💊 NASAL DECONGESTANTS

🧠 WHAT THEY DO:

• Main goal: relieve nasal obstruction and discharge.

• Mechanism: Constrict arterioles in the nasal mucosa via adrenergic (sympathomimetic) activity → reduces swelling and improves airflow.

🧪 PROTOTYPE DRUG: Pseudoephedrine

Drug Class

• Therapeutic: Nasal decongestant

• Pharmacologic: Adrenergic (sympathomimetic)

Action

• Acts on alpha-adrenergic receptors → vasoconstriction in nasal mucosa → ↓ swelling, ↑ drainage.

• Can also release norepinephrine, enhancing its effect.

• Can stimulate the heart → caution in cardiac patients.

Use

• Temporary relief of nasal congestion:

  • Colds

  • Allergies

  • Rhinosinusitis

• Also used pre-surgery or for visualization of nasal mucosa.

Pharmacokinetics

• Onset: ~30 min

• Peak: 1–2 hours

• Half-life: 4–8 hours

• No known need for hepatic dose adjustment.

⚠ CONTRAINDICATIONS

• Severe hypertension or CAD

• Narrow-angle glaucoma

• MAO inhibitors or tricyclic antidepressants

• Use cautiously in:

  • Cardiac dysrhythmias

  • Hyperthyroidism

  • Diabetes mellitus

  • Prostatic hypertrophy

💥 ADVERSE EFFECTS (Know at least 2 common and 2 serious!)

Common:

• Insomnia

• Restlessness

• Headache

• Dry nose

Serious:

• Cardiac dysrhythmias

• Seizures

• Thrombocytopenia

• Urinary retention

👶 SPECIAL POPULATIONS

Pediatrics

• FDA says NO OTC pseudoephedrine in kids <2 years

• Not recommended for kids <4 years due to:

  • Seizures

  • Tachycardia

  • Decreased LOC

  • Death

• Extended-release tabs → NOT for kids <12

Older Adults

• More sensitive to:

  • Hypertension

  • Cardiac arrhythmias

  • Nervousness

  • Insomnia

• Topical > Oral due to fewer systemic effects.

Pregnancy

• NOT preferred during pregnancy.

• Avoid in 1st trimester → risk of congenital anomalies

• Avoid prolonged use later in pregnancy.

⚠ INTERACTIONS

🧃 Caffeine: Can worsen nervousness and insomnia.

🌿 Herbs:

• Coleus → increases effect

• Tea/Witch hazel (tannins) → ↓ absorption

🩺 NURSING IMPLICATIONS

Preventing Interactions

• Screen for OTCs, caffeine intake, antidepressants, and herbal use.

Administering the Drug

• Take with or without food

• Do not crush extended-release tablets

Monitoring

• ✅ Therapeutic: ↓ nasal congestion

• ⚠ Adverse: Monitor BP, HR, chest tightness, throat swelling → D/C if signs of anaphylaxis

📣 PATIENT TEACHING (Box 31.2 Highlights)

• These do not cure the cold — just relieve symptoms.

• Don't use nasal sprays >3 days → risk of rebound congestion

• Do not double up on meds with the same ingredient (pseudoephedrine is common in combo meds!)

• Educate on hidden acetaminophen or ibuprofen in combo meds → avoid overdose

• Diabetic patients: check for sugar content in syrups.

• Store meds safely away from children.

• Reinforce that cough syrups aren’t candy, especially if flavored.

💡 OTHER DRUGS TO KNOW

Oxymetazoline (Afrin) — Topical Spray

• Acts on alpha receptors → vasoconstriction

• Fast-acting, localized

• Max use: 3 days only

• Less systemic absorption = better for cardiac patients

• Overuse = rebound congestion

Phenylephrine

• Available in both oral and intranasal forms

• Max use: 3 days intranasally

• Different concentrations = dose appropriately

✅ NCLEX-STYLE QUESTIONS (Success Section)

1. Adrenergic drugs relieve nasal congestion by:

   • ✅ Constriction of arterioles and reduced blood flow to nasal mucosa

   • ❌ Not air movement, mast cells, or cough reflex

2. Why should oxymetazoline be limited to 3 days?

   • ✅ Rebound nasal congestion

   • ❌ Not secretions, tinnitus, or cough reflex

3. FDA Opioid Warnings in Children (Select all that apply):

   • ✅ A cough should not be suppressed unless it's harmful (e.g., causing vomiting, poor sleep)

   • ✅ Labeling protects children from unnecessary opioid exposure

   • ✅ Risk outweighs benefit in most children

   • ✅ Hydrocodone/codeine carry abuse/addiction risk in children

🔑 KEY TAKEAWAYS

• Pseudoephedrine is effective but cardiac-sensitive and restricted in pediatrics and pregnancy.

• Nasal sprays like oxymetazoline = quick relief but risk rebound congestion if used >3 days.

• Patient education is huge — especially around OTC use, ingredient overlap, and proper dosing for kids.

• Adrenergic agents work by vasoconstriction, not by clearing mucus directly.

• Avoid combining multiple products with the same active ingredients.