The patient is admitted for treatment of migraine headaches. The drug sumatriptan succinate is prescribed for the patient. Which of the following in the patient's history should be reported to the doctor?

1. A

   Diabetes

2. B

   Angina

3. C

   Cancer

4. D

   Cluster headaches

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

• Sumatriptan is a serotonin (5-HT) receptor agonist that causes vasoconstriction to alleviate migraine symptoms.
• This vasoconstrictive action is systemic and can affect the coronary arteries, which supply blood to the heart.
• In a patient with angina (a symptom of ischemic heart disease), this vasoconstriction can trigger a dangerous coronary artery spasm, leading to myocardial ischemia or infarction.
• Therefore, a history of angina is a critical contraindication that must be reported to the physician before administering the drug.

Why Other Options Were Wrong

• Option A: Diabetes mellitus is a metabolic disorder and, by itself, is not a direct contraindication to sumatriptan. It becomes a concern only if the patient has developed significant cardiovascular complications as a result of diabetes.
• Option C: A history of cancer has no pharmacological interaction with the mechanism of sumatriptan and is not considered a contraindication.
• Option D: A history of cluster headaches is an indication for sumatriptan use, not a contraindication. Sumatriptan (often in subcutaneous or intranasal form) is a first-line treatment for acute cluster headache attacks.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pharmacology: Contraindications for Sumatriptan to guide bedside assessment, documentation, and the next nursing action.
• A thorough cardiovascular assessment is a critical nursing responsibility before administering the first dose of any triptan medication. This includes asking specifically about chest pain, heart disease, stroke, and high blood pressure.
• Patient education is vital. The nurse must instruct the patient to report any chest, jaw, or neck tightness immediately after taking the medication, as this could signal cardiac ischemia.
• What if the patient had well-controlled hypertension? The nurse must still report this to the physician. While uncontrolled hypertension is an absolute contraindication, the prescriber needs a complete picture of the patient's cardiovascular status to make a safe risk-benefit assessment.

How to Approach the Question

• First, identify the drug in question: sumatriptan. Recognize this as a common migraine medication.
• Next, recall the drug class and its primary mechanism of action. Sumatriptan is a 'triptan,' a serotonin agonist that causes vasoconstriction.
• Consider the systemic effects of vasoconstriction. The most significant risk is to the cardiovascular system.
• Evaluate each option in light of this vasoconstrictive effect. Angina is a disease of the coronary arteries, making it highly relevant.
• Rule out the other options. Diabetes is metabolic, cancer is unrelated, and cluster headaches are actually an indication for the drug.
• Conclude that angina presents the most direct and severe risk, making it the history that absolutely must be reported before administration.

Concept Tested & Keywords

• Concept Tested: Pharmacology: Contraindications for Sumatriptan
• Stem keywords: sumatriptan succinate, migraine headaches, patient's history, report to the doctor
• Lead-in keywords: Which of the following
• Clinical cues: The patient is prescribed sumatriptan for migraines, indicating a need to screen for contraindications.

Question ID

QILfqxJg7nV2lvrbqLI-PF

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 55-57

E6 Pharmacology Nursing Lilley 11e Part 1 p. 224-226