A patient who has migraine headaches is prescribed sumatriptan ...

[cartlidgeashley]

A patient who has migraine headaches is prescribed sumatriptan Imitrex 5 mg unit-dose nasal spray. The patient has administered two sprays at 1400, 1600, and 1800 and calls to report little relief from headache pain.
 
  What will the nurse instruct the patient to do? a. Administer 2 sprays at 2000 and call the provider if no relief.
  b. Continue using 2 sprays every 2 hours as needed to relieve discomfort.
  c. Contact the provider to ask about using an ergot alkaloid medication.
  d. Use 3 sprays at the next dose to increase the dose.

Question 2

A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose.
 
  The patient has normal vital signs, is awake and alert, and reports mild pain. What does the nurse recognize about this patient? a. This patient exhibits a negative placebo effect with a reduced response to the drug.
  b. This patient has developed a reaction known as tachyphylaxis because of re-peated exposure to the drug.
  c. This patient has developed pharmacody-namic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.
  d. This patient produces higher than normal hepatic enzymes as a result of prolonged exposure to the drug.

[wfdfwc23]

Answer to Question 1

A
Sumatriptan nasal spray may be used every 2 hours with a maximum 24-hour dose of 40 mg. The patient has already used 30 mg and another 2-spray dose will bring the total dose to 40 mg. The patient should be instructed to contact the provider if the next dose is not effective. Ergot alkalo-ids should not be given within 24 hours of a triptan. Increasing the next dose to 15 mg would exceed the 24-hour dose maximum.

Answer to Question 2

C
Pharmacodynamic tolerance results when a patient takes a drug over a period of time. Adaptive processes occur in response to chronic receptor occupation. The result is that the body requires increased drug, or an increased MEC, to achieve the same effect. This patient is getting adequate pain relief, so there is no negative placebo effect. Tachyphylaxis is a form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time; this occurs over several months. Barbiturates induce synthesis of hepatic enzymes that cause increased metabolism of the drug, but it does not increase the MEC.

[cartlidgeashley]

Excellent

[Alyson.hiatt@yahoo.com]

Gracias!