Week 6: Leukotriene Modifiers and Respiratory Inhalants Flashcards
Leukotriene Modifiers Indication and Examples
Allergies/allergic rhinitis with asthma - if pt is not well controlled during times when seasonal allergies are worse
Montelukast (Singular)
Zafirlukast
Zileuton (Zyflo)
Montelukast and Zafirlukast MOA
Leukotriene receptor antagonist (LTRAs) - blocks the cysteinyl leukotriene (CysLT1) receptor with decreases the inflammatory response in the lungs
Zileuton (Zyflo) MOA
- prevents the synthesis of leukotrienes - inhibits 5-lipoxygenase, the enzyme that catalyzes the formation of leukotrienes from arachidonic acid
Leukotriene Modifiers cautions/contraindications
- Zafirlukast and Zileuton- use with caution in patients with hepatic disease
- Not to be used in acute asthma exacerbation
Leukotriene Modifiers ADRs
- headache, GI upset, myalgias
- Neuropsychiatric: hallucinations, agitation, aggression, suicidal ideations and behavior, insomnia, depression
- Zafirlukast and Zileuton/Zyflo: can cause hepatotoxicity
Clinical use of LTRAs
- Montelukast - persistent asthma in patients 1 year old and older -
- Zafirlukast - chronic asthma in patients 5 years old and older
- Zileuton - persistent asthma in patients 12 years old and older
*** needs to be taken daily - takes 3-5 days to reach full effect
Fluticasone (Flovent/Flonase) drug class
Inhaled corticosteroids (ICSs) - pulmonary inhalers and intranasal
Budesonide - another example of an ICS medication
ICSs indications
- Primarily used in asthma (2nd line if pt is using SABAs more than 2x/week)
- can also be used in COPD to reduce exacerbations - keep pts out of the hospital
ICSs MOA
- potent anti-inflammatory and vasoconstriction action
- inhaled: inhibit IgE in mast cell migration of inflammatory cells into the bronchioles - used in all ages
- intranasal: focuses on inflammation in the nasal mucosa alone
- used in patients 2 years and older
ICSs cautions/ contraindications
- NOT for asthma exacerbation
- use caution in active infection
- watch potassium levels, glucose, bone density, growth (high doses for a long time)
Avoid in: Cushing syndrome, herpes, tuberculosis, nasal trauma or ulcers, untreated respiratory infection
ICSs ADRs
-dry mouth (xerostomia), hoarseness, mouth and throat irriation, flushing, bad taste, oral candidiasis, rash, urticaria (rare)
ICS Patient education
- rinse mouth and spit after use
- keep taking as directed - the only way you know this is working is by less use of SABAs
- if using the a bronchodilator - use the bronchodilator 1st and then after a few minutes use the ICS inhaler
- nasal: blow nose prior to application
- effects are not immediate - takes 3-7 days to see full effect
Cromolyn sodium drug class
Mast Cell stabilizers - decrease bronchi hyperactivity to stimuli such as allergies
Cromolyn sodium Indication
Exercise induced bronchospasm (EIB) - asthma - allergic rhinitis
Cromolyn sodium MOA
- inhibits antigen-induced bronchospasm and blocks the release of histamine by inhibiting mast cell degranulation
- has no effect of beta receptors, but can help reduce the need for Albuterol - good for patients that have a need to SABA prior to athletics more than 2 times a week - use this instead
