Decongestants

Decongestants cause local vasoconstriction, thereby reducing blood flow to the mucous membranes of the nasal passages and sinus cavities. Nasal decongestants (sympathomimetic amines) stimulate the alpha-adrenergic receptors, producing vascular constriction of the capillaries within the nasal mucosa. Decongestants are usually adrenergic or sympathomimetic.

Learn about the uses and nursing care plan considerations needed for patients taking decongestants in this nursing pharmacology study guide.

Table of Contents

• Decongestants: Generic and Brand Names
• Disease spotlight: Sinusitis
• What are decongestants?
• Therapeutic actions of decongestants
• Indication
• Pharmacokinetics
• Contraindications and Cautions
• Adverse effects
• Interactions
• Nursing considerations
  • Nursing Assessment
  • Nursing Diagnosis and Care Planning
  • Nursing Implementation with Rationale
  • Evaluation
• Practice Quiz: Decongestants
• Recommended Resources
• See Also
• References and Sources

Decongestants: Generic and Brand Names

Here is a table of commonly encountered decongestants, their generic names, and brand names:

• Topical Nasal Decongestants
  • ephedrine (Pretz-D)
  • oxymetazoline (Afrin, Allerest)
  • phenylephrine (Coricidin)
  • tetrahydrazoline (Tyzine)
  • xylometazoline (Otrivin)
• Oral Decongestants
  • pseudoephedrine (Sudafed, Decofed)
• Topical Steroid Nasal Decongestants
  • beclomethasone (Beclovent)
  • budesonide (Pulmicort)
  • dexamethasone (Decadron)
  • flunisolid (Aerobid)
  • fluticasone (Flovent)
  • triamcinolone (Azmacort)

Disease spotlight: Sinusitis

Sinusitis occurs when the epithelial lining of the sinus cavities becomes inflamed.

• The resultant swelling often causes severe pain due to pressure against the bone, which cannot stretch, leading to blockage of the sinus passage.
• The danger of a sinus infection is that, if it is left untreated, microorganisms can travel up the sinus passages and into brain tissue.
• Symptoms of sinusitis include pain, swelling, and tenderness around the cheek, eyes, or forehead, a blocked nose, reduced sense of smell, a sinus headache, and a high temperature of 38°C.

What are decongestants?

Decongestants decrease the overproduction of secretions by causing local vasoconstriction to the upper respiratory tract.

• This vasoconstriction leads to a shrinking of swollen mucous membranes and tends to open clogged nasal passages, providing relief from the discomfort of a blocked nose and promoting drainage of secretions and improved airflow.
• Topical nasal decongestants, oral decongestant, and topical steroid nasal decongestants are classifications of decongestants.

Therapeutic actions of decongestants

The desired actions of decongestants include the following:

Topical nasal decongestants

• Imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and inflammation of the nasal membranes.
• Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis.
• Dilation of the nares to facilitate medical examination or to relieve the pain and congestion of otitis media.

Oral decongestants

• Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis.
• Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes.
• This shrinkage results in a decrease in membrane size promoting drainage of the sinuses and improving airflow.

Topical nasal steroid decongestants

• The exact mechanism of action of topical steroids is unknown.
• Their anti-inflammatory action results from their ability to produce a direct local effect that blocks many of the complex reactions responsible for the inflammatory response.

Indication

Indications for decongestants include:

Topical nasal decongestants

• Relieves discomfort of nasal congestion associated with the common cold, sinusitis, allergic rhinitis.
• Relieves pressure of otitis media.

Oral decongestants

• Decreases nasal congestion associated with the common cold, allergic rhinitis.
• Relief of pain and congestion of otitis media.

Topical nasal steroid decongestants

• Treatment of seasonal allergic rhinitis in patients who are not obtaining a response with other decongestants or preparations.
• Relieves inflammation following removal of nasal polyps.

Pharmacokinetics

Topical nasal decongestants

• Because these drugs are applied topically, the onset of action is almost immediate and there is less chance of systemic effects.

Route	Onset	Duration
Topical (nasal spray)	Immediate	4-6h
T 1/2: 0.4 to 0.7 hours | Metabolism: Liver | Excretion: Urine

Oral decongestants

Pseudoephedrine is generally well absorbed and reaches peak levels quickly- in 20 to 45 mins.

Route	Onset	Duration
Oral	30 mins	4-6h
T 1/2: 7 hours | Metabolization: Liver | Excretion: Urine

Topical nasal steroids decongestants

The onset of action is not immediate, and these drugs may actually require up to 1 week to cause any changes.

Route	Onset	Peak	Duration
Topical (nasal spray)	Immediate	10-30min	4-6h
T 1/2: Not generally absorbed systemically.

