Sympathomimetic Medications

• Sympathomimetic medications are administered to alleviate nasal congestion associated with various conditions; they lack therapeutic effects on sneezing, itching, or allergic rhinitis.

Prototype and Other Medications

• Phenylephrine is the prototype sympathomimetic medication.
• Pseudoephedrine and ephedrine are rarely prescribed due to their abuse potential, with many states restricting over-the-counter access.

Expected Pharmacologic Action

• Sympathomimetics activate alpha1-adrenergic receptors in the nose, mimicking the sympathetic nervous system's actions.
• Activation of alpha1-adrenergic receptors causes vasoconstriction, shrinking nasal turbinates and relieving congestion.
• Topical application provides quick relief, but overuse can lead to rebound congestion, requiring more frequent use.

Adverse Drug Reactions

• Stimulation of adrenergic receptors causes side effects.
• Oral administration can cause CNS stimulation, leading to agitation, anxiety, and insomnia.
• Systemic vasoconstriction may result in hypertension, arrhythmias, and heart palpitations.
• Pseudoephedrine and ephedrine have abuse potential.
• Overuse of nasal applications can cause rebound congestion.

Interventions

• Administer sympathomimetics only when necessary.
• Monitor for agitation, anxiety, and insomnia due to CNS stimulation.
• Report increased heart rate, blood pressure, and palpitations, as they may indicate overdosage.
• Recommend a nasal glucocorticoid when discontinuing long-term intranasal use to minimize rebound congestion.
• Inform clients taking pseudoephedrine or ephedrine about the risk of abuse.

Safety Alert

• Monitor clients with cardiac dysrhythmias, hypertension, or coronary artery disease, as sympathomimetics can increase heart rate and blood pressure.
• Discontinue use if blood pressure rises or dysrhythmias occur.

Administration

• Do not exceed the recommended dose for oral sympathomimetics.
• Instruct clients to take medication only when necessary.
• Limit topical sympathomimetic use for nasal congestion to 3 to 5 days to prevent rebound congestion.

Client Instructions

• Notify the provider of excessive CNS stimulation, like agitation and anxiety.
• Short-term use of a hypnotic or sleep aid may be necessary.
• Report prolonged tachycardia or heart palpitations as they may indicate overdosage.
• Avoid using nasal preparations for more than 3 to 5 days due to rebound congestion risk.
• Taper intranasal use by extending time between administrations or using the medication in one nostril only, when discontinuing.

Safety Alert

• Clients with hypertension should have their blood pressure checked regularly while taking sympathomimetics.

Contraindications and Precautions

• Contraindicated for chronic rhinitis due to their unsuitability for long-term use.
• Pseudoephedrine and ephedrine are contraindicated due to high abuse risk.
• Contraindicated in clients with narrow-angle glaucoma, uncontrolled heart disease, hypertension, or dysrhythmia.
• Administer cautiously in clients with coronary artery disease or hypertension.
• Over-the-counter medications containing sympathomimetics must provide a written warning on their label.
• Use caution in older adults due to vasoconstrictive effects and potential for decreased excretion.

Interactions

• MAOI antidepressants potentiate sympathomimetics; avoid use within 3 weeks of each other.
• Beta2-adrenergic agonists and other stimulants potentiate hypertensive effects.

Question

• A client using phenylephrine spray for nasal congestion should limit the use of the medication to 3 to 5 days to avoid rebound congestion.

Sympathomimetic medications, like phenylephrine, alleviate nasal congestion. They activate alpha1-adrenergic receptors in the nose, causing vasoconstriction and shrinking nasal turbinates. Overuse can lead to rebound congestion. Oral administration can cause CNS stimulation, leading to agitation, anxiety, and insomnia.