A patient admitted to the hospital has been using phenylephrine ...

[Bernana]

A patient admitted to the hospital has been using phenylephrine nasal spray (Neo-Synephrine), 2 sprays every 4 hours, for a week.
 
  The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
  a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
  b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
  c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
  d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.

Question 2

A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine (Claritin-D) every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious.
 
  The patient's heart rate is 90 beats per minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to:
  a. discuss using an intranasal glucocorticoid and loratadine (Claritin).
  b. report acute toxicity caused by pseudoephedrine.
  c. suggest using an agent with a sympathomimetic drug only.
  d. suggest using a topical decongestant to minimize systemic symptoms.

[234sdffa]

Answer to Question 1

ANS: B
This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid while withdrawing the decongestant is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion.

Answer to Question 2

ANS: A
This patient is showing central nervous system (CNS) and cardiovascular side effects of the pseudoephedrine. A better option would be to use single-ingredient products for each symptom; an intranasal glucocorticoids and an oral antihistamine are considered first-line treatments. This patient is demonstrating adverse effects but not acute toxicity. Using a sympathomimetic agent would increase the adverse effects, because pseudoephedrine is a sympathomimetic drug. Topical decongestants are not first-line drugs for allergic rhinitis.

[Bernana]

Excellent

[upturnedfurball]

TYSM