A patient who has a history of asthma experiences three or four ...

[Mr.Thesaxman]

A patient who has a history of asthma experiences three or four migraine headaches each month.
 
  The patient uses sumatriptan (Imitrex) as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider?
  a. Botulinum toxin
  b. Meperidine (Demerol)
  c. Timolol
  d. Topiramate (Topamax)

Question 2

A young woman with migraine headaches who has recently begun taking sumatriptan (Imitrex) calls the nurse to report a sensation of chest and arm heaviness.
 
  The nurse questions the patient and determines that she feels pressure and not pain. What will the nurse do?
  a. Ask the patient about any history of hypertension or coronary artery disease.
  b. Determine whether the patient might be pregnant.
  c. Reassure the patient that this is a transient, reversible side effect of sumatriptan.
  d. Tell the patient to stop taking the medication immediately.

[nathang24]

Answer to Question 1

ANS: D
Topiramate can be used for migraine prophylaxis, and its benefits appear equal to those of the first line beta blockers. Botulinum toxin can be used for migraine prophylaxis in patients who have 15 or more headaches a month. Meperidine may be used as abortive therapy but has addictive potential. Timolol is a beta blocker; this patient has asthma, and because beta blockers cause bronchoconstriction, these agents are not recommended.

Answer to Question 2

ANS: C
Some patients taking sumatriptan experience unpleasant chest symptoms, usually described as heavy arms or chest pressure. These symptoms are transient and are not related to heart disease. Patients experiencing angina-like pain when taking sumatriptan, as a result of coronary vasospasm, should be asked about hypertension or coronary artery disease (CAD); they should not take sumatriptan if they have a history of either of these. The symptoms this patient describes are not characteristic of pregnancy. There is no need to stop taking the medication.

[Mr.Thesaxman]

Thank you!

[nathang24]

Always glad to help...