Contraindications and Cautions

The following are contraindications and cautions for the use of decongestants:

• Caution must be used when there is lesion or erosion in the mucous membrane that could lead to systemic absorption.
• Caution should also be used in patients with any condition that might be exacerbated by sympathetic activity.
• If used during pregnancy or lactation, caution is advised.
• Caution should be used in any patient who has an active infection, including tuberculosis because systemic absorption would interfere with the inflammatory and immune response.

Adverse effects

Adverse effects from the use of decongestants include:

• Rebound congestion. An adverse effect that accompanies frequent or prolonged use of the drug is a rebound congestion, technically called rhinitis medicamentosa.
• Topical nasal decongestants. Adverse effects associated with topical decongestants include local stinging and burning, which may occur the first few times the drug is used.
• Oral decongestants. Because this drug is taken systemically, adverse effects related to the sympathomimetic effects are more likely to occur, including feelings of anxiety, tenseness, restlessness, tremors, hypertension, arrhythmia, sweating and pallor.
• Topical nasal steroids decongestants. The most common adverse effects are local burning, stinging, dryness of the mucosa, and headache.

Interactions

Interactions involved in the use of decongestants include the following:

• Cyclopropane or halothane. The use of topical nasal decongestants is contraindicated with concurrent use of cyclopropane or halothane anesthesia because serious cardiovascular effects could occur.
• OTC products. Many OTC products, including cold remedies, allergy medications, and flu remedies may contain pseudoephedrine; taking many of these products concurrently can cause serious adverse effects.
• Acute infections. Because nasal steroids block the inflammatory response, their use is contraindicated in the presence of acute infections such as Candida albicans infection, tuberculosis, and any airborne infections (e.g., chicken pox, measles) because systemic absorption would interfere with the inflammatory and immune responses.

Nursing considerations

The nursing considerations in the administration of decongestants include the following:

Nursing Assessment

History taking and examination of a client using decongestants should include the following:

• Assess for possible cautions and contraindications: any history of allergy to the drug or a component of the drug vehicle; glaucoma; hypertension; diabetes; thyroid disease; coronary disease; and prostate problems; pregnancy and lactation, and acute infections, all of which could be exacerbated by the sympathomimetic effects and which require cautious use of the drug.
• Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
• Assess skin color and temperature to assess the sympathetic response.
• Evaluate orientation and reflexes to evaluate the central nervous system (CNS) effects of the drug.
• Monitor pulse, blood pressure, and cardiac auscultation to assess cardiovascular and sympathomimetic effects.
• Evaluate respirations and adventitious breath sounds to assess the effectiveness of the drug and the potential excess effect.
• Evaluate nasal mucous membrane to monitor for lesions that could lead to systemic absorption and to evaluate the decongestant effect.
• Monitor urinary output to evaluate for urinary retention.
• Monitor temperature to monitor for the possibility of acute infection.

Nursing Diagnosis and Care Planning

Nursing diagnoses related to the use of the drug include:

• Acute pain related to GI, CNS, or local effects of the drug.
• Disturbed sensory perception (Kinesthetic) related to CNS effects.
• Deficient knowledge regarding drug therapy.
• Increased cardiac output related to sympathomimetic actions of the drug.
• Risk for injury related to the suppression of inflammatory reaction.

Nursing Implementation with Rationale

The nursing interventions for clients using decongestants are:

• Proper administration. Teach the patient the proper administration of the drug to ensure the therapeutic effect.
• Proper technique. The patient should be instructed to clear the nasal passages before use, to tilt the head back when applying the drops or spray, and to keep it tilted back for a few seconds after administration; this techniques helps to ensure contact with the affected mucous membranes and decreases the chances of letting the drops trickle down the back of the throat, which may lead to more systemic effects.
• Duration of intake. Caution the patient not to use the drug for longer than 5 days and to seek medical care if signs and symptoms persist after that time to facilitate detection of underlying medical conditions that may require treatment.
• Avoid overdosage. Caution the patient that these drugs are found in many over-the-counter preparations and that care should be taken not to inadvertently combine drugs with the same ingredients, which could lead to overdose.
• Safety measures. Provide safety measures if dizziness or sedation occurs as a result of drug therapy to prevent patient injury.
• Comfort measures. Institute other measures to help relieve the discomfort of congestion (e.g., use of a humidifier, increased fluid intake, cool environment, avoidance of smoke-filled areas) as appropriate.
• Patient teaching. Provide thorough patient teaching, including the drug name and prescribed dosage, measures to help avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance.
• Provide support. Offer support and encouragement to help the patient cope with the disease and the drug regimen.
• Ensure compliance. For topical nasal steroid decongestants, encourage the patient to continue using the drug regularly, even if results are not seen immediately, because benefits may take 2 to 3 weeks to appear.
• Monitor for infection. Monitor the patient for the development of acute infection that would require medical intervention; encourage the patient to avoid areas where airborne infections could be a problem because steroid use decreases the effectiveness of the immune and inflammatory responses.

