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Contraindications/ Precautions of Opioid Agonists
* Morphine is contraindicated after biliary tract surgery.
* Morphine is contraindicated for premature infants during and after delivery because of respiratory depressant effects.
* Meperidine is contraindicated for clients who have kidney failure because of the accumulation of normeperidine, which can result in seizures and neurotoxicity.
* Morphine, fentanyl, meperidine, methadone, codeine, oxycodone, and hydromorphone are pregnancy category risk \n C medications
* Clients who are pregnant (risk of physical dependence of the fetus)
o Clients in labor (risk of respiratory depression in the newborn and inhibition of labor by decreasing uterine contractions)
* Use cautiously with the following \n o Clients who have asthma, emphysema, or head injuries; infants; and older adult clients (risk of respiratory \n depression)
* Clients who are extremely obese (greater risk for prolonged adverse effects because of the accumulation of medication that is metabolized at a slower rate)
* \
* Morphine is contraindicated for premature infants during and after delivery because of respiratory depressant effects.
* Meperidine is contraindicated for clients who have kidney failure because of the accumulation of normeperidine, which can result in seizures and neurotoxicity.
* Morphine, fentanyl, meperidine, methadone, codeine, oxycodone, and hydromorphone are pregnancy category risk \n C medications
* Clients who are pregnant (risk of physical dependence of the fetus)
o Clients in labor (risk of respiratory depression in the newborn and inhibition of labor by decreasing uterine contractions)
* Use cautiously with the following \n o Clients who have asthma, emphysema, or head injuries; infants; and older adult clients (risk of respiratory \n depression)
* Clients who are extremely obese (greater risk for prolonged adverse effects because of the accumulation of medication that is metabolized at a slower rate)
* \
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INTERACTIONS of : CNS depressants (barbiturates, phenobarbital, benzodiazepines, alcohol) have additive CNS depression action. CLIENT EDUCATION
* Avoid the use of these medications in conjunction with opioid agonisis
* Avoid consumption of alcohol.
* Avoid consumption of alcohol.
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INTERACTIONS of : Anticholinergic agents (atropine or scopolamine), antihistamines (diphenhydramine), and tricyclic antidepressants (amitriptyline) have additive anticholinergic effects (constipation, urinary retention).CLIENT EDUCATION
Increase fluids and dietary fiber to prevent constipation.
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INTERACTIONS of : Meperidine can interact with monoamine oxidase inhibitors (MAOIs) and cause hyperpyrexic coma, characterized by excitation, seizures, and respiratory depression. NURSING ACTION :
Avoid the use of meperidine with MAOls to prevent occurrence of this syndrome.
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INTERACTION of : Antihypertensives have additive hypotensive effects. CLIENT EDUCATION :
Refrain from using opioids with antihypertensive agents.
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INTERACTIONS of : Additional medications (amphetamines, clonidine, and dextromethorphan) can increase opioid-induced analgesia. CLIENT EDUCATION:
Avoid taking other medications that have a CNS effect with opioid medication.
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NURSING ADMINISTRATION of : Opioid Agonists
* Assess pain level on a regular basis. Document the client's response.
* Take baseline vital signs. If the respiratory rate is less than 12/min, notify the provider and withhold the medication.
* Follow controlled substance procedures.
* Double-check opioid doses with another nurse prior to administration.
* Administer IV opioids slowly over 4 to 5 min. Have naloxone and resuscitation equipment available.
* Warn clients not to increase dosage without consulting the provider.
* For clients who have cancer, administer opioids on a fixed schedule around the clock. Administer supplemental doses as needed.
* Advise clients who have physical dependence not to discontinue opioids abruptly. Opioids should be withdrawn slowly, and the dosage should be tapered over a period of 3 days.
* Closely monitor patient-controlled analgesia (PCA) pump settings (dose, lockout interval, 4-hr limit). Reassure clients regarding safety measures that safeguard against self-administration of excessive doses. Encourage clients to use
* PCA prophylactically prior to activities likely to augment pain levels.
* When switching clients from PCA to oral doses of opioids, make sure the client receives adequate PCA dosing until the onset of oral medication takes place.
* The first administration of a transdermal fentanyl patch will take several hours to achieve the desired therapeutic effect. Administer short-acting opioids prior to onset of therapeutic effects and for breakthrough pain.
