All of the following are FDA-approved indications for montelukast sodium, EXCEPT?
Allergic Rhinitis
Prevention of Exercise-induced Bronchoconstriction
Asthma
COPD
The Correct Answer is D
Montelukast sodium is a selective leukotriene receptor antagonist (LTRA) that blocks the action of cysteinyl leukotrienes (CysLT1). These inflammatory mediators are potent bronchoconstrictors and contributors to airway edema and mucus secretion. It is used as a maintenance therapy to prevent chronic respiratory symptoms. It is frequently prescribed for patients who have concomitant asthma and allergies.
Rationale:
A. Allergic rhinitis is an FDA-approved indication for montelukast. It is effective for both seasonal and perennial allergic rhinitis in adults and pediatric patients. It helps relieve symptoms such as nasal congestion, sneezing, and rhinorrhea by blocking leukotriene-mediated inflammation in the nasal mucosa and upper respiratory tract.
B. Prevention of exercise-induced bronchoconstriction (EIB) is a specifically approved indication for montelukast. It is taken at least 2 hours before exercise to provide protection for up to 24 hours. This makes it an alternative for patients who do not achieve adequate control with short-acting beta agonists alone.
C. Asthma is the primary FDA-approved indication for montelukast sodium. It is used for the long-term prophylaxis and chronic treatment of asthma in patients as young as 12 months. It helps reduce the frequency of asthma attacks but is never used to treat an acute exacerbation or status asthmaticus.
D. COPD (Chronic Obstructive Pulmonary Disease) is not an FDA-approved indication for montelukast. While leukotrienes are present in COPD, clinical trials have not consistently shown that LTRAs provide significant benefit for airflow obstruction in this population. Maintenance of COPD typically relies on long-acting bronchodilators and inhaled corticosteroids instead.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Nitrogen metabolism involves the safe transport of potentially toxic ammonia from peripheral tissues to the liver for neutralization. Ammonia is converted into organic forms to prevent neurotoxicity during transport in the blood. The urea cycle in the liver then converts this nitrogen into urea for renal excretion. Specific amino acids serve as specialized "carriers" to move nitrogen across the body's metabolic compartments.
Rationale:
A. Alanine is a significant nitrogen carrier, specifically from skeletal muscle to the liver via the glucose-alanine cycle. While important, it primarily handles nitrogen generated during muscle protein catabolism. It is not the "major" contributor to total systemic nitrogen transport compared to the more versatile and high-capacity glutamine pathway.
B. Glycine is the simplest amino acid and participates in many biosynthetic pathways, including heme and creatine synthesis. While it contains nitrogen, it does not function as a dedicated carrier for the transport of excess ammonia for excretion. Its role in the urea cycle is indirect and not related to systemic transport.
C. Lysine is an essential amino acid and is purely ketogenic. It does not participate in the transamination reactions that are central to nitrogen transport and urea cycle priming. Therefore, it cannot serve as a vehicle for moving excess nitrogen from peripheral tissues to the hepatocyte for processing into urea.
D. Glutamine is the major contributor to systemic nitrogen transport. It carries two ammonia groups in a non-toxic form (as the amide of glutamate). Most tissues convert free ammonia into glutamine via glutamine synthetase for safe passage to the liver and kidneys, making it the most abundant amino acid in human plasma.
E. Ornithine is a key intermediate within the urea cycle itself. It combines with carbamoyl phosphate to form citrulline inside the mitochondria. While essential for the production of urea, it acts as a catalytic carrier within the hepatocyte rather than a vehicle for transporting nitrogen through the systemic circulation.
Correct Answer is D
Explanation
Step 1. Calculate the duration of the infusion.
Time = Total Volume / Rate
Time = 150 mL / 25 mL/hr = 6 hours.
Step 2. Determine the completion time.
Start time: 8 am
8 am + 6 hours = 2 pm.
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