# A nurse teaches the parent of a 12-year-old child starting montelukast for exercise-induced asthma. Which counseling point most reflects the FDA boxed warning for this medication?

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> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

A nurse teaches the parent of a 12-year-old child starting montelukast for exercise-induced asthma. Which counseling point most reflects the FDA boxed warning for this medication?

## Option

1. Monitor for new mood changes, nightmares, agitation, depression, or suicidal thoughts and report them immediately **✔ Correct answer**
2. Schedule weekly liver function tests to monitor for the common hepatotoxic effects of montelukast.
3. Instruct the child to limit physical activity for the first month of treatment to reduce the risk of asthma attacks.
4. Eliminate dairy products from the child's diet because montelukast can cause severe lactose intolerance.

**Correct answer: 1**

## Explanation

Correct (2): Montelukast has an FDA boxed warning for serious neuropsychiatric events — agitation, depression, sleep disturbances, hallucinations, irritability, hostility, anxiety, and suicidal thoughts/behavior, especially in children/adolescents. Parents and patients must be counseled to report symptoms immediately. (1) Routine LFT not required for montelukast (different from zafirlukast). (3,4) Unrelated.

## In-depth explanation

Memory Tip Montelukast = "Mont = MOOD warning" — boxed neuropsychiatric warning since 2020. Reserve for clients in whom benefits outweigh psychiatric risk.

## Clinical scenario

Scenario 12-year-old child with exercise-induced asthma starting montelukast 5 mg PO HS. Parents seek pre-treatment teaching.

## Key concepts

- **LTRA boxed warning** — Montelukast FDA boxed warning for neuropsychiatric events; counsel and monitor.
- **Leukotriene receptor antagonist** — Montelukast, zafirlukast; control mediators in asthma and allergic rhinitis.
- **Mental health monitoring** — Screen at each visit for mood changes in clients on montelukast.

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