* Take baseline vital signs. If the respiratory rate is less than 12/min, notify the provider and withhold the medication.
* Follow controlled substance procedures.
* Double-check opioid doses with another nurse prior to administration.
* Administer IV opioids slowly over 4 to 5 min. Have naloxone and resuscitation equipment available.
* Warn clients not to increase dosage without consulting the provider.
* For clients who have cancer, administer opioids on a fixed schedule around the clock. Administer supplemental doses as needed.
* Advise clients who have physical dependence not to discontinue opioids abruptly. Opioids should be withdrawn slowly, and the dosage should be tapered over a period of 3 days.
* Closely monitor patient-controlled analgesia (PCA) pump settings (dose, lockout interval, 4-hr limit). Reassure clients regarding safety measures that safeguard against self-administration of excessive doses. Encourage clients to use
* PCA prophylactically prior to activities likely to augment pain levels.
* When switching clients from PCA to oral doses of opioids, make sure the client receives adequate PCA dosing until the onset of oral medication takes place.
* The first administration of a transdermal fentanyl patch will take several hours to achieve the desired therapeutic effect. Administer short-acting opioids prior to onset of therapeutic effects and for breakthrough pain.
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Nursing Evaluation of Medication effectiveness of : Opioid Agonists
Depending on the therapeutic intent, effectiveness can be evidenced by the following.
* Relief of moderate to severe pain (postoperative pain, cancer pain, myocardial pain)
* Cough suppression
* Resolution of diarrhea
* Relief of moderate to severe pain (postoperative pain, cancer pain, myocardial pain)
* Cough suppression
* Resolution of diarrhea
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Agonist-Antagonist Opioids Prototype medication
Butorphanol
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Agonist-Antagonist Opioids : Other medications
* Nalbuphine
* Buprenorphine
* Pentazocine
* Buprenorphine
* Pentazocine
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Agonist-Antagonist Opioids : Route of Administration
* Butorphanol: IV, IM, intranasal
* Nalbuphine: IV, IM, subcutaneous
* Buprenorphine: IV, sublingual, transdermal
* Pentazocine: IV, IM, subcutaneous
* Nalbuphine: IV, IM, subcutaneous
* Buprenorphine: IV, sublingual, transdermal
* Pentazocine: IV, IM, subcutaneous
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Agonist-Antagonist Opioids : Expected Pharmacological Action :
* These medications act as antagonists on mu receptors and agonists on kappa receptors, except for buprenorphine, whose agonist/antagonist activity is on opposite receptors.
* Compared to pure opioid agonists, agonist-antagonists have the following.
* Low potential for abuse, causing little euphoria. In fact, high doses can cause adverse effects (anxiety, restlessness, mental confusion).
* Less respiratory depression
* Less analgesic effect
* Compared to pure opioid agonists, agonist-antagonists have the following.
* Low potential for abuse, causing little euphoria. In fact, high doses can cause adverse effects (anxiety, restlessness, mental confusion).
* Less respiratory depression
* Less analgesic effect
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Agonist-Antagonist Opioids- therapeutic uses :,
* Relief of moderate to severe pain
* Treatment of opioid dependence (buprenorphine)
* Adjunct to balanced anesthesia
* Relief of labor pain
* Treatment of opioid dependence (buprenorphine)
* Adjunct to balanced anesthesia
* Relief of labor pain
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Agonist-Antagonist Opioids Complications of : Abstinence Syndrome
Cramping, hypertension, vomiting, fever, and anxiety
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Abstinence Syndrome Nursing Actions :
* This syndrome can be precipitated when these medications are given to clients who are physically dependent on opioid agonists.
* Advise clients to stop opioid agonists (morphine) before using agonist-antagonist medications (pentazocine).
* Avoid giving to clients if undisclosed opioid use is suspected.
* Advise clients to stop opioid agonists (morphine) before using agonist-antagonist medications (pentazocine).
* Avoid giving to clients if undisclosed opioid use is suspected.
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Agonist-Antagonist Opioids Complications of Sedation, respiratory depression - NURSING ACTIONS:
* Have naloxone and resuscitation equipment available.
* Monitor for respiratory depression.
* Monitor for respiratory depression.
