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
inhibits the cysteinyl leukotriene (CysLT1) receptor (patho of asthma)
CysLT1’s job is airway edema and smooth muscle contraction
Zileuton (Zyflo) [Leukotriene Modifier] MOA & indication
- inhibits 5-lipoxygenase, the enzyme that catalyzes the formation of leukotrienes from arachidonic acid = reduction in inflammation, edema, mucous secretion, and bronchoconstriction
indic: chronic asthma
Leukotriene Modifiers cautions/contraindications
- Zafirlukast and Zileuton- NO in active liver disease, NO peds/lac/preg
NO acute asthma exacerbation
Leukotriene Modifiers ADRs
- headache, GI upset, myalgias, increase ALT, URI
- Neuropsychiatric: hallucinations, agitation, aggression, suicidal ideations and behavior, insomnia, depression
- Zafirlukast and Zileuton/Zyflo: can cause hepatotoxicity
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), COPD, allergic rhinitis
- can also be used in COPD to reduce exacerbations - keep pts out of the hospital
ICSs MOA
- extremely potent vasoconstriction & anti-inflammatory
- 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
- caution in active infection
- watch K levels, elevated BS, bone breakdown with long term use, affects growth in children
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
inhaled anti-inflammatory agent / mast cell stabilizer
Cromolyn sodium Indication
Exercise induced bronchospasm (EIB) / bronchspasm prophylaxis
- 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
- intranasal: takes up to 4 weks to show improvements for allergic rhinitis (educate pt)
Cromolyn sodium cautions/contraindications
NO asthma exacerbation or < 2 years old
Examples of Inhaled Antihistamines (intranasal)
- Azelastine (Astepro)
- Olopatadine (Patanase)
Inhaled antihistamines cautions/contraindications
- do not combine w/ CNS depressants (causes somnolence)
- NO driving, heavy machinery
not first choice for peds and elderly
