A patient has been using an intranasal sympathomimetic for allergic rhinitis for 10 days. While reducing the medication, the patient notices increased stuffiness. Select the nurse's best response
a. "Restart the nasal spray and continue it indefinitely, because you have chronic rhinitis."
b. "Do not restart the spray. You will need systemic glucocorticoids to relieve the symptoms."
c. "Discontinue drug use in one nostril at a time to reduce this rebound congestion."
d. "These agents were inappropriate for use in your condition, and you should never use them again."
ANS: C
Rebound congestion can occur when intranasal sympathomimetics are used for prolonged periods, requiring the patient to increase the frequency of doses. This can be stopped by abrupt decongestant withdrawal, which can be extremely uncomfortable. A less drastic approach is to discontinue the drug in one nostril at a time.
Rebound congestion develops when topical agents are used for longer than a few days. Restarting the spray would cause the patient to use progressively larger and more frequent doses to overcome the rebound congestion. This would not be an appropriate recommendation.
Glucocorticoids would not reverse the rebound congestion.
Intranasal sympathomimetics are appropriate for allergic rhinitis, but their use should be limited to 3 to 5 days to minimize rebound congestion.
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