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Agonist-Antagonist Opioids Complications of Dizziness : Client Education:
Use caution in standing up and avoid driving or using heavy machinery.
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Agonist-Antagonist Opioids Complications of Headache - Nursing Actions :
* Monitor for headache.
* Assess level of consciousness.
* Assess level of consciousness.
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Agonist-Antagonist Opioids Contraindications:
Use cautiously in clients who have a history of myocardial infarction, kidney or liver disease, respiratory depression, or head injury, and clients who are physically dependent on opioids.
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INTERACTIONS Agonist-Antagonist Opioids of CNS depressants and alcohol can cause additive effects: NURSING ACTIONS
* Use together cautiously.
* Monitor respirations.
* Monitor respirations.
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INTERACTIONS Agonist-Antagonist Of Opioid agonists can antagonize and reduce analgesic effects of the opioid-NURSING ACTIONS:
Do not use concurrently.
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Agonist-Antagonist Opioids Nursing Administration:
* Obtain baseline vital signs. If the respiratory rate is less than 12/min, withhold the medication and notify the provider. QeBP
* Have naloxone and resuscitation equipment available.
* Assess clients for opioid dependence prior to administration. Agonist-antagonists can trigger withdrawal manifestations.
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* Have naloxone and resuscitation equipment available.
* Assess clients for opioid dependence prior to administration. Agonist-antagonists can trigger withdrawal manifestations.
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Agonist-Antagonist Opioids : CLIENT EDUCATION
* Do not increase dosage without consulting the provider.
* Use caution when getting out of bed or standing. Do not operate heavy machinery or drive until CNS effects are known.
* • Do not increase dosage without consulting the provider.
* Use caution when getting out of bed or standing. Do not operate heavy machinery or drive until CNS effects are known.
* • Do not increase dosage without consulting the provider.
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Agonist-Antagonist Opioids- NURSING EVALUATION OF MEDICATION EFFECTIVENESS:
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Monitor for improvement of manifestations (relief of pain).
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OPIOID ANTAGONISTS : PROTOTYPE MEDICATION:
Naloxone
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OPIOID ANTAGONISTS- other medications
* Naltrexone
* Methylnaltrexone
* Alvimopan
* Methylnaltrexone
* Alvimopan
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OPIOID ANTAGONISTS -ROUTE OF ADMINISTRATION:
* Naloxone: IV, IM, subcutaneous
* Naltrexone: Oral, IM
* Methylnaltrexone: Subcutaneous
* Alvimopan: Oral
* Naltrexone: Oral, IM
* Methylnaltrexone: Subcutaneous
* Alvimopan: Oral
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OPIOID ANTAGONISTS-EXPECTED PHARMACOLOGICAL ACTION
Opioid antagonists interfere with the action of opioids by competing for opioid receptors. Opioid antagonists have no effect in the absence of opioids.
THERAPEUTIC USES
* Treatment of opioid abuse by preventing euphoria (naltrexone)
* Reversal of effects of opioids (respiratory depression \[naloxone\])
* Reversal of respiratory depression in an infant (naloxone)
* Reversal of severe opioid-caused constipation in clients who have late-stage cancer or other disorders (methylnaltrexone, alvimopan)
Opioid antagonists interfere with the action of opioids by competing for opioid receptors. Opioid antagonists have no effect in the absence of opioids.
THERAPEUTIC USES
* Treatment of opioid abuse by preventing euphoria (naltrexone)
* Reversal of effects of opioids (respiratory depression \[naloxone\])
* Reversal of respiratory depression in an infant (naloxone)
* Reversal of severe opioid-caused constipation in clients who have late-stage cancer or other disorders (methylnaltrexone, alvimopan)
Opioid antagonists interfere with the action of opioids by competing for opioid receptors. Opioid antagonists have no effect in the absence of opioids.
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OPIOID ANTAGONISTS -THERAPEUTIC USES:
\
* Treatment of opioid abuse by preventing euphoria (naltrexone)
* Reversal of effects of opioids (respiratory depression \[naloxone\])
* Reversal of respiratory depression in an infant (naloxone)
* Reversal of severe opioid-caused constipation in clients who have late-stage cancer or other disorders (methylnaltrexone, alvimopan)
* Treatment of opioid abuse by preventing euphoria (naltrexone)
* Reversal of effects of opioids (respiratory depression \[naloxone\])
* Reversal of respiratory depression in an infant (naloxone)
* Reversal of severe opioid-caused constipation in clients who have late-stage cancer or other disorders (methylnaltrexone, alvimopan)
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OPIOID ANTAGONISTS Complications of Tachycardia and tachypnea: Nursing Actions
* Monitor heart rhythm (risk of ventricular tachycardia) and respiratory function.
