1Use montelukast in place of the rescue inhaler when sudden wheezing begins during exercise.
2Double the evening dose after a missed tablet to restore leukotriene blockade before sleep.
3Watch for behavior, mood, or sleep changes; stop the drug and contact the prescriber if they occur.✓ Correct answer
4Expect urine discoloration and gum enlargement as signs that the medication is effective.
Explanation
Montelukast has a boxed warning for serious neuropsychiatric events, including agitation, depression, sleep disturbance, and suicidal thoughts or behavior. The child and caregivers should monitor for new behavioral or mood symptoms, stop montelukast, and contact the prescriber if they occur. Montelukast is not a rescue medication, missed doses are not doubled, and urine discoloration or gingival enlargement do not indicate benefit.
Clinical reasoning Leukotriene receptor blockade helps prevent asthma symptoms but does not rapidly reverse acute bronchospasm. Neuropsychiatric changes can emerge during therapy and require prompt action.
Decision rule Teach the boxed warning, preserve access to a rescue inhaler, and distinguish preventive therapy from acute symptom relief.
Scenario A 12-year-old child with asthma and exercise-induced bronchoconstriction is prescribed montelukast 5 mg each evening.
Leukotriene receptor antagonist — A medication that blocks cysteinyl leukotriene receptors to reduce airway inflammation and bronchoconstriction.
Neuropsychiatric event — A new or worsening change in mood, sleep, behavior, or suicidal thinking associated with a medication.
Mental health monitoring — Screen at each visit for mood changes in clients on montelukast.