30 Drugs for headache
Terms in this set (19)
An adult patient is admitted to the hospital with a severe migraine headache. The patient tells the nurse that he has been taking a nonsteroidal anti-inflammatory drug for pain. The nurse understands that the most appropriate drug for a patient with a severe migraine is which of the following drugs?
a. Ibuprofen (Motrin)
b. Propranolol (Inderal)
c. Sumatriptan (Imitrex)
d. Verapamil (Calan)
Sumatriptan is the medication of choice to abort the severe pain of an actual migraine.
Ibuprofen is used for mild to moderate pain and is not the drug of choice for severe migraine pain.
Propranolol and verapamil are used as preventive therapy for migraines, not to abort the actual pain of a migraine.
A patient is admitted to the emergency department for a severe migraine headache. The patient tells the nurse that she has used Cafergot (ergotamine tartrate and caffeine) for frequent migraine headaches over the past 6 months and has been experiencing numbness and tingling in the fingers and toes. The nurse should further assess the patient for which of the following signs and symptoms? (Select all that apply.)
a. Diminished peripheral pulses
b. Muscle aches
c. Pallor of the extremities
ANS: A, B, C
Chronic use of Cafergot can lead to overdose, which should be suspected in this case because the patient has had frequent episodes of migraines and subsequent numbness and tingling in the fingers and toes. Overdose can cause ischemia secondary to constriction of peripheral arteries and arterioles, which can cause the extremities to become cold, pale, and numb. Muscle pain develops, and gangrene eventually may result.
Nausea and vomiting are side effects, not the effects of a possible overdose of Cafergot.
A nurse is providing community education on headaches. A member of the audience who has a history of migraines asks if a medication is available that will prevent attacks. The nurse's best response would be to identify which medication as preventive therapy for migraines?
a. Propranolol (Inderal)
b. Sumatriptan (Imitrex)
c. Ergotamine (no trade name)
d. Dihydroergotamine (D.H.E.)
Beta blockers such as propranolol are the preferred drugs for migraine prevention. Treatment can reduce the number and intensity of attacks in approximately 70% of patients.
Sumatriptan, ergotamine, and dihydroergotamine all are indicated to abort ongoing migraines, not prevent them.
A patient has been prescribed propranolol (Inderal) for migraine headaches. The patient asks the nurse how the medication works. Select the nurse's most appropriate response for this medication's benefits.
a. This medication can reduce the number and intensity of migraine attacks.
b. This medication can abort an acute migraine attack.
c. This medication is more effective in women than in men.
d. This medication is especially useful in treating menstrual migraines.
Propranolol can reduce the number and intensity of attacks in approximately 70% of patients, but it does not abort acute attacks.
Propranolol is a preventive treatment for migraines, not an abortive treatment.
Propranolol is not more effective in women than men as a preventive treatment for migraines.
Menstrual migraines are more effectively managed with estrogen therapy, because they are hormone induced
A prescriber orders sumatriptan (Imitrex) for a patient for a migraine headache. Prior to administration of this drug, it would be important for the nurse to gather which vital assessment information?
a. Does the patient have a family history of migraines?
b. Has the patient taken ergotamine in the past 24 hours?
c. Has the patient taken acetaminophen in the past 3 hours?
d. Is the patient allergic to sulfa compounds?
Sumatriptan, other triptans, and ergot alkaloids all cause vasoconstriction and should not be combined, or excessive and prolonged vasospasm could result. Sumatriptan should not be used within 24 hours of an ergot derivative and another triptan.
A family history is important, but it is not vital assessment data as it relates to this scenario.
Acetaminophen has no drug-to-drug interaction with sumatriptan
Sulfa is not a component of sumatriptan and is therefore not relevant
A 27-year-old female patient comes to the clinic with complaints of increasingly frequent migraines. The patient has been taking nonsteroidal anti-inflammatory drugs for previous migraines but states that they are not as effective as they once were. The patient is prescribed ergotamine with a first dose now. What action should the nurse take?
a. Ask the patient if she is pregnant or thinks she may be pregnant.
b. Instruct the patient to take the medication with food.
c. Instruct the patient to avoid the concurrent use of nonsteroidal anti-inflammatory drugs.
d. Have the laboratory draw blood for a complete blood count.
Ergotamine should not be taken during pregnancy because it promotes uterine contractions, which can cause fetal harm or spontaneous abortion.
Ergotamine may be taken with or without food.
Nonsteroidal anti-inflammatory drugs are not contraindicated with ergotamine.
Ergotamine is not contraindicated for patients with abnormal complete blood count results. It is contraindicated in patients with renal and hepatic impairment
A nurse is teaching a class on migraine headaches. The class is discussing ergotamine. One of the participants in the class asks the nurse why ergotamine is coupled with caffeine. Which of the following statements is most appropriate for the nurse to give?
a. Caffeine is used to counteract the fatigue caused by ergotamine.
b. Caffeine is given with ergotamine to suppress emesis.
c. Caffeine enhances vasoconstriction and ergotamine absorption.
d. Caffeine potentiates the analgesic effects of ergotamine.
