Which of the following is a contraindication for intranasal medications?

• A. Nasal deformity
• B. Pain control
• C. Seizure control
• D. Anxiety

Answer: (A)

Intranasal medications depend on a relatively intact nasal mucosa for reliable absorption. A nasal deformity can alter the nasal cavity’s shape, hinder proper placement of the delivery device, and disrupt mucosal contact, leading to inconsistent dosing or injury. Because of these absorption and administration issues, a nasal deformity is a contraindication to intranasal delivery.

Pain control and seizure control are common, appropriate indications for intranasal medications in prehospital care (for example, intranasal fentanyl for analgesia and intranasal midazolam for seizures), so they are not contraindications. Anxiety is not a contraindication either; intranasal meds can be used to manage agitation or distress in many scenarios.