* Have resuscitative equipment, including oxygen, on standby during administration.
* Have resuscitative equipment, including oxygen, on standby during administration.
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OPIOID ANTAGONISTS Complications of Abstinence Syndrome
Cramping, hypertension, vomiting, and reversal of analgesia
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OPIOID ANTAGONISTS Complications of Abstinence Syndrome -NURSING ACTIONS:
These manifestations can occur when given to clients physically dependent on opioid agonists.
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OPIOID ANTAGONISTS CONTRAINDICATIONS/PRECAUTIONS
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* Opioid antagonists are Pregnancy Risk Category B, except Naltrexone, which is Pregnancy Risk Category C.
* Naloxone and naltrexone are contraindicated in clients who have opioid dependency.
* Naltrexone is contraindicated for clients who have acute hepatitis or liver failure and during lactation.
* Opioid antagonists are Pregnancy Risk Category B, except Naltrexone, which is Pregnancy Risk Category C.
* Naloxone and naltrexone are contraindicated in clients who have opioid dependency.
* Naltrexone is contraindicated for clients who have acute hepatitis or liver failure and during lactation.
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OPIOID ANTAGONISTS Nursing Administration
* Naloxone has rapid first-pass inactivation and should be administered IV, IM, or subcutaneously. Do not administer orally.
* Observe withdrawal manifestations or abrupt onset of pain. Be prepared to address the need for analgesia if given for postoperative opioid-related respiratory depression.
* Titrate naloxone dosage to achieve reversal of respiratory depression without full reversal of pain management \n effects.
* Rapid infusion of naloxone can cause hypertension, tachycardia, nausea, and vomiting.
* Half-life of opioid analgesic can exceed the half-life of naloxone (60 to 90 min).
* Monitor respirations for up to 2 hr after use to assess for recurrence of respiratory depression and the need for repeat dosage of naloxone.
* Alvimopan is only administered for a 7-day period due to increased risk for myocardial infarction in prolonged
* Observe withdrawal manifestations or abrupt onset of pain. Be prepared to address the need for analgesia if given for postoperative opioid-related respiratory depression.
* Titrate naloxone dosage to achieve reversal of respiratory depression without full reversal of pain management \n effects.
* Rapid infusion of naloxone can cause hypertension, tachycardia, nausea, and vomiting.
* Half-life of opioid analgesic can exceed the half-life of naloxone (60 to 90 min).
* Monitor respirations for up to 2 hr after use to assess for recurrence of respiratory depression and the need for repeat dosage of naloxone.
* Alvimopan is only administered for a 7-day period due to increased risk for myocardial infarction in prolonged
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OPIOID ANTAGONISTS -NURSING EVALUATION OF MEDICATION EFFECTIVENESS:
* \
* Reversal of respiratory depression
* Respirations are regular.
* Client is without shortness of breath.
* Respiratory rate is 12 to 20/min in adults and 30 to 60/min in newborns.
* Reduced euphoria in alcohol dependency and decreased craving for alcohol in alcohol dependency (naltrexone)
* Severe opioid-induced constipation (methylnaltrexone, naloxegol) and opioid-induced ileus (alvimopan) are relieved.
* Reversal of respiratory depression
* Respirations are regular.
* Client is without shortness of breath.
* Respiratory rate is 12 to 20/min in adults and 30 to 60/min in newborns.
* Reduced euphoria in alcohol dependency and decreased craving for alcohol in alcohol dependency (naltrexone)
* Severe opioid-induced constipation (methylnaltrexone, naloxegol) and opioid-induced ileus (alvimopan) are relieved.
