A client asks the nurse why the physician prescribed an oral rather than an intranasal decongestant. The nurse responds:

Question

Standard Text: Select all that apply.
1. "Intranasal decongestants can worsen congestion once the effects of the drug wear off."
2. "You will need medication for the length of the allergy season, but intranasal decongestants shouldn't be taken for longer than 5 days."
3. "Oral decongestants take less time to alleviate symptoms."
4. "Oral decongestants are more effective at relieving severe congestion."
5. "Oral decongestants carry a lower risk of systemic adverse effects."

Answer 1

Correct Answer: 1,2
Rationale 1: Prolonged use of intranasal decongestants causes hypersecretion of mucus and worsening nasal congestion once the drug effects wear off.
Rationale 2: Because of the possibility of rebound congestion, the client would not be able to use intranasal decongestant longer than 5 days, which might not be long enough to control symptoms.
Rationale 3: Oral decongestants take longer than intranasal decongestants to alleviate symptoms.
Rationale 4: Oral decongestants are less effective than intranasal decongestants at relieving severe congestion.
Rationale 5: Oral decongestants carry a greater risk for systemic adverse effects such as high blood pressure, insomnia, and anxiety.
Global Rationale: The most serious, limiting adverse effect of the intranasal preparations 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. When administered PO, sympathomimetics do not produce rebound congestion. Their onset of action by this route, however, is much slower than when administered intranasally, and they are less effective at relieving severe congestion. They carry a greater risk for systemic adverse effects.