The triptans are a class of drugs that cause cranial vascular constriction and relief of migraine headache pain in many patients. These drugs are not associated with the vascular and GI effects of the ergot derivatives. The triptan of choice for a particular patient depends on personal experience and other preexisting medical conditions. A patient may have a poor response to one triptan and respond well to another.
The triptans bind to selective serotonin receptor sites to cause vasoconstriction of cranial vessels, relieving the signs and symptoms of migraine headache. They are indicated for the treatment of acute migraine and are not used for prevention of migraines.
Sumatriptan, the first drug of this class, is used for the treatment of acute migraine attacks and for the treatment of cluster headaches in adults. It can be given orally, subcutaneously, or by nasal spray.
Naratriptan, rizatriptan, zolmitriptan, and eletriptan are used orally only for the treatment of acute migraines. Rizatriptan and zolmitriptan are also available as fast-dissolving tablets.
The triptans are rapidly absorbed from many sites; they are metabolized in the liver (sumatriptan by monoamine oxidase) and are primarily excreted in the urine. They cross the placenta and have been shown to be toxic to the fetus in animal studies. They also enter breast milk. The safety and efficacy of use in children have not been established.
Triptans are contraindicated with any of the following conditions: Allergy to any triptan to avoid hypersensitivity reactions; pregnancy because of the possibility of severe adverse effects on the fetus; and active CAD, which could be exacerbated by the vessel-constricting effects of these drugs. These drugs should be used with caution in elderly patients because of the possibility of underlying vascular disease; in patients with risk factors for CAD; in lactating women because of the possibility of adverse effects on the infant; and in patients with renal or hepatic dysfunction, which could alter the metabolism and excretion of the drug. Rizatriptan seems to have more angina-related effects, and it is not recommended for patients with a history of CAD, which could be exacerbated by its cardiac effects.
Combining triptans with ergot-containing drugs results in a risk of prolonged vasoactive reactions.
曲坦类药与含麦角药物联用导致血管反应延长危险。
There is a risk of severe adverse effects if these drugs are used within 2 weeks after discontinuation of a MAOI because of the increased vasoconstrictive effects that occur. If triptans are to be given, it is imperative that the patient has not received an MAOI in more than 2 weeks.
★Vocabulary ★ triptan – n. 曲坦
preexisting – a. 事先存在的
almotriptan – n. 阿莫曲坦
Axert – n. 阿莫曲坦商品名
eletriptan – n. 依来曲坦
Relpax – n. 依来曲坦商品名
frovatriptan – n. 夫罗曲坦
Frova – n. 夫罗曲坦商品名
naratriptan – n. 那拉曲坦
Amerge – n. 那拉曲坦商品名
rizatriptan – n. 利扎曲坦
Maxalt – n. 利扎曲坦商品名
Maxalt-MLT – n. 利扎曲坦商品名
sumatriptan – n. 舒马曲坦
Imitrex – n. 琥珀酸舒马曲坦注射剂
zolmitriptan – n. 佐米曲坦
Zomig – n. 佐米格
Zomig-ZMT – n. 佐米曲坦商品名 vasoconstrictive – a. 血管收缩的
1. The client presents to the emergency department complaining of a migraine headache and is prescribed medication. Which scientific rationale is most appropriate for administering the medication by the parenteral route?
A. The client requests the medication be given IVP.
B. Migraine headaches do not respond to oral medications.
C. Migraine headaches can cause nausea, vomiting, and gastric stasis.
D. The client is not as likely to develop an addiction to the medications. 2. The male client diagnosed with chronic migraine headaches, who has taken medications daily for years to prevent a migraine from occurring, tells the clinic nurse that now he has a headache “all the time, no matter what I take.” Which situation would the nurse suspect is occurring?
A. The client has developed a resistance to pain medication.
B. The client is addicted and wants to get an increase in narcotics prescribed.
C. The client has developed medication overuse headaches.
D. The client may have a complication of therapy and has a brain tumor.
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答案 Answers 1. C. Migraine headaches can cause nausea, vomiting, and gastric stasis. Rationale: Because migraine headaches often cause nausea, vomiting, and gastric stasis, oral medications may not be tolerated or may not be effective once an attack has begun.
2. C. The client has developed medication overuse headaches. Rationale: Medication overuse headaches occur when clients take headache medication every day. These headaches are also known as rebound headaches or drug-induced headaches. The headache will persist for days to weeks after the medication has been discontinued.
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