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Migraine Medications Prototype Medications
* Aspirin-like medications: Acetaminophen, NSAIDs (aspirin, naproxen)
* Serotonin receptor agonists (triptans): Sumatriptan (oral, subcutaneous, inhalation, transdermal)
* Ergot alkaloids
* Ergotamine (oral, sublingual, rectal)
* Dihydroergotamine (IV, IM, subcutaneous, intranasal)
* Beta blockers: Propranolol (oral) \n Anticonvulsants: Divalproex (oral), topiramate
* Tricyclic antidepressants: Amitriptyline (oral)
* Estrogens: Estrogen (gel, patches)
* Serotonin receptor agonists (triptans): Sumatriptan (oral, subcutaneous, inhalation, transdermal)
* Ergot alkaloids
* Ergotamine (oral, sublingual, rectal)
* Dihydroergotamine (IV, IM, subcutaneous, intranasal)
* Beta blockers: Propranolol (oral) \n Anticonvulsants: Divalproex (oral), topiramate
* Tricyclic antidepressants: Amitriptyline (oral)
* Estrogens: Estrogen (gel, patches)
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Migraine Medications Other medications
* Triptans: Almotriptan, frovatriptan, naratriptan, zolmitriptan
* Ergot alkaloids: Ergotamine and caffeine
* Combination OTC analgesics: Acetaminophen, aspirin, caffeine
* Other combinations: Isometheptene, dichloralphenazode/acetaminophen
* Isometheptene relieves headaches through vasoconstriction of arterioles.
* Dichloralphenazone has sedative properties.
* Acetaminophen is a mild analgesic.
* Ergot alkaloids: Ergotamine and caffeine
* Combination OTC analgesics: Acetaminophen, aspirin, caffeine
* Other combinations: Isometheptene, dichloralphenazode/acetaminophen
* Isometheptene relieves headaches through vasoconstriction of arterioles.
* Dichloralphenazone has sedative properties.
* Acetaminophen is a mild analgesic.
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Migraine Medications EXPECTED PHARMACOLOGICAL ACTION:
Migraine medications prevent inflammation and dilation of the intracranial blood vessels, thereby relieving migraine pain.
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Migraine Medications -THERAPEUTIC USES:
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* Some medications are used as abortive therapy to stopla migraine after it begins or after prodromal manifestations start. These include nonsteroidal anti-inflammatory drugs (NSAIDs) and combination anti-inflammatory medications, triptans, and ergot alkaloids.
* Other medications are used as prophylactic therapy to help prevent a migraine headache. Preventive agents include beta blockers, anticonvulsants, amitriptyline, and estrogens.
* Some medications are used as abortive therapy to stopla migraine after it begins or after prodromal manifestations start. These include nonsteroidal anti-inflammatory drugs (NSAIDs) and combination anti-inflammatory medications, triptans, and ergot alkaloids.
* Other medications are used as prophylactic therapy to help prevent a migraine headache. Preventive agents include beta blockers, anticonvulsants, amitriptyline, and estrogens.
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Migraine Medications -COMPLICATIONS : Bone marrow suppression -Nursing Actions :
Periodically monitor CBC, including platelets.
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Bone marrow suppression - CLIENT EDUCATION:
Observe for indications of easy bruising and bleeding, fever, or sore throat, and notify the provider If they occur.
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Migraine Medications -COMPLICATIONS Gastrointestinal (GI) distress
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* Abdominal pain, ulceration, nausea, vomiting, and diarrhea or constipation
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* Abdominal pain, ulceration, nausea, vomiting, and diarrhea or constipation
*
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Gastrointestinal (GI) distress NURSING ACTIONS:
Monitor for Gl bleeding (coffee-ground emesis; bloody or black tarry stools; abdominal pain).
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Gastrointestinal (GI) distress CLIENT EDUCATION:
Take with food, milk, or antacid
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Migraine Medications -Myocardial infarction (MI) or stroke -NURSING ACTIONS:
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* Monitor cardiac status, especially in older adult clients and clients who have a history of cardiac disease.
* All NSAIDs except aspirin increase the risk of thrombotic events.
* Monitor cardiac status, especially in older adult clients and clients who have a history of cardiac disease.
* All NSAIDs except aspirin increase the risk of thrombotic events.
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Migraine Medications -COMPLICATIONS Chest pressure (heavy arms or chest tightness)
CLIENT EDUCATION
CLIENT EDUCATION
* Medications have increased risk for these manifestations; however, the manifestations are self-limiting and not dangerous.
* Notify the provider for continuous or severe chest pain.
* Notify the provider for continuous or severe chest pain.
