DRUG STUDY Generic Name/ Trade Name Brand Name: Imitrex, Alsuma Dosage/ Frequency Indication Contraindication Side

Effects Nursing Responsibilities

Generic Name: sumatriptan

The recommended oral dose is 25-100 mg and the maximum dose is 200 mg daily. The recommended intranasal dose is 5-20 mg and the maximum dose is 40 mg daily. The recommended injection dose is 4 or 6 mg injected under the skin. The maximum dose is two 6 mg injections separated by 1 hour

Sumatriptan is a drug that is used fortreating migraine headaches. It belongs to a class of drugs called selective serotonin receptor agonists.

Sumatriptan succinate tablets should not be given to patients with history, symptoms, or signs of ischemic cardiac, cerebrovascular, or peripheral vascular syndromes. In addition, patients with other significant underlying cardiovascular diseases should not receive sumatriptan succinate tablets. Ischemic cardiac syndromes include, but are not limited to, angina pectoris of any type (e.g., stable angina of effort and vasospastic forms of angina such as the Prinzmetal variant), all forms of myocardial infarction, and silent myocardial ischemia. Cerebrovascular syndromes include, but are not limited to, strokes of any type as well as transient ischemic attacks. Peripheral vascular disease includes, but is not limited to, ischemic bowel disease .

Side effects are generally transient. Some common side effects include pain or tightness in the chest or throat, tingling, flushing,weakness, dizzi ness, abdominal discomfort, sweating, nasal irritation, and injection site reactions. Rarely, allergic reactions have been reported, usually in individuals who are highly allergic to multiple allergens. Sumatriptan may elevate blood pressure in individuals with or without a history of high blood pressure. Individuals with uncontrolled high blood pressure should not use sumatriptan. Sumatriptan rarely has been associated with coronary artery spasm, heart attacks, stroke, abnorm al heart beats, and seizures.

Obtain complete health history including allergies, cardiac, renal, gastro-intestinal, biliary, and hematologic, including EKG, X-ray, tomography and laboratory studies: CBC, cardiac enzymes, BUN, creatinine, electrolytes, liver enzymes, etc. Obtain patients drug history to determine pain and analgesic usage patterns, possible hypersensitivity, possible pregnancy and lactation. Assess for LOC and pain before and after administration..

Brand Name: Ergomar

Generic Name: ERGOTAMINE

Procedure: For the best results, dosage should start at the first sign of an attack. Adults: Take 2 tablets at the start of attack; 1 additional tablet every hour, if needed for full relief (maximum 6 tablets per attack, 10 per week). Early Administration Gives Maximum Effectiveness. Maximum Adult Dosage: Six tablets is the maximum dose for an individual attack. Total weekly dosage should not exceed 10 tablets. Ergotamine tartrate and caffeinetablets should not be used for chronic daily administration.

This combination medication is used to treat or prevent a certain type of headache (vascular headaches such as migraine headaches andcluster headaches). Ergotamine helps narrow widened blood vessels in the head, which reduces the throbbing effects of vascular headaches.

Co administration of ergotamine with potent CYP 3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, and troleandomycin) has been associated with acute ergot toxicity (ergotism) characterized by vasospasm and ischemia of the extremities with some cases resulting in amputation. There have been rare reports of cerebral ischemia in patients on protease inhibitor therapy when ergotamine tartrate and caffeine was coadministered, at least one resulting in death. Because of the increased risk for ergotism and other serious vasospastic adverse events, ergotamine use is contraindicated with these drug and other potent inhibitors of CYP 3A4 (e.g., ketoconazole, itraconazole

CNS: dizziness. CV: MYOCARDIAL INFARCTION, hypertensi on, angina pectoris, arterial spasm, intermittent claudication. GI: abdominal pain, nausea, vomiting, diarrhea, polydipsia. MS: extremity stiffness, muscle pain, stiff neck, stiff shoulders. Neuro: leg weakness, numbness or tingling in fingers or toes. Misc: fatigue

Assess frequency, location, duration, and characteristics (pain, nausea, vomiting, visual disturbances) of chronic headaches. During acute attack, assess type, location, and intensity of pain before and 60 min after administration. Monitor BP and peripheral pulses periodically during therapy. Report any increases in BP. Assess for signs of ergotism (cold, numb fingers and toes; nausea; vomiting; headache; muscle pain; weakness). Assess for nausea and vomiting. Ergotamine stimulates the chemoreceptor trigger zone.

Brand Name:

Usual adult dose 4-8 mg daily. Tablets to be given with meals.

Generic Name: Note: There must be a medication-free METHYSERGIDE interval of 3-4 weeks after every 6-month course of treatment

This medication is used to prevent or decrease the pain/frequency of certain severe recurring headaches (vascular headaches such as migraineheadaches and cluster headaches). Because of possible serious side effects, it is used after other treatments (e.g., beta blockers) have not worked.Methysergide is an ergot alkaloid. It is thought to work by narrowing blood vessels in the head, thereby reducing the throbbing effects of vascular headaches. Methysergide is not used to treat migraine attacks when they occur.

Hypersensitivity to the drug or to tartrazine (FD&C Yellow #5) or any other components of the formulation, pregnancy, lacta tion, peripheral vascular disease, severearteriosclerosis, severe hypertension, coronar y artery disease, phlebitis or cellulitis of the lower limbs, pulmonary disease, col lagen diseases or fibrotic processes, impaired liver or renal functi on, valvular heart disease, debilitated states and serious infections.

Nausea, vomiting, diarrhea, dizziness, drowsiness, stomach upset, heartburn, trouble sleeping, and flushing may occur.

Advise patient to make position changes slowly