Antimigraine
Antimigraine
Triptans bind to serotonin receptors to cause vascular constrictive effects on cranial blood vessels, causing the relief of migraine in selective patients.
Indications
Treatment of acute migraine attacks with or without aura Treatment of cluster headaches (sumatriptan injection) Contraindications and cautions
Contraindicated with allergy to any triptan, active coronary artery disease, uncontrolled hypertension, hemiplegic migraine, pregnancy. Use cautiously in the elderly; with lactation. Adverse effects
CNS: Dizziness, vertigo, headache, anxiety, malaise or fatigue, weakness, myalgia CV: BP alterations, tightness or pressure in chest, MI GI: Abdominal discomfort, dysphagia Local: Injection site discomfort Other: Tingling, warm or hot sensations, burning sensation, feeling of heaviness, pressure sensation, numbness, feeling of tightness,feeling strange, cold sensation Interactions
Drug-drug Prolonged vasoactive reactions when taken concurrently with ergotcontaining drugs, MAOIs, other triptans Risk of increased blood levels and prolonged effects with hormonal contraceptives; monitor patient very closely if this combination must be used Risk of serious serotonin syndrome if combined with SSRIs ?Drug-alternative therapyIncreased risk of severe reaction if combined with St. John’s Wort Nursing considerations
Assessment
History: Allergy to any triptan, active coronary artery disease, uncontrolled hypertension, hemiplegic migraine, pregnancy, lactation Antimigraine Drugs (Triptans) Antimigraine Drugs (Triptans) ? 29 Physical: Skin color and lesions; orientation, reflexes, peripheral sensation; P, BP; LFTs, renal function tests Interventions
Administer to relieve acute migraine, not as a prophylactic measure. Administer as prescribed—by inhalation, injection, or orally. Establish safety measures if CNS, visual disturbances occur. Provide appropriate analgesics as needed for pains related to therapy. Monitor injection sites—pain and redness are common—for signs of infection or irritation. Control environment as appropriate to help relieve migraine (eg, lighting, temperature). Monitor BP of patients with possible coronary artery disease; discontinue triptan at any sign of angina, prolonged high BP. Teaching points
Learn to use the autoinjector; injection may be repeated in no less than 1 hour if relief is not obtained; do not administer more than two injections in 24 hours (if appropriate). These drugs should not be taken during pregnancy; if you suspect that you are pregnant, contact your health care provider and refrain from using the drug. Continue to do anything that usually helps you feel better during a migraine—control lighting, noise. Take these drugs at first sign of a migraine. Contact your health care provider immediately if you experience chest pain or pressure that is severe or does not go away. You may experience these side effects: Dizziness, drowsiness (avoid driving or operating dangerous machinery while using these drugs); numbness, tingling, feelings of tightness or pressure. Report feelings of heat, flushing, tiredness, sickness, swelling of lips or eyelids. Representative drugs
almotriptan eletriptan frovatriptan naratriptan rizatriptan sumatriptan zolmitriptan
