Adrenergic drugs: nasal decongestants: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Adrenergic drugs: nasal decongestants

Sample item

A 30-year-old man has used oxymetazoline nasal drops several times daily for three weeks for a cold. The cold has resolved but he now has worse nasal obstruction that is relieved only by more drops. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Stop the decongestant and start an intranasal corticosteroid

Prolonged use of topical alpha agonists causes rebound vasodilatation and mucosal oedema (rhinitis medicamentosa), probably through receptor downregulation and reactive hyperaemia. Treatment is to stop the drug, often with an intranasal steroid to bridge the rebound. Decongestants should be restricted to about 3 to 5 days.

Option by option

  • A. Switch to long-term oral pseudoephedrine

    Long-term systemic decongestants carry hypertension and other adverse effects and do not address the cause.

  • B. Start a course of oral antibiotics

    There is no evidence of bacterial infection, and antibiotics will not help rebound congestion.

  • C. Stop the decongestant and start an intranasal corticosteroid (correct)

    Correct. Withdrawing the topical agonist and using a nasal steroid treats rebound congestion.

  • D. Increase the oxymetazoline frequency

    More drops perpetuate the rebound cycle.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Stop the decongestant and start an intranasal corticosteroid. Prolonged use of topical alpha agonists causes rebound vasodilatation and mucosal oedema (rhinitis medicamentosa), probably through receptor downregulation and reactive hyperaemia.

Why is "Switch to long-term oral pseudoephedrine" not the answer?

Long-term systemic decongestants carry hypertension and other adverse effects and do not address the cause.

Why is "Start a course of oral antibiotics" not the answer?

There is no evidence of bacterial infection, and antibiotics will not help rebound congestion.

Why is "Increase the oxymetazoline frequency" not the answer?

More drops perpetuate the rebound cycle.

What concept does this question test?

It tests Adrenergic drugs: nasal decongestants in Pharmacology. Treatment is to stop the drug, often with an intranasal steroid to bridge the rebound. Decongestants should be restricted to about 3 to 5 days.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Adrenergic drugs: nasal decongestants?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.