NCLEX Review Guide: Nasal Decongestants

Mechanism of Action

• Nasal decongestants work by causing vasoconstriction of nasal blood vessels, reducing swelling and congestion in nasal passages.
• They stimulate alpha-adrenergic receptors in the nasal mucosa, leading to decreased blood flow and reduced tissue edema.

Topical Decongestants

• Oxymetazoline (Afrin) and phenylephrine nasal spray provide rapid, localized relief with minimal systemic absorption.
• Rebound congestion (rhinitis medicamentosa) occurs with use >3 days due to receptor desensitization and increased nasal secretions.

Oral Decongestants

• Pseudoephedrine (Sudafed) and phenylephrine oral provide systemic decongestant effects with longer duration.
• Oral forms have greater systemic side effects including increased blood pressure, heart rate, and CNS stimulation.

Contraindications & Precautions

• Hypertension, coronary artery disease, and hyperthyroidism are major contraindications due to sympathomimetic effects.
• Diabetes mellitus requires monitoring as decongestants can increase blood glucose levels.
• MAOIs interaction can cause hypertensive crisis - avoid concurrent use or within 14 days.

Critical Teaching Points

1. Limit topical decongestants to 3 days maximum to prevent rebound congestion
2. Monitor blood pressure regularly, especially in hypertensive patients
3. Take oral forms with food to reduce GI irritation
4. Avoid late-day dosing to prevent insomnia
5. Use saline rinses between decongestant doses to maintain nasal moisture