Report new or worsening mood changes, agitation, hallucinations, or suicidal thoughts immediately.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A client with asthma is prescribed montelukast. The nurse explains that this medication is used for which purpose?
Answer: A. Montelukast is a leukotriene receptor antagonist used for long-term maintenance control of asthma; it is taken daily, often in the evening, to prevent symptoms. It is not a rescue inhaler and does not relieve acute bronchospasm, so the client must keep a short-acting bronchodilator for acute attacks.
Question 2 of 4
A client with asthma is prescribed montelukast. The nurse explains that this medication is used for which purpose?
Answer: B. Montelukast is a leukotriene receptor antagonist used for long-term control and prevention of asthma symptoms, including exercise-induced bronchospasm and allergic rhinitis. It is taken daily and is not a rescue medication. It has no role in relieving an acute attack because it does not produce rapid bronchodilation.
Question 3 of 4
A nurse is caring for a child taking montelukast for asthma. The nurse should teach the caregiver to monitor for and report which adverse effect associated with this medication?
Answer: A. Montelukast carries a boxed warning for neuropsychiatric events, including mood changes, agitation, depression, sleep disturbances, and suicidal thinking. Caregivers should be taught to monitor for and report new behavioral or mood changes. The other listed effects are not characteristic concerns for this leukotriene receptor antagonist.
Question 4 of 4
A nurse is reviewing new prescriptions for a client with COPD. Which medication, if prescribed, should the nurse question due to its anticholinergic effects in a client with a history of narrow-angle glaucoma and benign prostatic hyperplasia?
Answer: B. Inhaled anticholinergics such as ipratropium and tiotropium are used cautiously in clients with narrow-angle glaucoma and benign prostatic hyperplasia because anticholinergic effects can raise intraocular pressure and worsen urinary retention. The nurse should question the anticholinergic. Albuterol, fluticasone, and montelukast do not carry these specific anticholinergic precautions.
Keep the streak going with more questions like these, each with a full rationale.
What is montelukast?
It is taken daily for long-term asthma control and allergic rhinitis, NOT for an acute attack. Memory aid: '-lukast' = leukotriene blocker.
Key points to remember
- It is a controller/prophylactic drug and does NOT relieve an acute bronchospasm or asthma attack.
- Given orally once daily, typically in the evening, with or without food.
- Effective for both asthma and seasonal/perennial allergic rhinitis, and prevents exercise-induced bronchospasm.
- Has a black box warning for serious neuropsychiatric events including agitation, depression, and suicidal thinking.
- Chewable tablets contain phenylalanine, a concern for patients with phenylketonuria (PKU).
Nursing priorities
- Confirm the patient understands this is daily prevention, not rescue, and continues to carry a short-acting bronchodilator.
- Assess and document baseline mood and behavior; monitor for new agitation, depression, or suicidal ideation.
- Administer in the evening for asthma to align with overnight/early-morning symptoms.
- Screen chewable forms for phenylalanine content in patients with PKU.
Patient teaching
- Take it every day even when you feel well; it works by preventing symptoms over time.
- Keep using your rescue inhaler for sudden breathing trouble.
- Report any unusual mood, sleep, or behavior changes to your provider.
Red flags: report now
- Report new or worsening mood changes, agitation, hallucinations, or suicidal thoughts immediately.
- Never substitute montelukast for a rescue inhaler during an acute attack.
References
Clinical references for this topic
