Teaching points

montelukast sodium
(mon tello o' kast) Singulair Pregnancy Category B
Drug classes

Take this drug regularly as prescribed; do not stop taking this drug during symptom-free periods; do not stop taking this drug without consulting your health care provider. Continue taking any other antiasthma drugs that have been prescribed for you. Notify your health care provider if your asthma becomes worse Do not take this drug for an acute asthma attack or acute bronchospasm; this drug is not a bronchodilator, and routine emergency procedures should be followed during acute attacks Avoid the use of aspirin or NSAIDs if you have a known sensitivity to these drugs. Montelukast will not prevent reactions. Report fever, acute asthma attacks, flulike symptoms, lethargy. Adverse effects inItal ic are most common; those inBold are life-threatening.

Antasthmatic Leukotriene receptor antagonist

Therapeutic actions

Selectively and competitively blocks the receptor that inhibits leukotriene formation, thus blocking many of the signs and symptoms of asthma\u2014neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction. These actions contribute to inflammation, edema, mucus secretion, and bronchoconstriction associated with the signs and symptoms of asthma.
Indications

Prophylaxis and chronic treatment of asthma in adults and children > 12 mo Relief of symptoms of seasonal allergic rhinitis in adults and children > 2 yr Unlabeled uses: Chronic urticaria, atopic dermatitis
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Pulmicort Flexhaler AERON MONTELUKAST

Contraindicated with hypersensitivity to montelukast or any of its components; acute asthma attacks; status asthmaticus
Adverse effects

A count of above 40 percent is known as lymphocytosis

A lymphocyte level that is more than 40% is considered to be abnormally high. Some basic causes of a high lymphocyte count are the flu and the chickenpox

CNS: Headache, dizziness

GI: Nausea, diarrhea, abdominal pain, dental pain

Respiratory: Influenza, cold, nasal congestion

Other: Generalized pain, fever, rash, fatigue

Interventions

Administer in the evening without regard to food.

Ensure that drug is taken continually for optimal effect.

Do not administer for acute asthma attack or acute bronchospasm.

Avoid the use of aspirin or NSAIDs in patients with known sensitivities while they are using this drug.

Ensure that patient has a readily available rescue medication for acute asthma attacks or situations when a short-acting inhaled agent is needed.

Risks A chest tube is a hollow, flexible tube in the chest. It acts like a drain. Chest tubes drain blood, fluid, or air from around your lungs. This allows your lungs to fully expand. The tube is placed between your ribs and into the space between the inner lining and the outer lining of your lung. This is called the pleural space. Some risks from the insertion procedure are: Moving the tube by accident (this could damage tissue around the tube) Bleeding or infection where the tube is inserted Buildup of pus Improper placement of the tube (into the tissues, abdomen, or too far in the chest) Injury to the lung, which could cause more breathing problems Injury to organs near the tube, such as the spleen, liver, stomach, or diaphragm

Description When your chest tube is inserted, you will lie on your side or sit partly upright, with one arm over your head. The area where the tube will be inserted is numbed. Sometimes you will receive medicine through a vein (intravenous, or IV) to make you relaxed and sleepy. Your skin where the tube will be inserted will be cleaned. The chest tube is inserted through a 1-inch cut in your skin between your ribs. Then it is guided to the correct spot. The tube is connected to a bottle or canister. Suction is often used to help it drain. Other times, gravity alone will allow it to drain. A stitch (suture) and tape keep the tube in place.

After the Procedure You will usually stay in the hospital until your chest tube is removed. People do not usually go home with a chest tube. While the chest tube is in place, your nurses will carefully check for air leaks, breathing problems, and if you need oxygen. They will also make sure the tube stays in place. Your nurses will tell you whether it is okay to get up and walk around or sit in a chair. What you will need to do: Breathe deeply and cough often (your nurse will teach you how to do this). Deep breathing and coughing will help re-expand your lung, help with drainage, and prevent fluids from collecting in your lungs. Be careful there are no kinks in your tube. The drainage bottle should always sit upright and be placed below your lungs. If it is not, the fluid or air will not drain and your lungs cannot re-expand.

After your chest tube insertion, you will have a chest x-ray to make sure the tube is in the right place. The chest tube usually stays in place until x-rays show that all the blood, fluid, or air has drained from your chest and your lung has fully re-expanded. The tube is easy to remove when it is no longer needed. Most people do not need medicine to relax or to numb the area when it is removed. Some people may have a chest tube inserted that is guided by x-ray or ultrasound. If you have major lung or heart surgery, a chest tube will be placed while you are under general anesthesia (asleep). Why the Procedure is Performed Chest tubes are used to treat conditions that can cause a lung to collapse. Some of these conditions are: After surgery or trauma in the chest Air leaks from inside the lung into the chest (pneumothorax) Fluid buildup in the chest (called a pleural effusion) due to bleeding into the chest, buildup of fatty fluid, abscess or pus buildup in the lung or the chest, or heart failure

Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. Bronchial asthma is the more correct name for the common form of asthma. The term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a separate condition that is caused by heart failure. Although the two types of asthma have similar symptoms, including wheezing (a whistling sound in the chest) and shortness of breath, they have quite different causes.

Chronic asthma attack or bronchial asthma acute exacerbation is a situation when the bronchial tubes present in the lungs constrict and swell up making the air passage narrower thereby, leading to a difficulty in breathing. In such a case, a person can enter a state of fright and lead to spasms and even death. Triggered by smoke, dust, pollen or animal hair, toxins present in the environment, strenuous physical activity and anxiety, the first asthma symptom of this condition is wheezing.

The person, in case of bronchial asthma in acute exacerbation, will try to take in more oxygen into the lungs while experiencing wheezing that stays for a long period. Panicking makes it worse and can lead to choking and death. Bronchial asthma in acute exacerbation has been categorised into four stages:

The symptom causing stage or mild asthma: In this stage, the person experiences minor breathing attacks along with wheezing. An inhaler can prevent this from happening. Mild persistent asthma attack. In this stage, the person experiences minor attacks, but frequent ones over a short period of time. Moderate persistent asthma attack. The attacks in this case are intense and are the worst kind that an asthmatic patient goes through. In this stage, oxygen supply to the patient is a must. Nasal spikes should be provided to the person immediately to ensure that the oxygen saturation in the blood is more than 90 percent.