Rebound congestion is occasionally a problem after use of some drugs for allergic rhinitis. Which preparation is mostly likely to cause this concern?
1. Intranasal decongestants
2. Intranasal steroids
3. Oral decongestants
4. Oral antihistamines
Correct Answer: 1
Rationale 1: Intranasal decongestants that are used repeatedly may cause rebound congestion. They should not be used for more than 5 consecutive days.
Rationale 2: Intranasal steroids relieve inflammation; they do not address congestion.
Rationale 3: Oral decongestants do not trigger rebound congestion.
Rationale 4: Oral antihistamines address irritation, drainage, and sneezing. They do have a decongestant effect.
Global Rationale: The most serious, limiting adverse effect of the intranasal decongestants is rebound congestion. In almost all patients, prolonged use causes hypersecretion of mucus and worsening nasal congestion once the drug effects wear off. This leads to a cycle of increased drug use as the condition worsens to obtain the desired effect from these drugs. Because of this rebound congestion, intranasal sympathomimetics should be used for no longer than 3 to 5 days. Intranasal steroids, oral decongestant, and oral antihistamines do not have rebound effects.
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