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Migraine Medications -COMPLICATIONS Coronary artery vasospasm/angina -NURSING ACTIONS;
Do not administer to a client who has or is at risk for koronary artery disease (CAD).
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Migraine Medications -COMPLICATIONS Teratogenesis -NURSING ACTIONS:
The medication should be avoided in clients who are pregnant, trying to become pregnant, or are not using adequate contraception.
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Migraine Medications -COMPLICATIONS : Gastrointestinal discomfort
Nausea and vomiting
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Gastrointestinal discomfort : Nursing Actions
Administer an antiemetic (metoclopramide).
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Migraine Medications -COMPLICATIONS : Acute or chronic toxicity (ergotism)
Muscle pain, paresthesias in fingers and toes; peripheral ischemia
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Acute or chronic toxicity (ergotism) -NURSING ACTIONS
\: Stop medication and immediately notify the provider if manifestations occur.
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Physical dependence - NURSING ACTIONS:
* Medication should not be taken daily on a long-term basis.
* Notify the provider if manifestations occur.
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* Notify the provider if manifestations occur.
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Physical dependence : CLIENT EDUCATION
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* Do not exceed the prescribed dose.
* Medications can cause manifestations of withdrawal (headache, nausea, vomiting, restlessness).
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* Do not exceed the prescribed dose.
* Medications can cause manifestations of withdrawal (headache, nausea, vomiting, restlessness).
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Migraine Medications -COMPLICATIONS -Fetal harm or abortion -Nursing Actions
Avoid using this medication during pregnancy.
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Fetal harm or abortion CLIENT EDUCATION
\: Use additional contraception while using the medication.
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Migraine Medication Complications (Beta blockers: propranolol )Extreme tiredness, fatigue, depression, asthma exacerbation CLIENT EDUCATION:
Observe for manifestations and notify the provider if they occur.
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Migraine Medicine Complications-Bradycardia, hypotension - NURSING ACTIONS
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* Monitor heart rate and blood pressure.
* Notify the provider of significant change.
* Notify the provider of significant change.
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Migraine Medicine Complications-Bradycardia, hypotension - Client Education
Take apical pulse prior to dosing
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Migraine Medicine Complications- GI Distress
Nausea , vomiting, diarrhea, dyspepsia; indigestion
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Migraine Medicine Complications- GI Distress : Nursing Actions
Reposts manifestations to provider
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Aspirin like drugs : NSAIDS , acetaminophen combination causes :
Bone marrow suppression , GI distress , MI of stroke
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Serotonin receptor agonists ( Tristan’s) : sumatriptan causes :
Chest pressure , coronary artery vasospasm/ angina , dizziness, teratogenesis
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Ergot alkaloids : ergotamine and dihydroergotamine causes
Gastrointestinal discomfort, acute or chronic toxicity, physical dependence and fetal harm or abortion
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Migraine Medicine Complications- Neural tube defects NURSING ACTIONS:
Avoid use during pregnancy.
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Neural tube defects CLIENT EDUCATION:
Use additional contraception if using this mediation.
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Migraine Medicine Complications- Hepatitis -Nursing Action
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* Monitor liver enzymes.
* Notify the provider of lethargy or fever.
* Monitor liver enzymes.
* Notify the provider of lethargy or fever.
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Migraine Medicine Complications- Pancreatitis - Client Education
Report abdominal pain, nausea, vomiting, and anorexia. Medication should be discontinued. Other adverse effects include fatigue, weight gain, tremor, bone loss, and reversible hair loss.
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Migraine Medication Anticholinergic effects Complications
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Dry mouth, constipation, urinary retention, blurred vision, tachycardia
Dry mouth, constipation, urinary retention, blurred vision, tachycardia
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"Anticholinergic effects Nursing Actions
* Increase daily fiber intake.
* Increase physical activity by engaging in regular exercise.
* Administer stimulant laxatives (bisacodyl) to counteract reduced bowel motility, or stool softeners (docusate sodium) to prevent constipation.
* Increase physical activity by engaging in regular exercise.
* Administer stimulant laxatives (bisacodyl) to counteract reduced bowel motility, or stool softeners (docusate sodium) to prevent constipation.
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Anticholinergic effects Client education
* Increase fluid intake, sip fluids throughout the day, chew sugarless gum or suck on sugarless hard candy, and use an alcohol-free mouthwash.
