Medications to Treat Inflammation: Leukotriene Modifiers, Mast Cell Stabilizers and IgE Anatgonist (Nursing)

00:00 Another group of medications that we use to treat inflammation are leukotriene modifiers Some people call them anti-leukotrienes.

00:08 Remember what leukotrienes do in your body? Yeah, they promote smooth muscle constriction and inflammatory response.

00:16 So, we want to modify those, we want to be against those if we have someone who is having difficulty with breathing.

00:23 So anti-leukotrienes or leukotriene modifiers will help block that constriction and inflammatory response.

00:30 That's what our goal is with those medications 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.

00:48 But listed are some names for you there, montelukast, zafirlukast, zileuton are listed right there.

00:54 If you've heard about this on other videos, stop for just a minute.

00:59 Two of these have the same ending, -lukast, right? but the fourth one doesn't.

01:05 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.

01:20 Now they do have some adverse effects, and they're kind of neuropsychiatric.

01:25 That means you might be irritable, you might have some crazy dreams.

01:29 I have had some patients that are very sensitive to this, and they have had some bizarre dreams.

01:35 It might also bring one some depression or maybe if there's an underlying depression, it might make this worse.

01:41 Or you might have difficulty sleeping, which will be hard to tell if that was the nightmares or if that was the medication.

01:48 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.

02:05 So we'll help the patient walk through with some of these effects.

02:08 And you can have some mild GI distress but most medications can cause GI distress in certain patients.

02:14 The other one I want you to remember, remember this drug that starts with a "Z" See it there on your screen, underline it.

02:22 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.

02:34 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.

02:59 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.

03:16 So that's how you can beneefit form treating your patients and from answering test questions.

03:23 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.

03:38 Now throughout this medicaton we may monitor the ALT levels regularly, just to make sure they're not getting into any problems.

03:44 Remember ALT is much more specific for the liver than AST.

03:50 Now here's one of our oldest friends - Cromolyn.

03:53 It's an inhaled medication, it's a mast cell stabilizer.

03:58 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.

04:10 It does not relieve bronchoconstriction.

04:13 In fact this is the medications that we use to prevent, just like these other meds prevent asthma attacks, not treat an asthma attack.

04:23 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.

04:37 Then you can alaso use a short acting beta-2 adrenergic agonist for that.

04:40 but Cromolyns - pretty safe, that's very available.

04:45 It's probably a lot cheaper than the other one.

04:47 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.

04:57 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.

05:09 Now this one is like a tongue twister.

05:13 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.

05:24 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.

05:33 But it's a second line drug for allergy-related asthma.

05:37 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.

05:47 Remember I told you it had a couple drawbacks? Well, subQ is one drawback but the cost is quite another.

05:55 It's greater than $10,000 a year for this medication.

05:59 So subQ, high cost but it can really benefit certain patients.

06:04 So if it's pescribed appropriately, this can make a big difference in their quality of life.

06:10 So, probably would be worth that $10,000 a year in just the right patients.

06:15 It also has a risk for anaphylaxis.

06:17 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.

06:30 You can also end up with an anaphylaxis which is obviously an allergic response.

06:35 It also might have some risk for cancer, so you'd want to weigh this out with your healthcare provider.

06:40 So let's wrap these medications up that we use to prevent attacks, not to treat acute attacks.

06:47 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.

07:05 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.

07:21 Now remember we don't want to give them to children because of the risk for suppressing their growth.

07:27 Leukotriene modifiers or anti-leukotriene medications are medications that block the action of leukotrienes.

07:34 Now we can add them and give them in combination with glucocorticoid medications.

07:40 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.

07:51 Now there'e our little friend mast cells stabilizer - the Cromolyn drug.

07:56 It's an old-school one, we have to use it ahead of time.

07:59 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.

08:11 Surely not like the ones like leukotriene modifiers or glucocorticoids.

08:15 Lastly, we've got the IgE antagonist.

08:18 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.

08:33 Thank you for watching our video today.