Anti-migraine Agents Flashcards
Use of anti-migraine agents across the lifespan: CHILDREN
- anti-migraine medication’s aren’t generally recommended for children
- Treat first with over-the-counter analgesics
- Need to be evaluated for other causes of headache
Triptans are only approved for children 6 yrs or older
Use of anti-migraine agents across the lifespan: ADULTS
-Adults also need to be a evaluated for the reason of their headache
- Ergots and tripans are contraindicated in pregnancy
- Alternative methods to feed baby
Use of anti-migraine agents across the lifespan: OLDER ADULTS
- Ergot derivatives and triptans can exacerbate cardiovascular effects, and renal or liver problems in patients with those pre-existing conditions like kidney failure, hypertension, CAD, and liver failure.
- Take the least amount of drug as possible
- Monitor closely for cardiovascular effects
Must report any sort of chest pain or cardiovascular changes immediately
Drug class: Ergot derivatives
What are the drug or suffixes in this class?
-Ergotamine
-Dihydroergotamine
Drug class: Ergot derivatives
What is the action?
Block alpha-adrenergic and serotonin receptor sites in the brain to cause constriction of cranial vessels, decrease in cranial artery pulsation, and decrease in hyperfusion of basilar artery bed.
(Work by decreasing the pressure in the brain by constructing the vessels and by decreasing the size of the vessels in the brain)
* by decreasing the size of the vessels, we alleviate the pain
* work by decreasing the throbbing pain
Drug class: Ergot derivatives
What are the indications?
-used to prevent migraine or vascular headaches
Dihydroergotamine is also approved for the treatment of cluster headaches.
Drug class: Ergot derivatives
What are the contraindications?
if patients already have coronary artery disease, hypertension, or peripheral vascular disease, their conditions can be exacerbated by ergot derivatives because we are giving them a vasoconstricting agent when they already have vessel construction, or reduced blood flow
- Know allergy.
-Altered liver function can lead to poor metabolism of the drug, and these drugs should not be given to pregnant or lactating patients.
(Ergotism = S/S of vomiting, diarrhea, and seizures)
Drug class: Ergot derivatives
What are the cautions?
Pruritus (itching) - can become worse with vasoconstriction
Malnutrition - ergot derivatives activate the chemo trigger zone which causes worsening of G.I. symptoms and thus worsening malnutrition.
Drug class: Ergot derivatives
What are the adverse effects?
all the adverse effects are related to the vasoconstricting properties of egot derivatives
-numbness, tingling of extremities, muscle pain
-pulselessness, weakness, chest pain, arrhythmias
-nausea, vomiting, diarrhea
Drug class: Ergot derivatives
What are the drug-drug interactions?
-Beta blockers (combined with ergot derivatives,increased risk of gangrene and peripheral ischemia)
-Tripans (combined with ergot derivatives can cause vaso spasms)
Drug class: Triptans
What drugs or suffixes are in this class?
“Triptans”
- Eletriptan
- Sumatriptan
- Zolmitriptan
Drug class: Triptans
What is the action?
Cause cranial vascular constriction and relief of migraine, headache, pain in many patients.
Drug class: Triptans
What is the indication?
Treatment of acute migraine and are not used for prevention of migraines.
Taken after a migraine has started
Drug class: Triptans
What are the contraindications?
-Know allergy
-Pregnancy
-Coronary artery disease (can become worse with vasoconstriction)
patients who are at increased risk of coronary artery disease should be monitored closely
Drug class: Triptans
What are the cautions?
- Elderly (older adults are more likely to have risk factors or coronary artery disease and renal or liver problems)
- Risk factors for coronary artery disease’
- Lactation
- Renal and hepatic function
Drug class: Triptans
What are the adverse effects?
all adverse effects are related to the vasoconstriction with decreased blood flow to the peripheries
-numbness, tingling, burning, sensation feelings of coldness, weakness, dysphasia, blood pressure alterations.
Drug class: Triptans
What are the drug-drug interactions?
- Ergot-containing drug (combining with triptans enhances the vasoconstrictive effect for a prolonged period of time)
- MAOIs
- SSRIs
^ Both MAOIs and SSRIs with triptans can cause serotonin syndrome
Drug class: Calcitonin Gene Related Peptides (CGRP Inhibitors) and Serotonin Agonists
What are the suffixes or drug names in this class?
CGRP inhibitors = “gepant”
- Rimegepant
- Ubrogepant
Serotonin agonists = Lasmiditan
Drug class: Calcitonin Gene Related Peptides (CGRP Inhibitors) and Serotonin Agonists
What are the actions?
CGRP: work by blocking the CGRP opponent method dilator chemical released during migraine headache attacks.
Serotonin agonists: selective serotonin agonists leading to vasoconstruction
Drug class: Calcitonin Gene Related Peptides (CGRP Inhibitors) and Serotonin Agonists
What are the indications?
CGRP: Acute migraine headache and prevention
Serotonin: Acute migraine with or without aura in adults (migraine aura= seeing flashes of light or feeling some sort of tingling aka warning of onset migraine)
Drug class: Calcitonin Gene Related Peptides (CGRP Inhibitors) and Serotonin Agonists
What are the contraindications?
Allergy
Drug class: Calcitonin Gene Related Peptides (CGRP Inhibitors) and Serotonin Agonists
What are the cautions?
CGRP: nausea
Serotonin: dizziness, fatigue, paresthesia, and sedation
Drug class: Calcitonin Gene Related Peptides (CGRP Inhibitors) and Serotonin Agonists
What are the drug drug interactions?
Lasmiditan - has the potential to cause several more adverse effects and is a schedule 4 medication
Lasmiditan - CNS depressants serotonergic medications
Lasmiditan and CGRP inhibitors- CYP3A4 agents
Nursing considerations for all anti migraine headache agents
Assessment:
Neuro for both cognition and Neuro for the extremities
-make sure their feet and hands aren’t going numb
-inspect the skin for localized, edema, itching or breakdown when using ergot derivatives
-assess vital signs and obtain an electrocardiogram
-monitor liver and renal function tests
Nursing considerations for all anti migraine headache agents
Nursing diagnoses:
-impaired comfort related to cardiovascular and vasoconstrictive effects
-altered cardiac output related to cardio vascular effects
-altered sensory perception (visual, auditory, kinesthetic, and tactile related to CNS effects
-injury risk related to changes in peripheral sensation
cardiovascular effects apply to vasoconstrictive agents
central nervous system affects apply to serotonin agents
Nursing considerations for all anti migraine headache agents
Implementation:
when implementing make sure to understand the order as some of these are for prevention and some of these are for treating acute migraines
-if treating an acute migraine, give the medication at the very first sign of a migraine
-arrange for safety precautions if CNS or visual changes occur
-monitor the blood pressure of any patient with the history of coronary artery disease and discontinue the drug of any sign of angina or prolonged hypertension occurs
(Should know to report signs of myocardial infarction, like shortness of breath, chest pain, or arm pain)
-reducing the environmental stress around the patient can enhance the relief from the migraine as well.
Nursing considerations for all anti migraine headache agents
Evaluation:
-we want to know if the migraine has stopped or pain has been reduced (relief of a cure or prevention of migraine headaches)
-we want to make sure that the adverse effects haven’t caused any circulation issues, nausea, cardiac problems, or neuronal changes.
