentration range is 0.1-0.5%. Surfactants are used, because they aid in the solubilization of flavors and in the removal of debris by providing foaming action.  Flavors are used in conjunction with alcohol and humectants to overcome disagreeable tastes; at the same time, flavors must be safe to use. The principle flavoring agents are peppermint, spearmint, cinnamon, wintergreen oils, menthol, or methyl salicylate. Other flavoring agents may be used singly or in combination.  Finally, coloring agents are also used in these products.

Otic solutions: These solutions are occasionally referred to as or aural preparations. Ear preparations are placed in the ear canal by drops or in small amounts for the removal of excessive cerumen (ear wax) or for the treatment of ear , inflammation, or pain. The main classes of drugs used for topical administration to the ear include:

 analgesics, such as benzocaine.  antibiotics, such as neomycin.  anti-inflammatory agents, such as cortisone .

Otic Solutions may contain appropriate buffers, solvents, and dispersants in an aqueous solution. The main solvents used in these preparations include glycerin or water. The viscous glycerin vehicle permits the drug to remain in the ear for a long time. Anhydrous glycerin, being hygroscopic, tends to remove moisture from surrounding tissues, thus, reducing swelling. Viscous like glycerin or propylene glycol are used either alone or in combination with a surfactant to aid in the removal of cerumen (ear wax). To provide sufficient time for aqueous preparations to act, it is necessary for patients to remain on their side for a few minutes, so the drops do not run out of the ear. Otic preparations are dispensed in a container that permits the administration of drops.

Nasal solutions: Nasal solutions are aqueous solutions designed to be administered to the nasal passages in drops or sprays. Other nasal preparations may be in the form of or suspensions. The adult nasal cavity has about a 20 mL capacity with a large surface area (about 180 cm2) for drug absorption afforded by the microvilli present along the pseudo-stratified columnar epithelial cells of the nasal mucosa. The nasal tissue is highly vascularized, making it an attractive site for rapid and efficient systemic absorption. Another advantage of nasal delivery is it avoids first-pass metabolism by the liver. For some peptides and small molecular compounds, intranasal bioavailability has been comparable to that of injections. However, bioavailability decreases as the molecular weight of a compound increases, and, for proteins composed of more than 27 amino acids, bioavailability is quite low.

Many drugs are administered for their local sympathomimetic effects to reduce nasal congestion, such as  Ephedrine Sulfate Nasal Solution, USP, or  Naphazoline Hydrochloride Nasal Solution, USP. A few other preparations, are administered in spray form for their systemic effect  Lypressin Nasal Solution, USP, for the treatment of diabetes insipidus  Oxytocin Nasal Solution, USP, for milk letdown prior to breast feeding.

Nasal solutions are formulated to be similar to nasal secretions with regard to tonicity, pH, and viscosity, so normal ciliary action is maintained. Thus, aqueous nasal solutions are isotonic and slightly buffered to maintain a pH of 5.5–6.5. In addition, antimicrobial preservatives, similar to those used in ophthalmic preparations, and appropriate drug stabilizers, if required, are included in the formulation. The patient should be advised that, should the solution become discolored or contain precipitated matter, it must be discarded.