Caffeine is present to enhance vasoconstriction and ergotamine absorption, thus enhancing migraine pain relief.
Caffeine, in conjunction with ergotamine, does not counteract fatigue.
Caffeine, in conjunction with ergotamine, does not suppress emesis.
Caffeine does enhance ergotamine absorption but does not potentiate the analgesic effects.
A prescriber orders naratriptan (Amerge) for a patient's migraine headache. Prior to the administration of this drug, which question(s) would be the most important for the nurse to ask? (Select all that apply.)
a. "Have you ever had a heart attack?"
b. "Do you have a history of urinary frequency?"
c. "Do you use tobacco products?"
d. "How long do you usually sleep at night?"
e. "Do you have high blood pressure?"
ANS: A, C, E
Naratriptan therapy should be avoided in patients with coronary artery disease, as exemplified by a history of heart attack; a history of tobacco use, because of the vasoconstrictive secondary effects of nicotine; or a history of high blood pressure, which can be exacerbated by the vasoconstrictive effects of naratriptan.
A history of urinary frequency would not be significant to the administration of naratriptan.
Sleep patterns, related to amount of sleep, would not be significant to the administration of naratriptan.
A patient on the unit complains of cluster headaches. A new graduate nurse is asked to differentiate between a migraine headache and cluster headaches. The graduate nurse is correct to state that manifestations and/or risk factors for a patient with cluster headaches include (Select all that apply.)
a. female gender.
b. male gender.
c. complaints of nausea and vomiting.
d. short duration (15 minutes to 2 hours).
e. auras prior to the onset of headache pain.
f. throbbing, sometimes piercing pain.
ANS: B, D, F
Cluster headaches are more common in males, are of short in duration, and present as throbbing and piercing pain.
Migraine headaches are more common in females and are manifested by nausea and vomiting and the presence of an aura prior to the onset of headache pain.
. An adult patient with a severe migraine headache self-medicates with an over-the-counter nonsteroidal anti-inflammatory drug. The patient does not achieve pain relief and telephones asking for a prescription for an opioid drug. Select the nurse's best action.
1. Educate the patient that opioids will make the pain of migraine headache worse.
2. Arrange for the patient to see the physician so that another drug can be prescribed.
3. Inform the patient, "Opioids will interact adversely with first-line migraine drugs."
4. Inform the patient, "Migraine pain is not severe enough to warrant opioid use."
A patient has used Cafergot (ergotamine tartrate and caffeine) for frequent migraine headaches over the past 6 months. The patient calls to report, "My fingers have been getting cold and numb recently." The nurse should give which instruction to the patient?
1. Decrease the dosage interval to increase the serum concentration of ergotamine.
2. Discontinue the ergotamine and take acetaminophen as a substitute.
3. Take an 81-mg aspirin tablet to improve circulation.
4. Come to the clinic for evaluation. This could be a sign of ergot toxicity.
A patient with a history of migraines asks for a medication to prevent attacks. Which drug will likely be prescribed?
A patient has been taking aspirin for migraines and requests another medication for use when a headache first begins in an effort to prevent a major attack. Which agent would be the most suitable for this purpose?
After beginning triptan therapy for migraine headaches, a patient complains of a heavy sensation in the arms and chest. Which information should the nurse provide to the patient?
1. Go to the nearest emergency department; a cardiac event is likely occurring.
2. An allergic reaction is in progress. Begin antihistamine therapy.
3. This symptom is common when starting these drugs and should be temporary.
4. Caffeinated beverages generally assist in the resolution of these symptoms
The physician prescribes sumatriptan for a patient's headache. Before administering this drug, the nurse should gather which assessment information?
1. Does the patient have a family history of migraines?
2. Has the patient taken ergotamine in the past 24 hours?
3. Has the patient taken acetaminophen in the past 3 hours?
4. Is the patient allergic to sulfa compounds?
Which patient can safely use ergotamine for a migraine headache?
1. A woman with severe menstrual migraines
2. A pregnant patient with severe migraines
3. An older man with coronary artery disease
4. An adolescent with renal insufficiency
Sumatriptan is prescribed for a 22-year-old woman with an intractable migraine headache. Before administering the drug, which question should the nurse ask the patient?
1. "When was your last menstrual period?"
2. "Have you ever experienced an eating disorder?"
3. "Do you perform monthly breast self-examinations?"
4. "Are you taking birth control pills?"
The physician prescribes naratriptan for a patient's migraine headache. Before administering this drug, which question(s) would be the most important to ask the patient? You may select more than one answer.
1. "Have you ever had a heart attack?"
2. "Have you had any recent infections?"
3. "Do you use tobacco products?"
4. "How long do you usually sleep at night?"
5. "Have you ever had high blood pressure?"
For patients with cluster headaches, which characteristics are the most likely? You may select more than one answer.
3. Complaints of nausea and vomiting
4. Short durations (15 to 120 minutes) of headache pain
5. Auras before the onset of headache pain
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