Another group of medications that we use to
treat inflammation are leukotriene modifiers
Some people call them anti-leukotrienes.
Remember what leukotrienes
do in your body?
Yeah, they promote smooth muscle
constriction and inflammatory response.
So, we want to modify those,
we want to be against those
if we have someone who is having
difficulty with breathing.
So anti-leukotrienes or
will help block that constriction
and inflammatory response.
That's what our goal is with
We have often add this on when
glucocorticoids aren't enough,
so this might be a second
medication that the patient's on,
they could be on glucocorticoids and also on an
anti-leukotriene or also called the leukotriene modifier.
But listed are some names
for you there,
zileuton are listed right there.
If you've heard about this on other
videos, stop for just a minute.
Two of these have the same ending, -lukast, right?
but the fourth one doesn't.
So to help you remember those two by kinda walk
through, making sure your brain is measuring
and imprinting these words as
anti-leukotrienes or leukotriene modifiers.
Now they do have some adverse effects,
and they're kind of neuropsychiatric.
That means you might be irritable,
you might have some crazy dreams.
I have had some patients that are very sensitive
to this, and they have had some bizarre dreams.
It might also bring one some depression or
maybe if there's an underlying depression,
it might make this worse.
Or you might have
which will be hard to tell if that was the
nightmares or if that was the medication.
The point is, educate your patients that, "hey if
you experience anything, any of these symptoms,
not everyone does but if you do, contact your
healthcare provider - we will work with you"
We know you need to breathe easily and you need
to sleep and not be difficult to live with.
So we'll help the patient walk
through with some of these effects.
And you can have some mild GI distress but most
medications can cause GI distress in certain patients.
The other one I want you to remember,
remember this drug that starts with a "Z"
See it there on your screen,
Now it's got an L in it and I want you to circle
the L because this drug might impact the liver,
not the -lukast ones, but this drug
may impact your patient's liver.
So how could they throw
this at you in a question?
They might give you some descriptions
of someone who's liver is struggling,
"Hey the patient is taking these four
medications, one of them happens to be zileuton
and the patients complain of being
extremely tired, they feel like
they feel like their urine's getting darker,
notice a change in their skintone"
ding, ding ding! those are three of the
things we look for when liver is involved.
Now they may ask you which of the following statement
is most important for you to follow up on as a nurse?
Well you're always thinking about what's
the worst-case scenario with a medication,
The patient was taking zileuton, the worst case
scenario would be, yeah any sign of liver damage.
So that's how you can beneefit form treating
your patients and from answering test questions.
If you recognize any medication
that takes out an organ,
that damages an organ -
ears, liver, or kidneys,
that's something you want to be on the
lookout for in your real life patients,
educate them to watch for it and
recognize it in a test question.
Now throughout this medicaton we may
monitor the ALT levels regularly,
just to make sure they're not
getting into any problems.
Remember ALT is much more
specific for the liver than AST.
Now here's one of our
oldest friends - Cromolyn.
It's an inhaled medication,
it's a mast cell stabilizer.
Anytime I can have a mast
cell that's more stable,
it's less likely to release the
beast of the inflammatory process,
So that's why I want to use
it to suppress inflammation.
It does not relieve bronchoconstriction.
In fact this is the medications that we use
to prevent, just like these other meds
prevent asthma attacks, not
treat an asthma attack.
This is the medication that's great to
use if you have exercise-induced asthma,
like you don't normally have asthma
attacks unless you're exercising
and then if you take this
medication before you exercise,
let it kick in, then you're
gonna be in good shape.
Then you can alaso use a short acting
beta-2 adrenergic agonist for that.
but Cromolyns - pretty safe,
that's very available.
It's probably a lot cheaper
than the other one.
You just have to give it time to kick in
and if this is good enough to treat it,
you won't have that significant tachycardic
response that you can get with the SABAs.
Really, we've talked about the adverse effects?
that's a very empty slide, isn't it?
Cromolyn - there's essentially no
adverse effects for this medication
and I sure can't say that very often
with the things that we've talked about.
Now this one is like a tongue twister.
I want you to practice pronouncing
that one cause it's just fun to say
but it's an IgE antagonist, but it has to be given
subQ so it's got a few drawbacks.
Most people don't like giving
themselves a subQmedication,
but if they have to choose between breathing and
a subQmedication, they'll usually opt for this.
But it's a second line drug
for allergy-related asthma.
Remember if we can stop it, boom! at the point
of IgE, if we can block the action of IgE,
we're gonna block all the rest
of that inflammatory response.
Remember I told you it
had a couple drawbacks?
Well, subQ is one drawback but
the cost is quite another.
It's greater than $10,000 a
year for this medication.
So subQ, high cost but it can
really benefit certain patients.
So if it's pescribed appropriately, this can
make a big difference in their quality of life.
So, probably would be worth that $10,000
a year in just the right patients.
It also has a risk for anaphylaxis.
Okay, what's a way to
remember all this stuff?
Remember this medication
is an IGE antagonist
which is part of the inflammatory
response or the allergic response.
You can also end up with an anaphylaxis
which is obviously an allergic response.
It also might have some risk for cancer, so you'd want
to weigh this out with your healthcare provider.
So let's wrap these medications up that we use
to prevent attacks, not to treat acute attacks.
Okay, so glucocorticoids, if we use those, we
want to minimize the systemic effects with them
so we try to use an inhaled
route rather than oral or IV,
because once we have to switch
from oral, to oral, or to IV,
that patient's gonna have a
lot more systemic effects.
And remember those - moon face, facial
hair, mood swings, buffalo hump,
extra failure, high blood pressure, fat
distribution that's really weird
that's gonna mess with your blood
sugars whether you're diabetic or not
but particularly if you're diabetic, and
it's really hard on your bones and skin.
Now remember we don't want
to give them to children
because of the risk for
suppressing their growth.
Leukotriene modifiers or anti-leukotriene medications
are medications that block the action of leukotrienes.
Now we can add them and give them in
combination with glucocorticoid medications.
But remember these leukotriene modifiers
can have some weird neuropsychotic effects
so it could mess with your
sleep, give you bad dreams,
make you kind of mood
swingy, all those things.
Now there'e our little friend mast
cells stabilizer - the Cromolyn drug.
It's an old-school one, we
have to use it ahead of time.
We use this particularly for exercise-induced
asthma and prevention of ongoing attacks
but it's virtually the most harmless
drug when it comes to adverse effects,
just doesn't really have them.
Surely not like the ones like leukotriene
modifiers or glucocorticoids.
Lastly, we've got the IgE antagonist.
They're expensive and you have to give them subQ
and they do have that slight risk for anaphylaxis
and possibly cancer, but in certain
patients it's really an effective choice
to improve their quality of
life through better breathing.
Thank you for watching our video today.