Name of the Leukotriene antagonists Drugs
- Montelukast
- Zafirlukast
1.Montelukast
| Montelukast |
| Availability: Oral granules: 4-mg base/packet Tablets: 10 mg Tablets (chewable): 4 mg, 5 mg |
| Administration and handling: ORAL GRANULES Children ages 12 to 23 mo. 4 mg daily in the evening. Maximum: 4 mg daily. CHEWABLE TABLETS Children ages 6 to 14. 5 mg daily in the evening. Maximum: 5 mg daily. Children ages 2 to 5. 4 mg daily in the evening. Maximum: 4 mg daily. TABLETS Adults and adolescents age 15 and over. 10 mg daily in the evening. Maximum: 10 mg daily. Administration ● Give with or without food. ● Administer oral granules either directly in mouth, dissolved in 1 teaspoon (5 mL) cold or room temperature baby formula or breast milk, or mixed with spoonful of cold or room temperature soft foods (applesauce, carrots, rice, or ice cream only). Don’t open packet until ready to use. After opening packet, administer full dose (with or without mixing with baby formula, breast milk, or food); dose must be given within 15 minutes. If granules have been mixed with baby formula, breast milk, or food, don’t store for future use. ● Ensure that patient taking drug for prevention of EIB has shortacting beta-agonist available for rescue. |
| Mechanism of action : Blocks action of leukotrienes, decreasing smooth muscle contractions and edema in bronchial airways and preventing inflammation and bronchospasm |
| Indications : Long-term asthma management |
| Contraindications : Hypersensitivity to drug or its components |
| Precautions : ● acute asthma attack, hepatic impairment, phenylketonuria ● pregnant or breastfeeding patients ● children younger than age 6 when used for EIB prevention (safety not established) ● children younger than age 2 when used for seasonal allergy (safety not established) ● children younger than age 1 when used for asthma (safety not established) ● children younger than age 6 months when used for perennial allergy (safety not established). |
Patient monitoring
- Assess eosinophil count.
- Monitor temperature. Watch for fever and other signs and symptoms of infection. 2Monitor patient for change in mood or behavior, including suicidal ideation.
Patient teaching
- Advise patient (or caregiver) who has asthma or asthma and rhinitis to take drug in evening.
- Instruct patient (or caregiver) who has EIB not to take another dose within 24 hours of previous dose.
- Inform patient (or caregiver) that he may sprinkle granules onto soft foods (applesauce, carrots, rice, or ice cream only) and take immediately. Drug isn’t intended to be dissolved in any liquid other than breast milk or baby formula. Don’t store drug that has been mixed with food or liquids for future use.
- Instruct patient or caregiver that after opening packet of oral granules, dose must be taken within 15 minutes.
- Tell patient or caregiver that drug is for preventive use only, not for treatment of acute asthma attacks and that appropriate rescue medication should be available.
- Instruct patient or caregiver to notify prescriber if mood or behavior changes.
- Caution patient to avoid driving and other hazardous activities, because drug causes dizziness.
- As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above
Nursing Considerations
- Montelukast shouldn’t be abruptly substituted for inhaled or oral corticosteroids; expect to taper corticosteroid dosage gradually, as directed.
- Monitor patient for adverse reactions, such as cardiac and pulmonary symptoms, eosinophilia, and vasculitis, in patient undergoing corticosteroid withdrawal. Notify prescriber if such reactions occur.
- Watch patient closely for suicidal tendencies during montelukast therapy, especially when therapy starts or dosage changes.
- Monitor patient for adverse neuropsychiatric effects and notify prescriber if present. Drug may need to be discontinued.
2.Zafirlukast
| Zafirlukast |
| Availability: Tablets (coated): 10 mg, 20 mg |
| Administration and handling: Adults and children ages 12 and older: 20 mg P.O. b.i.d. Children ages 5 to 11: 10 mg P.O. b.i.d. Administration: ● Give at least 1 hour before or 2 hours after a meal. |
| Mechanism of action: Antagonizes activity of three leukotrienes at specific receptor sites in airway smooth muscle, inhibiting inflammation |
| Indications: To treat chronic asthma |
| Contraindications: ● Hypersensitivity to drug or its components ● Hepatic impairment, including hepatic cirrhosis |
| Precautions: acute asthma attacks ● concurrent use of warfarin ● patients older than age 55 ● pregnant patients ● breastfeeding patients (use not recommended) ● children younger than age 5 (safety not established). |
Patient monitoring
- Assess patient’s respiratory status to help evaluate drug efficacy.
- Monitor liver function tests closely, watch for signs and symptoms of liver dysfunction.
Patient teaching
- Tell patient to take at least 1 hour before or 2 hours after a meal.
- Advise patient to take exactly as prescribed, even if he is symptom-free.
- Tell patient to immediately report asthma attack. Advise him not to use drug for rapid relief of bronchospasm.
- Instruct patient to continue taking other asthma drugs unless prescriber directs otherwise.
- Instruct patient to immediately report signs and symptoms of liver dysfunction (nausea, anorexia, fatigue, lethargy, pruritus, jaundice, flulike symptoms, or right upper quadrant abdominal pain).
- Instruct patient or caregiver to report insomnia or depression.
- Instruct female patient to consult prescriber if she plans to breastfeed.
- As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above.
| Omalizumab |
| Availability: Powder for injection: 150 mg/vial |
| Administration and handling: Adults and adolescents ages 12 and older: 150 to 375 mg subcutaneously q 2 to 4 weeks |
| Mechanism of action :Inhibits binding of IgE to high-affinity IgE receptors on |
| Indications : Persistent asthma in patients with positive skin tests or in vitro reactivity to perennial allergens whose symptoms aren’t adequately controlled by inhaled corticosteroids |
| Contraindications :● Hypersensitivity to drug |
| Precautions: elderly patients ● pregnant or breastfeeding patients ● children younger than age 12. |
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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