The nurse reviews a client's history before the first dose of sumatriptan for migraine. Which finding is a contraindication to the medication?
1Documented coronary artery disease with episodes of unstable angina✓ Correct answer
2Seasonal asthma controlled with an inhaled bronchodilator
3Depression treated with scheduled outpatient follow-up
4Tension headaches relieved by rest and hydration
Explanation
Sumatriptan is contraindicated in ischemic coronary artery disease, including angina, because its vasoconstrictive effect can cause coronary vasospasm, myocardial ischemia, or infarction. Documented coronary disease with unstable angina therefore rules out the medication. The other histories require routine assessment but are not the listed ischemic-cardiac contraindication.
Clinical reasoning Triptans activate serotonin receptors that constrict cranial vessels but can also constrict coronary arteries. Existing ischemic coronary disease creates an unacceptable cardiac risk.
Decision rule Screen for coronary disease, vasospasm, stroke or TIA, peripheral vascular disease, and uncontrolled hypertension before sumatriptan.
Scenario 54-year-old male with severe migraine presents for sumatriptan 6 mg SC. Chart: history of unstable angina with recent positive stress test.
Triptan — A serotonin-receptor agonist used for acute migraine treatment that can cause clinically important vasoconstriction.
Ischemic coronary artery disease — Reduced coronary blood flow, including angina or prior myocardial infarction, that makes sumatriptan contraindicated.