* Void just before taking medication and then every 4 hr. Report urinary retention to the provider.
* Report blurred vision.
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* Void just before taking medication and then every 4 hr. Report urinary retention to the provider.
* Report blurred vision.
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Migraine Medicine Complications Drowsiness or dizziness - CLIENT EDUCATION:
Avoid driving or operating heavy machinery until medication effects are known.
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Migraine Medicine Contraindications: Ergotamine
* Contraindicated in clients who have renal and/or liver dysfunction, sepsis, hypertension, history of myocardial infarction, and CAD, as well as during pregnancy.
* Pregnancy Risk Category X.
* Pregnancy Risk Category X.
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Migraine Medicine Contraindications: Triptans
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* Contraindicated in clients who have liver failure, ischemic heart disease, a history of myocardial infarction, uncontrolled hypertension, and other heart diseases.
* Pregnancy Risk Category C. "
* Contraindicated in clients who have liver failure, ischemic heart disease, a history of myocardial infarction, uncontrolled hypertension, and other heart diseases.
* Pregnancy Risk Category C. "
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Migraine Medicine Contraindications: Propranolol
* Contraindicated in clients who have greater than first-degree heart block, bradycardia, bronchial asthma, cardiogenic shock, or heart failure.
* Use with caution in clients taking other antihypertensives or who have liver or renal impairment, diabetes mellitus, or Wolff-Parkinson-White syndrome.
* Pregnancy Risk Category C.
* Use with caution in clients taking other antihypertensives or who have liver or renal impairment, diabetes mellitus, or Wolff-Parkinson-White syndrome.
* Pregnancy Risk Category C.
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Migraine Medicine Contraindications-Divalproex
* Contraindicated in clients who have liver disease.
* Pregnancy Risk Category D.
* Pregnancy Risk Category D.
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Migraine Medicine Contraindications-Amitriptyline
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* Contraindicated in clients who have recent MI or within 14 days of a MAOI.
* Use with caution in clients who have seizure history, urinary retention, prostatic hyperplasia, angle-closure glaucoma, hyperthyroidism, and liver or kidney disease.
* Pregnancy Risk Category C.
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* Contraindicated in clients who have recent MI or within 14 days of a MAOI.
* Use with caution in clients who have seizure history, urinary retention, prostatic hyperplasia, angle-closure glaucoma, hyperthyroidism, and liver or kidney disease.
* Pregnancy Risk Category C.
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Migraine Medicine Contraindications-Aspirin-like drugs
* Most NSAIDS are Pregnancy Risk Category C, though if taken later in pregnancy, can result in Pregnancy Risk Category D.
* Contraindicated in clients who have severe renal/hepatic disease.
* Contraindicated in clients who have severe renal/hepatic disease.
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Migraine Medicine Contraindications-Acetaminophen
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• Acetaminophen is Pregnancy Risk Category B.
• should not be used alone, but only in combination with other medications.
• Acetaminophen is Pregnancy Risk Category B.
• should not be used alone, but only in combination with other medications.
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Migraine Medication Interactions- NSAIDs can reduce the effectiveness of antihypertensives, furosemide, thiazide diuretics, and oral antidiabetic medications. NURSING ACTIONS:
Monitor for medication effectiveness.
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Migraine Medication Interactions -Corticosteroids, alcohol, and tobacco can increase GI effects. CLIENT EDUCATION
\: Do not use these together.
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Migraine Medication Interactions-NSAIDs can increase levels of oral anticoagulants and lithium. NURSING ACTIONS
\: Monitor medication levels.
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Migraine Medication Interactions. There is an increased risk of bleeding with the use of other NSAIDs, thrombolytics, antiplatelets, anticoagulants, and salicylates. NURSING ACTIONS
* Clients who take medications together should use caution.
* Monitor for bleeding.
* Monitor for bleeding.
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Migraine Medication Interactions - Concurrent use of MAOIs can lead to MAOI toxicity. NURSING ACTIONS
\: Do not give triptans within 2 weeks of stopping MAOIs.
\
\
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Migraine Medication Interactions-Concurrent use with ergotamine or another triptan can cause a vasospastic reaction. NURSING ACTIONS
\: Avoid concurrent use of these medications.
