{"id":11238,"date":"2026-10-21T00:16:37","date_gmt":"2026-10-21T08:16:37","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=11238"},"modified":"2026-10-19T12:32:06","modified_gmt":"2026-10-19T20:32:06","slug":"usmle-step-1-question-of-the-day-nasal-decongestant","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-nasal-decongestant","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Nasal decongestant"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_86 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-nasal-decongestant\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-nasal-decongestant\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-nasal-decongestant\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-nasal-decongestant\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-nasal-decongestant\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-nasal-decongestant\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today\u2019s USMLE\u00ae Step 1 question of the day features a 27-year-old woman with a runny nose, cough, and sore throat who&#8217;s also feeling anxious. What medication mechanism of action is at work? Let\u2019s find out!<\/em><\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>27-year-old woman<\/strong> presents to her outpatient provider for <strong>evaluation of nasal congestion and clear nasal discharge<\/strong>. These <strong>symptoms began two days ago<\/strong> and have been bothersome, as she <strong>frequently feels the urge to blow her nose<\/strong>. The patient has also experienced a <strong>cough and sore throat<\/strong>. Past medical history is unremarkable. Temperature is 38.3\u00b0C (100.9\u00b0F), blood pressure is 112\/70 mmHg, and pulse is 69\/min. <strong>Mild erythema is present in the oropharynx.<\/strong> The lungs are clear to auscultation bilaterally. The patient is prescribed a nasal decongestant and is provided with anticipatory guidance on its side effects, which can include hypertension, anxiety, and rebound congestion with prolonged use. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following best describes this medication\u2019s mechanism of action?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Blockade of NMDA receptors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Antagonization of H1 receptors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Inactivation of NF-KB<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Stimulation of \u03b1\u2081-adrenergic receptors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Blockade of leukotriene receptors<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Stimulation of \u03b1\u2081-adrenergic receptors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Blockade of NMDA receptors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Dextromethorphan is an antitussive that has activity, in part, through NMDA-receptor antagonism. Side effects, particularly with overdose, include hallucinations, confusion, euphoria, nausea, vomiting, and nystagmus. In severe cases, patients may experience seizures, coma, and respiratory depression.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Antagonization of H1 receptors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Antihistamines (e.g., diphenhydramine, loratadine, and cetirizine) can be used to treat nasal symptoms caused by allergies and may modestly improve rhinorrhea associated with the common cold. First-generation antihistamines can cause drowsiness, anticholinergic symptoms (e.g., urinary retention, mydriasis, and dry mouth), and \u03b1\u2081-adrenergic antagonism can cause postural hypotension.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Inactivation of NF-KB<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Corticosteroids inhibit NF-KB and block the production of downstream inflammatory cytokines. Intranasal corticosteroids can be used to treat nasal congestion caused by allergies. However, these medications are not typically used to treat cold symptoms and would not account for the constellation of side effects described in the question stem.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Blockade of leukotriene receptors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Medications such as montelukast and zafirlukast block leukotriene receptors and are primarily used in the treatment of asthma. Side effects may include hypersensitivity reactions, headaches, gastrointestinal irritation, and, particularly with montelukast, neuropsychiatric effects.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with symptoms of an uncomplicated viral upper respiratory infection, or common cold. The <strong>side effect profile of hypertension, anxiety, and rebound congestion is consistent with an alpha-adrenergic decongestant, such as oxymetazoline and pseudoephedrine<\/strong>. <strong>These drugs produce adrenergic stimulation, particularly of \u03b1\u2081 receptors, causing vasoconstriction of blood vessels in the nasal mucosa. This reduces mucosal edema and improves nasal airflow.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Topical agents administered as nasal sprays, such as <strong>oxymetazoline, should generally not be used for more than a few days because prolonged use can cause rebound congestion<\/strong>. Systemic agents taken orally, such as pseudoephedrine, can produce hypertension and central nervous system stimulation, causing restlessness or anxiety.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"898\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/10\/image-4.png\" alt=\"Osmosis.org style illustration showing symptom-relief treatments for illness, including rest, hydration, and over-the-counter medications, with a person resting in bed alongside medicine, warm soup, and water.\" class=\"wp-image-11243\" style=\"aspect-ratio:1.0417362270450752;width:624px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/10\/image-4.png 936w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/10\/image-4.png?resize=300,288 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/10\/image-4.png?resize=768,737 768w\" sizes=\"auto, (max-width: 936px) 100vw, 936px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Alpha-adrenergic decongestants reduce nasal congestion by stimulating \u03b1\u2081 receptors, causing vasoconstriction and decreased nasal mucosal edema. Topical agents can cause rebound congestion with prolonged use, whereas oral agents can cause hypertension, restlessness, and anxiety.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Adrenergic_receptors\">Adrenergic receptors<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Johnson, D.A., Hricik, J.G. (1993) <strong>The pharmacology of alpha-adrenergic decongestants. Pharmacotherapy.<\/strong> 13(6 Pt 2), 110S-115S. PMID: 7507588.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Want more practice questions? Get your&nbsp;<a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and discover why millions of clinicians and caregivers love learning by Osmosis.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A patient with nasal congestion is prescribed a decongestant and counseled about several notable side effects. Can you use those clues to identify how the medication works?<\/p>\n","protected":false},"author":208,"featured_media":11242,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[3460,2967,489,3108,3456,84,2372,1762,3455,462,261,3458,3459,3457,664],"class_list":["post-11238","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-adrenergic-receptors","tag-board-exam-prep","tag-clinical-reasoning","tag-clinical-vignette","tag-common-cold","tag-medical-education","tag-medication-side-effects","tag-nasal-congestion","tag-nasal-decongestants","tag-osmosis","tag-pharmacology","tag-rebound-congestion","tag-sympathomimetics","tag-upper-respiratory-infection","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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