Decongestants

Decongestants Nursing Pharmacology Study Guide

Decongestants NCLEX Nursing Pharmacology Review

Nursing Pharmacology Study Guide on Decongestants

Decongestants are a class of medication that is utilized to control airway secretions. They are usually adrenergic or sympathomimetic, wherein they cause localized vasoconstriction to the mucus membranes of the nasal passages and sinus cavities.

They come in different forms and are usually available as over-the-counter medications. Because of this, decongestants may be used excessively and is potential for drug abuse. 

Nursing Stat Facts 1

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Nursing Stat Facts 1

Indications for Decongestants

Decongestants are typically divided into various forms and used for the following instances:

  1. Decongestants as topical nasal agents
    • Alleviates nasal congestion associated with the common cold, allergic rhinitis, sinusitis
    • Relieves pressure brought about by otitis media
  2. Decongestants as oral agents
    • Reduces nasal congestion brought about by allergic rhinitis, the common cold
    • Reduces and relieves pain and congestion of otitis media
  3. Decongestants as topical nasal steroid agents
    • As treatment for patients who is unresponsive to other decongestant preparations (i.e.. Seasonal allergic rhinitis)
    • Reduces inflammation after removal of nasal polyps

Actions of Decongestants

The actions of decongestants vary and depend on its form but generally follow these mechanisms of action:

  1. Decongestants as topical nasal agents
    • Emulate the effects of the sympathetic nervous system, causing vasoconstriction that leads to diminished edema and inflammation of membranes
    • Reduces discomfort brought about by nasal congestion from the common cold, sinusitis, and allergic rhinitis.
    • Relaxes the membranes in the nares prior medical examination, or to relieve pain and stuffiness from otitis media
    • Pharmacokinetics: Because of their drug form (topical), there is almost immediate onset of action and therefore would have lesser systemic effects. The effect duration in this form is 4 to 6 hours, with a half-life of 0.4 to 0.7 hours. In this form, it is metabolized in the liver and is excreted via the urine.
  2. Decongestants as oral agents
    • Reduces nasal congestion from nasal conditions (eg. Common cold, sinusitis)
    • Shrinks the nasal mucus membranes through the stimulation of the alpha adrenergic receptors found in the inner lining of the nose. This in turn reduces airway size, promoting improved drainage of mucus and better air flow
    • They are adrenergic agonists that acts indirectly to the body by releasing norepinephrine from storage sites in the body. Norepinephrine in turn produces vasoconstriction, consequently shrinking nasal mucosa membranes.
    • Pharmacokinetics: In this form, the decongestant is generally well absorbed in the gut with the onset of action reaching in 20 to 45 minutes after intake. The effect duration in this form is 4 to 6 hours, with a half-life of 7 hours. In this form, it is metabolized in the liver and is excreted via the urine.
  3. Decongestants as topical nasal steroid agents
    • Mechanism of action of topical nasal steroid is unknown.
    • The anti-inflammatory action of steroids comes from their direct localized effect in blocking various inflammatory reactions of the body due to the immune response.
    • Pharmacokinetics: In this form, it may require a maximum of 1 week to reach the desired effect and desired changes. It is also not absorbed systemically, hence no half-life data can be provided.

Side Effects and Adverse Effects of Decongestants

The common side effects of decongestants include the following:

Some patients using decongestants may experience:

  • Blurred vision
  • Tinnitus
  • Chest tightness
  • Dry nose
  • Nasal congestion

Moderate to severe reactions to decongestants may include:

  • Cardiac – arrhythmias (premature ventricular contractions, atrial fibrillation, myocardial infarction, severe hypertension)
  • Respiratory distress
  • Gastrointestinal – gastric irritation, ischemic colitis
  • Anaphylaxis – includes generalized rash, severe dizziness, difficulty breathing

Adverse effects of Decongestants include but are not limited to the following:

  • Rebound congestion – Otherwise known as rhinitis medicamentosa, is an adverse effect brought about by frequent or prolonged use of decongestants.
  •  Localized stinging or burning – especially true for the first few uses of the topical nasal form of decongestants
  • Sympathomimetic effects – Examples of which are anxiety, restlessness, tremors, hypertension, arrhythmia, sweating and pallor when oral forms of decongestants are utilized.
  • Localized dryness of nasal mucosa, headache – Observed when using the topical nasal steroid form of the decongestant.