Evaluation

Evaluation of a client using decongestants include:

• Monitor patient response to the drug (relief of nasal congestion).
• Monitor for adverse effects ( local stinging and burning).
• Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and measures to take to increase the effectiveness of the drug.
• Monitor the effectiveness of comfort and safety measures and compliance of the regimen.

Practice Quiz: Decongestants

Here’s a 5-item quiz for this decongestants study guide. Please visit our nursing test bank page for more NCLEX practice questions.

1. Gab, a 20-year-old student, used to buy OTC drugs whenever he feels sick. Which of the following statements best describes the danger of self-medication with over-the-counter drugs?

A. Clients are not aware of the action of over-the-counter drugs
B. Clients are not aware of the side effects of over-the-counter drugs
C. Clients do not realize the effects of over-the-counter drugs
D. Clients minimize the effects of over-the-counter drugs because they are available without a prescription

1. Answer: D. Clients minimize the effects of over-the-counter drugs because they are available without a prescription.

• Option D: This choice is correct because it includes the other three risks noted in choices A, B, and C.

2. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will:

A. Experience less nasal obstruction and discharge
B. Cough productively without chest discomfort
C. Experience chills only once a day
D. Maintain a fluid intake of 800 ml every 24 hours

2. Answer: A. Experience less nasal obstruction and discharge.

• Option A: A client recovering from an upper respiratory infection (URI) should report decreasing or no nasal discharge and obstruction.
• Option B: A productive cough with chest pain indicated pulmonary infection, not an upper respiratory infection (URI).
• Option C: The temperature should be below 100*F (37.8*C) with no chills or diaphoresis.
• Option D: Daily fluid intake should be increased to more than 1 L every 24 hours to liquefy secretions.

3. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug?

A. Diplopia
B. Restlessness
C. Constipation
D. Bradycardia

3. Answer: B. Restlessness.

• Option B: Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic effects on the CNS. The most common CNS effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness.
• Options A and C: Constipation and diplopia are not side effects of pseudoephedrine.
• Option D: Tachycardia, not bradycardia, is a side effect of pseudoephedrine.

4. A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate?

A. “You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.”
B. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”
C. “This is an anticipated side-effect of your medication. It should go away in a couple of weeks.”
D. “You are using your inhaler too much and it has irritated your mouth.”

4. Answer: A. “You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.”

• Option A: Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development of oral thrush, a fungal infection.
• Option B: Although good oral hygiene can help prevent the development of a fungal infection, it cannot be used alone to treat the problem.
• Option C: Once developed, thrush must be treated by antibiotic therapy; it will not resolve on its own.
• Option D: Fungal infections can develop even without overuse of the Corticosteroid inhaler.

5. A nurse is about to administer Albuterol (Ventolin HFA) 2 puff and Budesonide (Pulmicort Turbohaler) 2 puff by metered dose inhaler. The nurse is planning to administer it by?

A. Budesonide inhaler first then the albuterol
B. Albuterol inhaler first then the budesonide
C. Alternating with a single puff each, starting with albuterol
D. Alternating with a single puff each, starting with budesonide

5. Answer: B. Albuterol inhaler first then the budesonide.

• Option B: If two different inhaled medications are prescribed and one of the medications contains a corticosteroid, administer the bronchodilator (Albuterol) first and the corticosteroid (Budesonide) second. This will allow for the widening of the air passages by the bronchodilator, making the corticosteroids more effective.

Recommended Resources

Our recommended nursing pharmacology resources and books:

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See Also

Here are other nursing pharmacology study guides:

• Nursing Pharmacology – Study Guide for Nurses
  Our collection of topics related to nursing pharmacology
• Pharmacology Nursing Mnemonics & Tips
  These nursing mnemonics aim to simplify the concepts of pharmacology through the use of a simple, concise guide.
• Generic Drug Name Stems Cheat Sheet
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• Common Drugs and Their Antidotes
  A guide to drug antidotes that nurses should be familiar about.
• IV Fluids and Solutions Guide & Cheat Sheet
  Get to know the different types of intravenous solutions or IV fluids in this guide and cheat sheet.
• Drug Dosage Calculations NCLEX Practice Questions (100+ Items)
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References and Sources

References and sources for this Decongestants Nursing Pharmacology Guide:

• Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link]
• Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
• Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing care.
• Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: JB Lippincott.