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Migraine Medication Interactions-Selective serotonin reuptake inhibitors (SSRIs) taken with triptans can cause serotonin syndrome (confusion, agitation, hyperthermia, diaphoresis, possible death). NURSING ACTIONS:
Do not use medications together.
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Migraine Medication Interactions-Concurrent use with triptans can cause a vasospastic reaction. NURSING ACTIONS
\: Triptans should be taken at least 24 hr apart from an ergotamine medication..
\:
\:
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Migraine Medication Interactions-Some HIV protease inhibitors, antifungal medications, macrolide antibiotics, and grapefruit juice can increase ergotamine levels, causing increased vasospasm. NURSING ACTIONS
Do not use together.
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Migraine Medication Interactions-Verapamil and diltiazem have additive cardiosuppression effects. NURSING ACTIONS:
If medications are used together, monitor ECG, heart rate, and blood pressure.
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\
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Migraine Medication Interactions-Diuretics and antihypertensive medications have additive hypotensive effects. NURSING ACTIONS:
Monitor blood pressure. Hold and notify the provider if systolic blood pressure is less than 90 mm Hg.
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Migraine Medication Interactions-Propranolol can mask the hypoglycemic effect of insulin and prevent the breakdown of fat in response to hypoglycemia. NURSING ACTIONS
\
* Use with caution.
* Monitor blood glucose.
* Use with caution.
* Monitor blood glucose.
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Migraine Medication Interactions-NSAIDs, erythromycin, and salicylates can cause divalproex toxicity. NURSING ACTIONS:
Monitor medication levels.
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\
\
\
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Migraine Medication Interactions- Benzodiazepines, opioids, antihistamines, and alcohol can cause CNS depression. NURSING ACTIONS
\: Do not use together.
\
\
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Migraine Medication Interactions-Divalproex can increase levels of phenobarbital and phenytoin. NURSING ACTIONS:
Monitor medication levels.
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Migraine Medication Interactions-Increase the effects of warfarin. NURSING ACTIONS
\
* Monitor for therapeutic effects of warfarin with PT and INR. Dosage can need to be adjusted.
* Monitor for bleeding.
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* Monitor for therapeutic effects of warfarin with PT and INR. Dosage can need to be adjusted.
* Monitor for bleeding.
\
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Migraine Medication Interactions-Barbiturates, CNS depressants, antihistamines, over-the- counter sleep aids, and alcohol can cause additive CNS depression. NURSING ACTIONS:
Do not use together. \n \n
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Migraine Medication Interactions-Cimetidine can increase amitriptyline levels.
. NURSING ACTIONS:
. NURSING ACTIONS:
Monitor medication effects.
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Migraine Medication Interactions-MAOIs can increase CNS excitation or cause seizures.
NURSING ACTIONS:
NURSING ACTIONS:
Do not give amitriptyline within 2 weeks of stopping MAOIs.
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Migraine Medication Nursing Administration
* Antiemetics, preferably metoclopramide, are useful as adjunct medications in migraine treatment.
* Use caution in case of orthostatic hypotension (amitriptyline, propranolol).
* Use caution in case of orthostatic hypotension (amitriptyline, propranolol).
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Migraine Medication Nursing Administration - Client Education
* Abortive medications should not be used more than 2 days a week.
* If having migraines, avoid trigger factors that cause stress and fatigue (consumption of alcohol and tyramine-containing foods \[wine, aged cheese\]).
* Lying down in a dark, quiet place can help ease manifestations.
* Check apical pulse before dosage (propranolol).
* Dosage can be taken with food to reduce Gl distress (divalproex) and increase absorption (propranolol).
* Protect skin and eyes from sun (amitriptyline) and avoid driving or operating heavy machinery until medication effects are known (amitriptyline, sumatriptan).
* If having migraines, avoid trigger factors that cause stress and fatigue (consumption of alcohol and tyramine-containing foods \[wine, aged cheese\]).
* Lying down in a dark, quiet place can help ease manifestations.
* Check apical pulse before dosage (propranolol).
* Dosage can be taken with food to reduce Gl distress (divalproex) and increase absorption (propranolol).
* Protect skin and eyes from sun (amitriptyline) and avoid driving or operating heavy machinery until medication effects are known (amitriptyline, sumatriptan).