Contraindications and Cautions for Decongestants

The following instances are contraindications and cautions in the use of decongestants:

  1. Caution must be considered when there are mucosal lesions or erosions in the nasal passages that may otherwise lead to systemic absorption of the drug
  2. Caution must also be exercised when use in patients with health conditions that may be affected and made worse by sympathetic activity (eg. Hypertension, cardiac disease, hyperthyroidism, close angle glaucoma, enlarged prostate, diabetes)
  3. Caution is advised when in use for pregnant or lactating mothers for the drug may pass in-utero and on breast milk.
  4. For patients with an active infections (eg. Tuberculosis, etc.), caution should also be exercised for systemic absorption would conflict with the body’s inflammatory and immune response.
  5. Since drowsiness can be a side effect, intake of decongestants are contraindicated while doing activities that needs alertness to do it safely (eg. Use of machinery).
  6. Liquid or chewable products may contain alcohol, sugar or artificial sweeteners (eg. Aspartame). Because of this, those with diabetes, liver disease should be cautioned when using decongestants.

Drug Interactions with Decongestants

Notable drug interactions of the use of decongestants include the following:

  • Anesthetics. Some anesthesia medications are contraindicated when using topical nasal decongestants for it may cause serious and debilitating cardiovascular effects. 
  • Antihistamines. Decongestants may further potentiate some side effects of anti-histamines, such as drowsiness, even further and thereby causing more drowsiness to the patient.
  • Blood pressure medications. May counteract with the relaxation effect of blood pressure medications with the vasoconstriction influence of decongestants to the blood vessels.
  • Medications for depression – Use of decongestants together with anti-depressant drugs may lead to serious and debilitating drug interaction.
  • Over-the-counter (OTC)products. OTC medications that are readily available, like cold, allergy remedies, can contain pseudoephedrine. Pseudoephedrine can be utilized to illegally produce methamphetamines. This in turn can be abused and may cause compounding systemic adverse effects.
  • Acute infections. Due to the inhibitive action of steroids to the immune response, using decongestants in conjunction with treating acute infections, such as tuberculosis, chicken pox, or measles, would interfere to the effectivity in treating them.

Nursing Care Plan for Patients on Decongestants

Possible Nursing Diagnoses

  • Acute Pain related to localized effects of decongestants (CNS or GI)
  • Disturbed sleep pattern related to the side effect of decongestants
  • Increased cardiac output related to the decongestant’s sympathomimetic actions
  • Risk for injury related to side effects of decongestants (dizziness or drowsiness)
  • Diarrhea related to GI effects of decongestants
  • Deficient knowledge related to new drug therapy

Nursing Assessment

InterventionsRationales
Assess the patient for signs and symptoms of nasal congestion, rhinitis, or other respiratory tract condition.To confirm the indication for administering decongestants.
Check the patient’s allergy status.Alternatives to decongestants should therefore be considered in case of allergy.
Assess if the patient is pregnant or lactating.Pregnant and breastfeeding women with nasal congestion or seasonal rhinitis can continue taking their Category B decongestants daily but will be closely monitored by their physician.
Assess the patient’s ability to self-administer the drug.To check for any potential problems with administration.
To ensure that the right form of decongestants is given through the right route (topical or oral).
 Check for current medications that include antihypertensives, some anesthesia medications, antidepressants, and over-the-counter medications as these should be used cautiously with decongestants.Caution is highly warranted as decongestants may result to increased cardiac output, dysrhythmia, and respiratory distress.

Nursing Planning and Intervention

InterventionsRationales
Administer decongestants at the same time each day, ideally before meals.Decongestants taken before meals can help the patient breathe better when eating or drinking.

When administering decongestants in nasal spray or drops formulation, ask the patient to clear nasal passages first. Then, tilt the head back and apply the drug. Keep the head tilted back for a few more seconds.To ensure optimal absorption and therapeutic action by decongestants.

Advise the patient that the decongestants should not be used over 5 days.Persistent symptoms may be clinical manifestations of a more serious condition.
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking decongestants. Instruct the patient on how to self-administer decongestants.To inform the patient on the basics of decongestants, as well as to empower him/her to safely self-administer the medication.
Monitor the patient’s sleep pattern and provide comfort measures that promote better sleep.Long-term or potent decongestants may cause insomnia.
Towards the end of the course of decongestants, inform the patient if the dosage of decongestants needs to be tapered down.Abruptly stopping some types of decongestants may cause withdrawal symptoms such as lightheadedness and dizziness.

Nursing Evaluation

InterventionsRationales
Ask the patient to repeat the information about decongestants.To evaluate the effectiveness of health teaching on decongestants.
Monitor the patient’s blood pressure levels.To ensure that the decongestants did not cause any adverse effect on cardiac output as evidenced by untoward blood pressure changes.

Monitor the patient’s response to decongestants.To check if the decongestants are effective or if the dose needs to be adjusted.
Monitor for diarrhea or gastrointestinal upset and treat these symptoms as they appear.Decongestants may cause gastric irritation or colitis.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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